OMB 1890-0014 (Survey on Ensuring Equal Opportunity for Applicants).doc

Applicant’s (Organization) Name:

Applicant’s DUNS Number:

Federal Program: CFDA Number:

1. Has the applicant ever received a grant or contract from the Federal government?

FORMCHECKBOX

Yes

FORMCHECKBOX

No

2. Is the applicant a faith-based organization?

3.

Is the applicant a secular organization?

FORMCHECKBOX

4. Does the applicant have 501(c)(3) status?

5. Is the applicant a local affiliate of a national organization?

FORMCHECKBOX

No

6.

How many full-time equivalent employees does the applicant have? (Check only one box).

FORMCHECKBOX

3 or Fewer

FORMCHECKBOX

15-50

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4-5

51-100

6-14

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over 100

7.

What is the size of the applicant’s annual budget? (Check only one box.)

Less Than $150,000

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$150,000 - $299,999

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$300,000 - $499,999

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$500,000 - $999,999

$1,000,000 - $4,999,999

$5,000,000 or more

Survey Instructions on Ensuring Equal Opportunity for Applicants

Provide the applicant’s (organization) name and DUNS number and the grant name and CFDA number.

1. Self-explanatory.

2. Self-identify.

3. Self-identify.

4.

501(c)(3) status is a legal designation provided on application to the Internal Revenue Service by eligible organizations. Some grant programs may require nonprofit applicants to have 501(c)(3) status. Other grant programs do not.

5.

Self-explanatory.

6.

For example, two part-time employees who each work half-time equal one full-time equivalent employee. If the applicant is a local affiliate of a national organization, the responses to survey questions 2 and 3 should reflect the staff and budget size of the local affiliate.

7.

Annual budget means the amount of money your organization spends each year on all of its activities.

Paperwork Burden Statement According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1890-0014. The time required to complete this information collection is estimated to average five (5) minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: The Agency Contact listed in this grant application package.

OMB No. 1890-0014 Exp. 02/28/09

Purpose: The Federal government is committed to ensuring that all qualified applicants, small or large, non-religious or faith-based, have an equal opportunity to compete for Federal funding. In order for us to better understand the population of applicants for Federal funds, we are asking nonprofit private organizations (not including private universities) to fill out this survey.

Upon receipt, the survey will be separated from the application. Information provided on the survey will not be considered in any way in making funding decisions and will not be included in the Federal grants database. While your help in this data collection process is greatly appreciated, completion of this survey is voluntary.

Instructions for Submitting the Survey: If you are applying using a hard copy application, please place the completed survey in an envelope labeled “Applicant Survey.” Seal the envelope and include it along with your application package. If you are applying electronically, please submit this survey along with your application.

Survey on Ensuring Equal Opportunity for Applicants

OMB No. 1890-0014 Exp. 02/28/09