oppNOAA-OAR-SG-2018-2005457-cfda11.417-cid2698276.pdf

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Attached to
National Sea Grant College Program 2018-19 Special Projects Federal grant opportunity
Opportunity number
NOAA-OAR-SG-2018-2005457
Issued by
Department of Commerce

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Submission D:20061219143208- 05'00' D:20061219143305- 05'00' Grant Application Package Grants.gov Grant Application Package Grants.gov CFDA Number:

Opportunity Title:

Offering Agency:

Agency Contact:

Opportunity Open Date:

Opportunity Close Date:

CFDA Description:

Opportunity Number:

Competition ID:

Application Filing Name:

Select Forms to Complete Mandatory Optional Instructions About the Application Package.

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Name- Version Form Tag Name Mandatory Name- Version Form Tag Name Optional Name- Version Form Tag Name SelectedOptional Name- Version Form Tag Name SelectedMandatory Grant Application Package Grants.gov Grant Application Package Grants.gov

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OMB Number: 4040-0004 Expiration Date: 10/31/2019

* 1. Type of Submission:

* 2. Type of Application:

* 3. Date Received:

4. Applicant Identifier:

5a. Federal Entity Identifier:

5b. Federal Award Identifier:

6. Date Received by State:

7. State Application Identifier:

* a. Legal Name:

* b. Employer/Taxpayer Identification Number (EIN/TIN):

* c. Organizational DUNS:

* Street1:

Street2:

* City:

County/Parish:

* State:

Province:

* Country:

* Zip / Postal Code:

Department Name:

Division Name:

Prefix:

* First Name:

Middle Name:

* Last Name:

Suffix:

Title:

Organizational Affiliation:

* Telephone Number:

Fax Number:

* Email:

* If Revision, select appropriate letter(s):

* Other (Specify):

State Use Only:

8. APPLICANT INFORMATION:

d. Address:

e. Organizational Unit:

f. Name and contact information of person to be contacted on matters involving this application:

Application for Federal Assistance SF-424 Type of Submission is required. Select one type of submission in accordance with agency instructions.

Type of Submission: Select one type of submission in accordance with agency instructions. One selection is required.

Type of Application: Select one type of application in accordance with agency instructions. One selection is required.

Type of Application is required. Select one type of application in accordance with agency instructions.

* 9. Type of Applicant 1: Select Applicant Type:

Type of Applicant 2: Select Applicant Type:

Type of Applicant 3: Select Applicant Type:

* Other (specify):

* 10. Name of Federal Agency:

11. Catalog of Federal Domestic Assistance Number:

CFDA Title:

* 12. Funding Opportunity Number:

* Title:

13. Competition Identification Number:

Title:

14. Areas Affected by Project (Cities, Counties, States, etc.):

* 15. Descriptive Title of Applicant's Project:

Attach supporting documents as specified in agency instructions.

Application for Federal Assistance SF-424 Form Attachments:

* a. Federal

* b. Applicant

* c. State

* d. Local

* e. Other

* f. Program Income

* g. TOTAL Prefix:

* First Name:

Middle Name:

* Last Name:

Suffix:

* Title:

* Telephone Number:

* Email:

Fax Number:

* Signature of Authorized Representative:

* Date Signed:

18. Estimated Funding ($):

21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001) ** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions.

Authorized Representative:

Application for Federal Assistance SF-424

* a. Applicant Attach an additional list of Program/Project Congressional Districts if needed.

* b. Program/Project

* a. Start Date:

* b. End Date:

16. Congressional Districts Of:

17. Proposed Project:

E.O. 12372 Review selection is required: Select status of Review.

Application Subject to Review: One selection is required.

Applicant Delinquent on Federal Debt: A selection is required.

Applicant Delinquent on Federal Debt is required: Select an option.

* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.)

* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?

If "Yes", provide explanation and attach Project Narrative File(s)

* Mandatory Project Narrative File Filename:

To add more Project Narrative File attachments, please use the attachment buttons below.

Form Attachments:

CERTIFICATION REGARDING LOBBYING

FORM CD-511

(REV 1-05)

U.S. DEPARTMENT OF COMMERCE

Applicants should also review the instructions for certification included in the regulations before completing this form. Signature on this form provides for compliance with certification requirements under 15 CFR Part 28, 'New Restrictions on Lobbying.' The certifications shall be treated as a material representation of fact upon which reliance will be placed when the Department of Commerce determines to award the covered transaction, grant, or cooperative agreement.

LOBBYING

As required by Section 1352, Title 31 of the U.S. Code, and implemented at 15 CFR Part 28, for persons entering into a grant, cooperative agreement or contract over $100,000 or a loan or loan guarantee over $150,000 as defined at 15 CFR Part 28, Sections 28.105 and 28.110, the applicant certifies that to the best of his or her knowledge and belief, that:

(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, 'Disclosure Form to Report Lobbying.' in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure occurring on or before October 23, 1996, and of not less than $11,000 and not more than $110,000 for each such failure occurring after October 23, 1996.

Statement for Loan Guarantees and Loan Insurance The undersigned states, to the best of his or her knowledge and belief, that:

In any funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, 'Disclosure Form to Report Lobbying,' in accordance with its instructions.

Submission of this statement is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure occurring on or before October 23, 1996, and of not less than $11,000 and not more than $110,000 for each such failure occurring after October 23, 1996.

As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above applicable certification.

* NAME OF APPLICANT

* AWARD NUMBER

* PROJECT NAME

Prefix:

* First Name:

Middle Name:

* Last Name:

Suffix:

* Title:

* SIGNATURE:

* DATE:

Budget Narrative File(s)

* Mandatory Budget Narrative Filename:

To add more Budget Narrative attachments, please use the attachment buttons below.

Form Attachments:

1.

OMB Number: 4040-0007 Expiration Date: 01/31/2019

ASSURANCES - NON-CONSTRUCTION PROGRAMS

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND

IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

NOTE:

Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified.

As the duly authorized representative of the applicant, I certify that the applicant:

Has the legal authority to apply for Federal assistance and the institutional, managerial and financial capability (including funds sufficient to pay the non-Federal share of project cost) to ensure proper planning, management and completion of the project described in this application.

Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee- 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and, (j) the requirements of any other nondiscrimination statute(s) which may apply to the application.

2.

Will give the awarding agency, the Comptroller General of the United States and, if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives.

3.

Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain.

4.

Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.

5.

Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).

6.

Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to:

(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C.§§1681- 1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Previous Edition Usable Standard Form 424B (Rev. 7-97)Prescribed by OMB Circular A-102 Authorized for Local Reproduction 7.

Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally-assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases.

8.

Will comply, as applicable, with provisions of the Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds.

Standard Form 424B (Rev. 7-97) Back 9.

12.

Will comply, as applicable, with the provisions of the Davis- Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§327- 333), regarding labor standards for federally-assisted construction subagreements.

Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §§1271 et seq.) related to protecting components or potential components of the national wild and scenic rivers system.

10.

Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.

11.

Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of Federal actions to State (Clean Air) Implementation Plans under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. §§7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L. 93-523); and, (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P.L. 93- 205).

13.

Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470), EO 11593(identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. §§469a-1 et seq.).

14.

Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance.

15.

Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance.

16.

Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. §§4801 et seq.) which prohibits the use of lead-based paint in construction or rehabilitation of residence structures.

17.

Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, "Audits of States, Local Governments, and Non-Profit Organizations."

18.

Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies governing this program.

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL

TITLE

DATE SUBMITTED

APPLICANT ORGANIZATION

Will comply with the requirements of Section 106(g) of the Trafficking Victims Protection Act (TVPA) of 2000, as amended (22 U.S.C. 7104) which prohibits grant award recipients or a sub-recipient from (1) Engaging in severe forms of trafficking in persons during the period of time that the award is in effect (2) Procuring a commercial sex act during the period of time that the award is in effect or (3) Using forced labor in the performance of the award or subawards under the award.

19.

SECTION A - BUDGET SUMMARY

BUDGET INFORMATION - Non-Construction Programs OMB Number: 4040-0006 Expiration Date: 01/31/2019 Grant Program Function or Activity (a) Catalog of Federal Domestic Assistance Number (b) Estimated Unobligated Funds New or Revised Budget Federal (c) Non-Federal (d) Federal (e) Non-Federal (f) Total (g)

5. Totals 4.

3.

2.

1.

Standard Form 424A (Rev. 7- 97) Prescribed by OMB (Circular A -102) Page 1

SECTION B - BUDGET CATEGORIES

7. Program Income

d. Equipment

e. Supplies

f. Contractual

g. Construction

h. Other

j. Indirect Charges

k. TOTALS (sum of 6i and 6j)

i. Total Direct Charges (sum of 6a-6h) (1) Authorized for Local Reproduction Prescribed by OMB (Circular A -102) Page 1A Standard Form 424A (Rev. 7- 97)

GRANT PROGRAM, FUNCTION OR ACTIVITY

(2) (3) (4) (5) Total

6. Object Class Categories

a. Personnel

b. Fringe Benefits

c. Travel Total Total Total Total Total

SECTION D - FORECASTED CASH NEEDS

14. Non-Federal

SECTION C - NON-FEDERAL RESOURCES

(a) Grant Program

(b) Applicant

(d) Other Sources

(c) State (e)TOTALS 8.

9.

10.

11.

12. TOTAL (sum of lines 8-11)

15. TOTAL (sum of lines 13 and 14)

13. Federal Total for 1st Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

FUTURE FUNDING PERIODS (YEARS)

SECTION F - OTHER BUDGET INFORMATION

SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT

Authorized for Local Reproduction 16.

17.

18.

19.

20. TOTAL (sum of lines 16 - 19)

21. Direct Charges:

22. Indirect Charges:

23. Remarks:

(a) Grant Program (b)First

(c) Second

(d) Third

(e) Fourth Standard Form 424A (Rev. 7- 97) Prescribed by OMB (Circular A -102) Page 2 Other Attachment File(s)

* Mandatory Other Attachment Filename:

To add more "Other Attachment" attachments, please use the attachment buttons below.

Form Attachments:

10. a. Name and Address of Lobbying Registrant:

9. Award Amount, if known:$

* Street 1

* City State Zip Street 2

* Last Name Prefix

* First Name Middle Name Suffix

DISCLOSURE OF LOBBYING ACTIVITIES

Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352 Approved by OMB 4040-0013

1. * Type of Federal Action:

Type of Federal Action: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

Type of Federal Action is required: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2. * Status of Federal Action:

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Status of Federal Action is required: Identify the status of the covered Federal action.

3. * Report Type:

Report Type: Identify the appropriate classification of this report. If this is a follow up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the previously submitted report by this reporting entity for this covered Federal action. This field is required.

For Material Change Only:

year quarter date of last report

4. Name and Address of Reporting Entity:

Reporting Entity: Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. This field is required.

Reporting Entity is required: Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

Tier if known:

* Name

* Street 1 Street 2

* City State Zip Congressional District, if known:

Congressional District, if known:

* Name

* City State

* Street 1 Street 2 Zip

6. * Federal Department/Agency:

7. * Federal Program Name/Description:

CFDA Number, if applicable:

8. Federal Action Number, if known:

b. Individual Performing Services (including address if different from No. 10a) Prefix

* First Name Middle Name

* Street 1

* City State Zip Street 2 11.

* Last Name Suffix Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

* Signature:

*Name:

Prefix

* First Name Middle Name

* Last Name Suffix Title:

Telephone No.:

Date:

Federal Use Only:

Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97)

Print: Select to print.:
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Opportunity Title: National Sea Grant College Program 2018-19 Special Projects
Agency Name: Pre-populated from the Application cover sheet.: Department of Commerce
CFDA Number: Pre-populated from the Application cover sheet.: 11.417
CFDA Description:
Opportunity Number: NOAA-OAR-SG-2018-2005457
Competition ID:
Opportunity Open Date: 2017-11-15
Close Date: 2019-09-30
Agency Contact Information:
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NameVersion:
FormTagName: SF424_2_1
FormTagName: Project
FormTagName: CD511
FormTagName: Budget
FormTagName: SF424B
FormTagName: SF424A
FormTagName: Other
FormTagName: SFLLL_1_2
FormDesc: Application for Federal Assistance (SF-424)
FormDesc: Project Narrative Attachment Form
FormDesc: CD511 Form
FormDesc: Budget Narrative Attachment Form
FormDesc: Assurances for Non-Construction Programs (SF-424B)
FormDesc: Budget Information for Non-Construction Programs (SF-424A)
FormDesc: Other Attachments Form
FormDesc: Disclosure of Lobbying Activities (SF-LLL)
CheckBox1:
Disclosure Statement: Click the button to read the "Review Public Burden Disclosure Statement".:
readerVersion:
XDPFirstField:
Mandatory:
Type of Submission is required. Select one type of submission in accordance with agency instructions. :
Type of Application is required. Select one type of application in accordance with agency instructions.:
DateEntered1:
DateEntered2:
Submission Type - Preapplication: Select one type of submission in accordance with agency instructions. One selection is required.

Select if the type of submission is a Preapplication.:

Submission Type - Application: Select one type of submission in accordance with agency instructions. One selection is required.

Select if the type of submission is an Application.:

Submission Type - Changed Application: Select one type of submission in accordance with agency instructions. One selection is required.

Select this submission if requested by the agency to change or correct a previously submitted application. Unless requested by the agency, applicants may not use this to submit changes after the closing date.:

Application Type - New: Select one type of application in accordance with agency instructions. One selection is required..

Select New if the application is being submitted to an agency for the first time.:

Application Type - Continuation: Select one type of application in accordance with agency instructions. One selection is required.

Select Continuation if the submission is an extension for an additional funding/budget period for a project with a projected completion date. This can include renewals.:

Application Type - Revision: Select one type of application in accordance with agency instructions. One selection is required.

Select Revision if the submission is a change in the Federal Government’s financial obligation or contingent liability from an existing obligation. :

Revision Type: Select a revision type from the list provided. A selection is required if Type of Application is Revision.:
Other (specify): Please specify the type of revision. This field is required if E. Other is checked.:
DateReceived:
Applicant Identifier: Enter the applicant's control number, if applicable.:
Federal Entity Identifier: Enter the number assigned to your organization by the Federal agency.:
Federal Award Identifier: For new applications leave blank. For a continuation or revision to an existing award, enter the previously assigned Federal award identifier number. If a changed/corrected application, enter the Federal Identifier in accordance with agency instructions.:
Date Received by State: Enter the date received by the State, if applicable. Enter in the format mm/dd/yyyy.:
State Application Identifier: Enter the identifier assigned by the State, if applicable.:
Name Of Applicant: Enter legal name

of applicant, which will undertake the assistance activity.:

EIN/TIN: Enter either TIN or EIN as assigned by the Internal Revenue Service. If your organization is not in the US, enter 44-4444444. This field is required.:
DUNS Number: Enter the DUNS or DUNS+4 number of the applicant organization. This field is required.:
Street1: Enter the first line of the Street Address. This field is required.:
Street2: Enter the second line of the Street Address.:
City: Enter the City. This field is required.:
County/Parish: Enter the County/Parish.:
State: Select the state, US possession or military code from the provided list. This field is required if Country is the United States.:
Province: Enter the Province.:
Country: Select the Country from the provided list. This field is required.:
ZIP/ Postal Code: Enter the nine-digit Postal Code (e.g., ZIP code). This field is required if the country is the United States.:
Department Name: Enter the name of primary organizational department, service, laboratory, or equivalent level within the organization which will undertake the assistance activity.:
Division Name: Enter the name of primary organizational division, office, or major subdivision which will undertake the assistance activity.:
AOR Prefix: Select the Prefix from the provided list or enter a new Prefix not provided on the list.:
AOR First Name: Enter the First Name. This field is required.:
AOR Middle Name: Enter the Middle Name.:
AOR Last Name: Enter the Last Name. This field is required.:
AOR Suffix: Select the Suffix from the provided list or enter a new Suffix not provided on the list.:
Title: Enter the title of the Certifying Official.:
Organizational Affiliation: Enter the organization if different from the applicant organization.:
Telephone Number: Enter the daytime Telephone Number. This field is required.:
Fax Number: Enter the Fax Number.:
Email: Enter a valid Email Address. This field is required.:
TextField1:
ViewBurdenStatement:
Type of Applicant 1: Select the appropriate applicant type. A selection is required.:
Type of Applicant 2: Select the appropriate applicant type.:
Type of Applicant 3: Select the appropriate applicant type.:
Type of Applicant Other: Enter the applicant type here if you selected "Other (specify)" for Type of Applicant.:
CFDA/Program Title: Pre-populated from the Application cover sheet.:
Opportuntity Number: Pre-populated from the Application cover sheet. This field is required.:
Opportunity Title: Pre-populated from the Application cover sheet. This field is required.:
Competition Number: Pre-populated from the Application cover sheet.:
Competition Title: Pre-populated from the Application cover sheet.:
spacer:
Project Title: Enter a brief, descriptive title of the project. This field is required.:
MimeType:
href:
hashAlgorithm:
HashValue_data:
ObjList:
FNList:
AttCount:
Add:
Delete:
View:
Done:
Optional Other Attachment Check Box. Indicates whether an Optional Other Attachment is attached:
View Optional Other Attachment:

Click here to view the optional "Other Attachment" file:

Delete Optional Other Attachment:

Click here to delete the optional "Other Attachment" file:

Add Optional Other Attachment:

Click here to add the optional "Other Attachment" file:

Debt Explanation - View Attachment Button: Click here to view the attachment.:
Debt Explanation - Delete Attachment Button: Click here to delete the attachment.:
Debt Explanation - Add Attachment Button: Click here to add the attachment.:
Debt Explanation is required.:
Applicant District: Enter the Congressional District in the format: 2 character State Abbreviation - 3 character District Number. Examples: CA-005 for California's 5th district, CA-012 for California's 12th district.

If outside the US, enter 00-000.

This field is required.:

Program District: Enter the Congressional District in the format: 2 character State Abbreviation - 3 character District Number. Examples: CA-005 for California's 5th district, CA-012 for California's 12th district.

If all districts in a state are affected, enter "all" for the district number. Example: MD-all for all congressional districts in Maryland.

If nationwide (all districts in all states), enter US-all.

If the program/project is outside the US, enter 00-000.

This field is required.:

Mandatory Other Attachment:
Add Mandatory Other Attachment:

Click here to add the mandatory "Other Attachment" file:

Delete Mandatory Other Attachment:

Click here to delete the mandatory "Other Attachment" file:

View Mandatory Other Attachment:

Click here to view the mandatory "Other Attachment" file:

Project Start Date: Enter the date in the format MM/DD/YYYY. This field is required.:
Project End Date: Enter the date in the format MM/DD/YYYY. This field is required.:
Federal Estimated Funding: Enter the dollar amount. This field is required.:
Applicant Estimated Funding: Enter the dollar amount. This field is required.:
State Estimated Funding: Enter the dollar amount. This field is required.:
Local Estimated Funding: Enter the dollar amount. This field is required.:
Other Estimated Funding: Enter the dollar amount. This field is required.:
Program Income Estimated Funding: Enter the dollar amount. This field is required.:
Total Estimated Funding: Enter the total dollar amount. This field is required.:
E.O. 12372 Review selection is required: Select status of Review.:
State Review Available: Click to select option.:
State Review Not Selected: Click to select option.:
State Review Not Covered: Click to select option.:
State Review Date: Enter the date in the format MM/DD/YYYY.:
Applicant Delinquent on Federal Debt is required: Select an option.:
Delinquent on Debt: Click to select option.:
Not Delinquent on Debt: Click to select option.:
I Agree checkbox is required: Check I Agree checkbox to provide the required Certifications and Assurances.:
Certification Agree: Check to select. This field is required.:
AOR Title: Enter the position title. This field is required.:
AOR Telephone Number: Enter the daytime Telephone Number. This field is required.:
AOR Fax Number: Enter the Fax Number.:
AOR Email: Enter a valid Email Address. This field is required.:
AORSignature:
DateEntered19:
DateEntered20:
DateSigned:
LastField:
Signature: Completed by Grants.gov upon submission.
Date Signed: Completed on submission to Grants.gov.:
GotoPreviousPage:
GotoNextPage:
PrintButton:
AboutButton:
Award Number:

Enter the project award number.:

Project Name:

Enter the name of the project.:

Prefix: Enter the prefix (e.g., Mr., Mrs., Miss), if appropriate, for the Lobbying Registrant.:
First Name: Enter the First Name.

This field is required.:

Middle Name: Enter the Middle Name.:
Suffix: Select the Suffix

from the provided list or enter a new Suffix not provided on the list.:

Title: Enter in the Position Title.:
btnVerify:
btnExport:
Title: Enter the title of the official certifying that the applicant organization will comply with the requirements set forth in this assurance form. This field is required.:
Applicant Organization: Enter the name of the applicant organization. This field is required.:
FormVersionIdentifier:
CHECK1:
Enter the name of the activity or function.:
Enter the catalog number.:
Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Total:
Enter the name of the activity or function.:
Enter the catalog number.:
Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the first funding period (usually a year).

For continuing grant program applications, submit these forms before the end of each funding period as required by the grantor agency. Enter in Columns (c) and (d) the estimated amounts of funds which will remain unobligated at the end of the grant funding period only if the Federal grantor agency instructions provide for this. Otherwise, leave these columns blank. Enter in columns (e) and (f) the amounts of funds needed for the upcoming period. The amount(s) in Column (g) should be the sum of amounts in Columns (e) and (f).

For supplemental grants and changes to existing grants, do not use Columns (c) and (d). Enter in Column (e) the amount of the increase or decrease of Federal funds and enter in Column (f) the amount of the increase or decrease of non-Federal funds. In Column (g) enter the new total budgeted amount (Federal and non-Federal) which includes the total previous authorized budgeted amounts plus or minus, as appropriate, the amounts shown in Columns (e) and (f). The amount(s) in Column (g) should not equal the sum of amounts in Columns (e) and (f).:

Lines 1-4, Columns (c) through (g)

For new applications, leave Column (c) and (d) blank. For each line entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the appropriate amounts of funds needed to support the project for the…

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