Pre-Award Information Sheet.docx

Version: October 4, 2024

PRE-AWARD INFORMATION SHEET

THE USE OF THE PRE-AWARD INFORMATION SHEET TEMPLATE IS OPTIONAL, BUT ALL DATA ELEMENTS WITHIN THE PRE-AWARD INFORMATION SHEET ARE MANDATORY.

Name of Organization Street Address City and County State and Zip + 4 (matches the USPS database)

Name and address must match SAM registration.

NOFO Number:

Topic Area/Area of Interest, if applicable Award Number:

Project Title:

Unique Entity Identifier (UEI):

Congressional District

Organization’s Fiscal Year End Date

A. TYPE OF ORGANIZATION

Please indicate the type of organization of the Recipient by selecting one of the following:

For-Profit Business:

Other Organization Types:

Other (specify type):

B. INTELLECTUAL PROPERTY

1. OWNERSHIP OF SUBJECT INVENTIONS

Definitions:

Subject Invention: Any invention or discovery of the Recipient or a Subrecipient conceived or first actually reduced to practice under the award.

a. Ownership Rights: For inventions made by the Recipient or a Subrecipient under the award, ownership rights differ by organization type, as follows:

i. A Recipient or Subrecipient has a statutory option to retain ownership (see the Bayh-Dole Act, 35 U.S.C. § 200 et seq.) if the inventing organization is a:

· domestic small business;

· domestic university or other institution of higher education; or

· domestic 501(c)(3) nonprofit.

ii. Unless DOE grants a patent waiver, U.S. Government retains ownership (see the Federal Non-Nuclear Energy Act of 1974, 42 U.S.C. § 5908) if the inventing organization is a:

· domestic large business;

· foreign-owned or foreign-controlled entity;

· state or local government; or

· any other organization type that is not a domestic small business, educational institution, or 501(c)(3) nonprofit.

b. Types Of Patent Waivers:

i. Class Patent Waiver: DOE may grant a class patent waiver that applies to a class of organizations. For example, there may be a class patent waiver that applies to domestic large businesses.

ii. Advance Patent Waiver: For an organization not covered by the Bayh-Dole Act or a class patent waiver, the organization may request an advance patent waiver that will cover all inventions that may be made by the organization under the award. Recipients and Subrecipients must request this waiver in advance of or within 30 days after the effective date of the award.

iii. Identified-Invention Patent Waiver: Any organization not covered by the Bayh-Dole Act, a class patent waiver, or an advance patent waiver may request an identified invention patent waiver once an invention has been made and disclosed under the award. This type of patent waiver would apply only to the invention identified in the patent waiver request.

c. Patent Waiver Requests (not applicable to Bayh-Dole Act organizations in Section 1.a.i. above)

In the text box below, please identify each organization, including the Recipient and any Subrecipient, that wants to request one of the patent waivers identified in Section 1.b. above. If a class patent waiver applies, further information may be found in the Notice of Funding Opportunity (NOFO). For each Subrecipient, please identify the type of organization using the categories above in section A of this Pre-Award Information Sheet.

2. IDENTIFICATION OF LIMITED RIGHTS DATA AND RESTRICTED COMPUTER SOFTWARE

Definitions:

· Data: recorded information, regardless of form or the media on which it may be recorded. The term includes technical data and computer software. The term does not include information incidental to administration, such as financial, administrative, cost or pricing or management information.

· Technical data: data which are of a scientific or technical nature. Technical data does not include computer software, but does include manuals and instructional materials and technical data formatted as a computer data base.

· Computer software: (i) computer programs which are data comprising a series of instructions, rules, routines, or statements, regardless of the media in which recorded, that allow or cause a computer to perform a specific operation or series of operations and (ii) data comprising source code listings, design details, algorithms, processes, flow charts, formulae and related material that would enable the computer program to be produced, created or compiled. The term does not include computer data bases.

· Computer data bases: a collection of data in a form capable of, and for the purpose of, being stored in, processed, and operated on by a computer. The term does not include computer software.

· Limited Rights Data: data developed at private expense that embody trade secrets or are commercial or financial and confidential or privileged. This data is developed at private expense outside of any government contract or award.

· Restricted Computer Software: computer software developed at private expense that is a trade secret; is commercial or financial and confidential or privileged; or is published copyrighted software, including modifications to such computer software. This computer software is developed outside of any government contract or award.

Please describe below any Limited Rights Data or Restricted Computer Software that will be used by the Recipient or any Subrecipient to carry out the work under the award. Describe it in a few sentences or bullets with sufficient detail so that DOE can understand how it relates to the award work. Published patent applications and patents should NOT be listed because those are public documents.

While DOE reserves the right to inspect Limited Rights Data and Restricted Computer Software at the project facility, the DOE normally does not reserve the right to call for delivery except as necessary to evaluate the award work. Based on the description below, DOE will determine whether or not it must retain the right to call for delivery; so, it is important to provide a sufficient description of the Limited Rights Data and Restricted Computer Software.

Based on the above, please check the option that applies and provide the descriptions when applicable:

|_| No Limited Rights Data will be utilized in the performance of this award.

|_| Limited Rights Data as described in the table below (or provide as an attachment in the format provided below) will be utilized in the performance of this award. Please provide Limited Rights Data for both the Recipient and Subrecipient(s), if applicable, in the format provided below.

Use this table to list Limited Rights Data or provide the information in an attachment using the same format as below.

Limited Rights Data

Recipient

· FILL IN

Subrecipient FILL IN NAME (repeat as needed)

· FILL IN

Based on the above, please check the option that applies and provide the descriptions when applicable:

|_| Restricted Computer Software will NOT be utilized in the performance of this award.

|_| Restricted Computer Software as described in the table below (or provide as an attachment in the format provided below) will be utilized in the performance of this award. Please provide Restricted Computer Software for both the Recipient and Subrecipient(s), if applicable, in the format provided below.

Use this table to list Restricted Computer Software or provide the information in an attachment using the same format as below.

Restricted Computer Software

Recipient

· FILL IN

3. TECHNICAL DATA PRODUCED UNDER THE AWARD

Definitions:

· Protected Data: technical data or commercial or financial data first produced in the performance of the award which, if it had been obtained from and first produced by a non-Federal party, would be a trade secret or commercial or financial information that is privileged or confidential under the meaning of 5 U.S.C. 552(b)(4) and which data is marked as being protected data by a party to the award.

The U.S. Government retains unlimited rights in all technical data produced under the award, including the right to distribute to the public. An exception is that DOE, pursuant to special authority, may agree to protect certain categories of data produced under an award (“Protected Data”) from public release. See the “Rights in Technical Data” section of the NOFO under which the award was selected to determine whether data protection is available for this award.

If data protection is authorized, the NOFO will indicate the maximum length of the protection period. While the Recipient is not obligated to accept data protection, if such protection is accepted, the provision titled “Rights in Data – Programs Covered Under Special Protected Data Statutes” (2 CFR 910.362(e)) will be included in an award made under this announcement. This provision will identify data or categories of data first produced in the performance of the award that will be delivered to DOE as unlimited rights data (as defined in the above referenced Rights in Data clause).

If data protection is offered under the NOFO, please indicate whether the Recipient wants it to be included in a resulting award. In order for a Subrecipient to be able to mark data as Protected Data, Protected Data must be authorized in the prime award with the Recipient.

|_| No, the Recipient and the Subrecipient(s) do not want the ability to mark certain data as Protected Data.

|_| Yes, the Recipient and the Subrecipient(s) want the ability to mark certain data as Protected Data under the award. If this option is selected, please provide a listing of Protected Data in the table below (or provide as an attachment in the format provided below) for both the Recipient and Subrecipient(s), if applicable.

Use this table to list Protected Data or provide the information in an attachment using the same format as below.

Protected Data

Recipient

· FILL IN

Even when Protected Data is not available or used, DOE will protect invention disclosures from public disclosure for a reasonable time in order to allow for the filing of a patent application.

4. IDENTIFICATION OF UNLIMITED RIGHTS DATA

Definitions:

· Unlimited Rights: the right of the Government to use, disclose, reproduce, prepare derivative works, distribute copies to the public, and perform publicly and display publicly, in any manner and for any purpose whatsoever, and to have or permit others to do so.

The U.S. Government retains unlimited rights in all data produced under the award, including the right to distribute it to the public. An exception is that DOE, pursuant to special statutory authority, may agree to protect certain categories of data produced under an award (“Protected Data”). See the “Rights in Technical Data” section of the NOFO under which the award was selected to determine whether Protected Data is available for this award.

If Protected Data is requested by the Recipient or Sub-recipient(s), please provide a listing of Unlimited Rights Data in the table below (or provide as an attachment in the format provided below) for both the Recipient and Subrecipient(s), if applicable.

Use this table to list Unlimited Rights Data or provide the information in an attachment using the same format as below.

Unlimited Rights Data

Recipient

· FILL IN

5. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM

Has your organization received any prior SBIR awards for development of the technology that will be further developed under THIS financial assistance agreement? If the Recipient or a Subrecipient is requesting that this award be considered as a SBIR Phase III award, please check “yes” below and provide your SBIR Phase II award number(s). See Three Phases of SBIR/STTR for more information.

|_| Yes, please list the SBIR award number(s):

|_| No

C. PROJECT PERFORMANCE SITE AND CONGRESSIONAL DISTRICT

List the address and congressional district for the primary site where the project will be performed:

Street Address:

City:

State:

Zip:

Congressional District:

D. BUSINESS ASSURANCES AND PAYMENT INFORMATION

1. DISCLOSURE OF POTENTIAL IMPROPRIETIES

Below, please disclose if any of the following conditions exist. If the answer to any question (a) through (g) below is yes, provide a detailed explanation in an attachment to this document.

a. Is the proposed Recipient, Subrecipient(s), or any of the Recipient’s or Subrecipient’s principals[footnoteRef:2] under investigation for or charged with a covered offense[footnoteRef:3]? [2: For this form, “principal” means: (1) An officer, director, owner, partner, principal investigator (PI), or other person (as defined in 2 C.F.R. 180.95) within the project team with management or supervisory responsibilities related to this project and any resulting transaction; or (2) A consultant or other person, whether or not employed by the Recipient, Subrecipient, or their principals, or paid with Federal funds, who (a) is in a position to handle Federal funds, (b) is in a position to influence or control the use of those funds, or (c) occupies a technical or professional position capable of substantially influencing the development or outcome of an activity required to perform the transaction, including but not limited to, any Co-PIs.

] [3: For this form, “covered offenses” include: (1) Commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public or private agreement or transaction; (2) Violation of Federal or State antitrust statutes, including those proscribing price fixing between competitors, allocation of customers between competitors, and bid rigging; (3) Commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, receiving stolen property, making false claims, or obstruction of justice; or (4) Commission of any other offense indicating a lack of business integrity or business honesty that seriously and directly affects the Recipient’s present responsibility.]

b. Has the proposed Recipient, Subrecipient(s), or any of the Recipient’s or Subrecipient’s principals been convicted of a covered offense in the last five-years or had a civil judgment rendered against them for one of those offenses in that time period?

c. Is the proposed Recipient, Subrecipient(s), or any of the Recipient’s or Subrecipient’s principals under investigation for potential violation of U.S. export control laws and regulations, or has the proposed Recipient, Subrecipient(s), or any of the Recipient’s or Subrecipient’s principals been convicted of any violations of U.S. export control laws and regulations?

d. Is the proposed Recipient or Subrecipient(s) under investigation for potential violations of the Drug-Free Workplace Act of 1988, or has the proposed Recipient or Subrecipient(s) been convicted of any violations of the Drug-Free Workplace Act of 1988?

e. Is the proposed Recipient, Subrecipient(s), or any of the Recipient’s or Subrecipient’s principals under investigation for research misconduct, or has the proposed Recipient, Subrecipient(s), or any of the Recipient’s or Subrecipient’s principals been convicted of research misconduct?

f. Has any Federal agency recommended or initiated proceedings against the proposed Recipient, Subrecipient(s), or any of the Recipient’s or Subrecipient’s principals for suspension or debarment, or is the proposed Recipient, Subrecipient(s), or any of the Recipient’s or Subrecipient’s principals debarred, suspended, publicly banned from doing business with the Federal government, or otherwise declared ineligible from receiving Federal contracts, subcontracts or financial assistance?

g. Is the proposed Recipient or Subrecipient(s) delinquent on federal debt or insolvent or at risk of insolvency or have the proposed Recipient or Subrecipient(s) filed for bankruptcy in any domestic or foreign jurisdiction?

2. POTENTIAL CONFLICTS OF INTEREST

a. Financial Conflicts of Interest: The Recipient must disclose in writing any managed or unmanageable financial conflicts of interest involving a member of the project team (i.e. investigators) and include sufficient information to enable DOE to understand the nature and extent of the financial conflict, and to assess the appropriateness of the non-Federal entity's management plan. See Section V(b)(3) of the DOE Interim Conflict of Interest Policy. As part of this DOE funded project, does the recipient or any subrecipients have any managed or unmanageable financial conflicts of interest involving a member of the project team?

b. Organizational Conflicts of Interest[footnoteRef:4]: The Recipient must disclose in writing any potential or actual organizational conflict of interest to DOE. See DOE Interim Conflict of Interest Policy Section VI and 2 CFR 200.318 for more information. As part of this DOE funded project, does the recipient or any subrecipients intend to engage in a procurement with a parent, affiliate, or subsidiary organization that is not a state, local government, or Indian tribe? [4: Organizational Conflict of Interest means a situation where because of relationships with a parent company, affiliate, or subsidiary organization, the non-Federal entity is unable or appears to be unable to be impartial in conducting a procurement action involving a related organization. 2 CFR 200.318(c)(2).]

3. PENDING AND CURRENT SOURCES OF FUNDING

Current and Pending support is intended to allow the identification of potential duplication, overcommitment, potential conflicts of interest or commitment, and all other sources of support. In a separate attachment, the PI and each senior/key person at the recipient and subrecipient level must each provide a list of all sponsored activities, awards, and appointments, whether paid or unpaid; provided as a gift with terms or conditions or provided as a gift without terms or conditions; full-time, part-time, or voluntary; faculty, visiting, adjunct, or honorary; cash or in-kind; foreign or domestic; governmental or private-sector; directly supporting the individual’s research or indirectly supporting the individual by supporting students, research staff, space, equipment, or other research expenses. All foreign government-sponsored talent recruitment programs must be identified in current and pending support.

For every activity, list the following items:

· The sponsor of the activity or the source of funding.

· The award or other identifying number.

· The title of the award or activity. If the title of the award or activity is not descriptive, add a brief description of the research being performed that would identify any overlaps or synergies with the proposed research.

· The total cost or value of the award or activity, including direct and indirect costs and cost share. For pending proposals, provide the total amount of requested funding.

· The award period (start date – end date).

· The person-months of effort per year being dedicated to the award or activity.

· If required to identify overlap, duplication of effort, or synergistic efforts, append a description of the other award or activity to the current and pending support.

· Details of any obligations, contractual or otherwise, to any program, entity, or organization sponsored by a foreign government must be provided on request to either the applicant institution or DOE.

Each PI and senior/key personnel must provide a separate disclosure statement listing the required information regarding current and pending support, even if no support is currently received or pending. The individual must sign and date their respective disclosure statement and include the following certification statement:

I, [Full Name and Title], certify to the best of my knowledge and belief that the information contained in this Current and Pending Support Disclosure Statement is true, complete and accurate. I understand that any false, fictitious, or fraudulent information, misrepresentations, half-truths, or omissions of any material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (18 U.S.C. §§ 1001 and 287, and 31 U.S.C. 3729-3733 and 3801-3812). I further understand and agree that (1) the statements and representations made herein are material to DOE’s funding decision, and (2) I have a responsibility to update the disclosures during the period of performance of the award should circumstances change which impact the responses provided above.

The information may be provided in the format approved by the National Science Foundation (NSF), which may be generated by the Science Experts Network Curriculum Vita (SciENcv), a cooperative venture maintained at https://www.ncbi.nlm.nih.gov/sciencv/, and is also available at https://www.nsf.gov/bfa/dias/policy/researchprotection/commonform_cps.pdf. The use of a format required by another agency is intended to reduce the administrative burden to researchers by promoting the use of common formats. If the NSF format is used, the individual must still include a signature, date, and a certification statement using the language included in the paragraph above.

4. PAYMENT INFORMATION AND ASSURANCES

a. Has your organization received any prior DOE awards administered by NETL?

|_| If yes, please list the most recent award number:

|_| No

Questions b through d are reserved for institutions of higher education, hospitals, other non-profit organizations and state and local governments that are not considered for-profit entities.

b. Is the Awardee currently enrolled with the U.S. Department of Treasury/ASAP system (Automated Standard Application for Payment System)?

|_| Yes, please enter Awardee Seven-digit ASAP ID Number:

|_| No

c. Please provide the following contact information for ASAP and/or Payments:

Important: If not currently enrolled in the ASAP system, the person identified below will be contacted by the U.S. Department of Treasury with further instruction on completing the ASAP enrollment process.

ASAP / Payments Contact Person:

Phone No.:

Extension:

E-mail:

d. Indicate preferred payment method below: (NOTE: this section is reserved for universities, hospitals, other non-profit organizations and state and local governments that are authorized to receive advance payments, unless a specific need is supported).

e. Total Estimated Project Cost is the sum of the Federal Government share and Recipient share of the estimated project costs. The Recipient’s cost share or matching must come from non-Federal sources unless otherwise allowed by law (Please reference 2 CFR 200.1 and 2 CFR 200.306). By accepting Federal funds under this award, you agree that you are liable for your percentage share of allowable project costs, on a budget period basis, even if the project is terminated early or is not funded to its completion.

Use this block to provide a detailed explanation for not providing cost share on a budget period basis or provide an attachment.

f. Indicate the name, phone number, and email address of the Designated Responsible Employee for complying with national policies prohibiting discrimination (see 10 CFR 1040.5 and the Certifications and Assurances SF-424B Assurances for Non-Construction Programs or SF-424D Assurances for Construction Programs found at: https://www.grants.gov/forms/forms-repository/sf-424-family).

Name/Title

Phone No/Email

E. ACCOUNTING SYSTEM

Your organization should have an accounting system that meets government standards for recording and collecting costs in accordance with 2 CFR 200.302(b)(1). If you have not had prior government awards or a recent accounting system review, the DOE may request the Defense Contract Audit Agency (DCAA) or an independent auditor to verify that the accounting system is acceptable.

Indirect costs are an acceptable cost component of an approved budget if they are adequately supported and properly allocated. Organizations proposing indirect costs will need to demonstrate that the proposed indirect (e.g., overhead, G&A) rates were developed using a methodology acceptable for Government contracting, and in accordance with applicable Federal cost principles. If a current provisional indirect rate agreement has been issued by a Federal agency then that agreement should have been provided with the initial application. If it has not been, or a more current provisional indirect rate agreement has been executed, it needs to be provided as an attachment. In the absence of a provisional indirect rate agreement, the most current final indirect rate agreement should be provided as an attachment to this document.

1. Information for Determining Cognizant Agency/Office

Cognizance related duties (i.e.; negotiating provisional/final indirect rates) are the responsibility of the Cognizant Federal Agency (CFA). The CFA is the Federal agency (e.g., Department of Defense, Department of Energy, etc.) that provided the preponderance (largest amount) of funding for your awards, across all federal agencies. Once a Federal agency assumes cognizance for an organization, it should remain cognizant for at least 5 years to ensure continuity and ease of administration. It is extremely important to confirm that you work with the correct cognizant federal agency/office.

As a rule of thumb, Department of Health & Human Services (DHHS) or the Office of Naval Research (ONR) is usually the CFA for Universities, Cities, States, and Counties. DHHS/ONR cognizance is not usually transferred.

Please identify the CFA by providing the following information:

Agency:

Point-of-Contact:

Phone No.:

E-mail:

To assist our office in validating the CFA, please provide the following information for the five (5) highest dollar award values for current Federal contracts, grants or awards for which the organization receives funding (either as a prime or subcontract) directly from a Governmental agency. (State and Local Governments, Institutions of Higher Education, and Tribal organizations can skip this section if DHHS/ONR is the cognizant agency). The total federal contract/award dollars should include the full project period, not just the incremental funding.

(e.g. NETL) Agency Contact Name/Phone/E-mail

If awardee has current DOE awards, identify Cognizant DOE Office (CDO) (office providing the preponderance of DOE funding), and provide DOE office name, a point-of-contact, phone number, and e-mail (If same as above, proceed to Section F, Financial Management System-Accounting System Survey).

DOE Office:

Point-of-Contact (Contracting Officer):

Phone No.:

E-mail:

To assist our office in validating the CDO, please provide the following information for the 5 highest dollar value awards for current DOE contracts, grants or awards for which the organization receives funding (either as a prime or subcontract) directly from a DOE office. (State and Local Governments, Institutions of Higher Education, and Tribal organizations can skip this section if DHHS/ONR is the cognizant agency). The total DOE contract/award dollars should include the full project period, not just the incremental funding.

Contact Name/Phone/E-mail

2. Information on Annual Incurred Cost Proposal

If it is determined that NETL is the CDO, your organization will be responsible for submitting an ANNUAL Incurred Cost Proposal (ICP) using the actual, allowable costs incurred by your organization during each fiscal year period.

Important: The ICP is not a project specific proposal, but rather, a proposal that encompasses the organization’s entire business base (i.e.; government and commercial), and it must incorporate the total direct and indirect costs incurred to develop the actual indirect rates for each fiscal year.

The ICP is due 180 days after your fiscal year end (i.e.; if fiscal year ends December 31st, the ICP is due June 30th). For an example of the ICE Model, please visit https://www.dcaa.mil/. Under “Customers > Checklists and Tools”, click on ICE (Incurred Cost Electronically) Model and download the ICE model. As an alternative to the DCAA ICE Model, please visit NETL’s website at https://www.netl.doe.gov/business/business-forms/financial-assistance for a sample of a completed incurred cost proposal. Once the information is received, NETL will have the responsibility of providing your organization with an annual indirect rate agreement. This indirect rate must be used on all Federal awards. If it is determined that NETL is not the CDO, you should contact the CFA for guidance.

F. FINANCIAL MANAGEMENT SYSTEM – ACCOUNTING SYSTEM SURVEY

To qualify for a financial assistance award, compliance with 2 CFR 200 as amended by 2 CFR 910 is required. This includes assurance of an adequate accounting system for estimating, accounting and billing for governmental funding received.

For additional information, please visit https://www.dcaa.mil. Under “CUSTOMERS->checklists and Tools,” click on “Pre-award Accounting System Adequacy Checklist”.

Please complete the checklist below as assurance of this requirement.

a. If yes, please provide a copy of the audit report as an attachment to this document.

c. If yes, have there been any changes to the accounting system since the DCAA audit? If the answer is “yes”, please provide a detailed explanation of the changes.

Use this block to explain the changes or provide an attachment.

Please provide the type of accounting system utilized (manual or electronic) and if electronic, provide the software system implemented. In addition, if you checked “No” to any of the boxes above, please provide a detailed explanation here or as an attachment.

G. ANNUAL AUDIT REQUIREMENTS (SINGLE & COMPLIANCE)

Definitions/Requirements

Single Audit: A non-Federal entity that expends $1,000,000 or more during the non-Federal entity’s fiscal year in Federal awards must have a single audit conducted in accordance with 2 CFR 200.514.

Compliance Audit: If a for-profit entity has one or more DOE awards with expenditures totaling $1,000,000 or more during the for-profit entity’s fiscal year, they must have a compliance audit, performed by an independent auditor, for each of the awards with $1,000,000 or more in expenditures in accordance with 2 CFR 910.514. If the entity has multiple awards, the auditor can issue one consolidated report. All audits must be conducted in accordance with Generally Accepted Accounting Standards and the associated audit costs are allowable under the award. The audit must be completed and submitted within the earlier of 30 calendar days after receipt of the auditor’s report, or nine months after the end of entity’s fiscal year end date.

a. Has your organization had an independent compliance audit or single audit performed?

b. Has your organization undergone a financial audit within the last 3 years?

If Yes to either a or b, please include a copy of the audit.

c. Was an electronic copy of the audit provided with the application package?

Use this block to explain why a financial audit was not completed or performed or provide an attachment.

H. REPRESENTATION/CERTIFICATION

Important: Certification of the information is required by the organization’s authorized representative.

|_| I certify that I have an active System for Award Management (SAM) registration.

|_| I certify that I have registered in FedConnect.net to receive award documentation.

|_| I certify that all cost information contained in the budget justification has been reviewed and that all costs are reasonable, allowable and allocable subrecipient/contractor cost information, and that all subrecipient/contractor costs are reasonable, allowable and allocable in accordance with the applicable cost principles. Any additional supporting budget documents should be available upon DOE request.

|_| I certify that all direct costs proposed in the application (under the personnel, travel, equipment, supplies, contractual, construction, and/or other direct costs categories) are direct to the project and are not duplicated in the proposed indirect costs.

|_| I certify that the processes undertaken to solicit any subrecipients, subawards, subcontracts and vendors comply with our organization’s written procurement procedures as outlined in “Procurement Standards” 2 CFR 200.317 through 2 CFR 200.327 inclusive.

|_| I certify the Recipient:

I. SIGNATURES

|_| I, the Authorization Official named below, represent by my signature that I am authorized to certify this information on behalf of the Recipient. I certify under penalty of perjury that the information contained in this Pre-Award Information Sheet is true, accurate and complete. I understand that false, fictitious, or fraudulent information, misrepresentations, half-truths, or omissions of any material fact, may subject me to criminal, civil, or administrative penalties for fraud, false statements, false claims or others. (18 U.S.C. §§ 1001 and 287, and 31 U.S.C. 3729-.730 and 3801-.3812). I further understand and agree that (1) the statements and representations made herein are material to DOE’s funding decisions, and (2) I have a responsibility to update the disclosures during the period of performance of the award should circumstances change which impact the responses provided above.

Name:

Title:

Signature of Authorized Official:

Date:

|_| I, the Principal Investigator named below, certify to the best of my knowledge and belief that the information contained in this Pre-Award Information Sheet is true, complete, and accurate. I understand that false, fictitious, or fraudulent information, misrepresentations, half-truths, or omissions of any material fact may subject me to criminal, civil, or administrative penalties for fraud, false statements, false claims or otherwise. (18 U.S.C. 1001 §§ 1001 and 287, and 31 U.S.C. 3729-3730 and 3801-3812). I further understand and agree that (1) the statements and representations made herein are material to DOE’s funding decision, and (2) I have a responsibility to update the disclosures during the period of performance of the award should circumstances change which impact the responses provided above.

Name:

Title:

Signature of Principal Investigator:

Date:

J. MISCELLANEOUS INFORMATION

1. Does your organization anticipate utilizing any Government Furnished Equipment (GFE) for this project?

|_| Yes (If yes, please attach a list of proposed GFE)

|_| No

2. Are there any changes to the proposed work that will impact the information provided on the Environmental Questionnaire (NETL F 451.1-1/3), (particularly the proposed work locations)?

|_| Yes (If yes, please attach an updated Environmental Questionnaire - NETL F 451.1-1/3 at http://www.netl.doe.gov/File%20Library/Business/forms/451_1-1-3.pdf.)

|_| No

3. Are there any changes to your proposed share of the estimated project costs?

|_| Yes (If yes, please provide a detailed explanation of the changes.)

|_| No image1.png