HAVA Application - States

REQUIREMENTS FOR THE SECRETARY OF STATE APPLICATION

OMB Number: 0970-0327

Expiration Date: TBD by OMB

Each State or Unit of Local Government that receives funding must prepare and submit an application in a format of their choice. The application should describe the activities for which that state will receive assistance under the Help America Vote Act (HAVA). The application is provided in writing and must include the following:

1)The name of the State submitting the application.

2) The name of the Chief Election Official of the State submitting the application.

3) Contact person: Name, title, address, phone, fax, and e-mail address.

4) A description of what the applicant intends to do in each of the four categories of activities outlined below:

1. Make polling places, including the path of travel, entrances, exits, and voting areas of each polling facility, accessible to individuals with the full range of disabilities (e.g., visual impairments, including blindness; hearing impairments, including deafness; the full range of mobility impairments, including gross and fine motor impairments, emotional impairments, and intellectual impairments);

2. Provide the same opportunity for access and participation (including privacy and independence) to individuals with the full range of disabilities;

3. Provide training for election officials, poll workers, and election volunteers on how best to promote the access and participation of individuals with the full range of disabilities in elections for Federal office;

4. Provide individuals with the full range of disabilities with information about the accessibility of polling places.

5) How much of the payment the applicant intends to spend on each of the four categories of activities.

6) An assurance that no later than December 31st of the year the Chief Election Official or his/her designee will submit a report to ADD for the Secretary describing how any funds authorized under HAVA were used with regard to the four categories of activities.

7) Signed by the Chief Election Official or Secretary of State.

The application must also include the following certifications:

1a) The Certification Regarding Lobbying, (45 CFR Part 93) may be found as Attachment C of this Instruction and at http://www.acf.hhs.gov/grants/grants_resources.html.

2a) The Disclosure of Lobbying Activities form (SF-LLL) may be found under the “Disclosures” heading at http://www.acf.hhs.gov/grants/grants_resources.html.

3a) Other Certifications: Certification Regarding Environmental Tobacco Smoke. The signature on the application by the Authorizing Official attests to the intent to comply with this Certification, which may be found at http://www.acf.hhs.gov/grants/grants_resources.html.

Paperwork Reduction Act of 1995, Pub.L. 104-13

As required by the Paperwork Reduction Act, 44 U.S.C. §§ 3501-3520, the public reporting burden for the application and reporting requirements in this notice are estimated to average 24 hours per response, whereas the annual report estimated to 26 hours for a total of 50 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection information. The reporting requirements information collection is approved under Office of Management and Budget (OMB) control number 0970-0327. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Renewal of OMB control number for the information collection is in process.