OMB Control No: 0970-0382
Expiration date: June 30, 2021
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
Public reporting burden for this collection of information is estimated to average 21 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.
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.
Community Services Block Grant (CSBG)
CARES Act Supplemental State Plan
Table of Contents
CSBG Cover Page (SF-424M)
Section 1: CSBG Administrative Information 2
Section 2: State Legislation and Regulation 4
Section 3: State Plan Development and Statewide Goals 5
Section 4: CSBG Hearing Requirements 6
Section 5: CSBG Eligible Entities 7
Section 6: Organizational Standards for Eligible Entities 9
Section 7: State Use of Funds 10
Section 8: State Training and Technical Assistance 12
Section 9: State Linkages and Communication 14
Section 10: Monitoring, Corrective Action, and Fiscal Controls 16
Section 11: Eligible Entity Tripartite Board 18
Section 12: Individual and Community Income Eligibility Requirements 19
Section 13: Results Oriented Management and Accountability (ROMA) System 20
Section 14: CSBG Programmatic Assurances and Information Narrative 21
For the purposes of the CARES Act, the Office of Community Services is accepting an abbreviated State Plan as a supplement to provide additional information to the Federal Fiscal Year (FFY) 2020 CSBG State Plan.
1.1. Identify the Submission Date of your FFY2020 CSBG State Plan: [Date Picker]
Note: This information can be found on the Report Status Page of your most recently submitted CSBG State Plan.
If you submitted a two-year plan in FFY2019, please provide that date.
If you submitted a plan in FFY2020, please provide that date.
1.2. Lead Agency: Update the following information in relation to the lead agency designated to administer CSBG in the state, as required by Section 676(a) of the CSBG Act. Information should reflect the responses provided in the Application for Federal Assistance, SF-424M.
Has information in regards to the state lead agency changed since the last submission of the state plan? Yes No
1.2a. Lead agency [Narrative, 150 Characters]
1.2b. Cabinet or administrative department of this lead agency [Check One and narrative where applicable]
Community Affairs Department
Community Services Department
Governor’s Office
Health Department
Housing Department
Human Services Department
Social Services Department
Other, describe: [Narrative, 100 characters]
1.2c. Cabinet or Administrative Department Name: Provide the name of the cabinet or administrative department of the CSBG authorized official [Narrative, 100 Characters]
1.2d. Authorized official of the lead agency. The authorized official could be the director, secretary, commissioner etc. as assigned in the designation letter (attached under item 1.3.). The authorized official is the person indicated as authorized representative on the SF-424M. [Narrative, 50 Characters each]
Name Title
1.2e. Street Address [Narrative, 200 characters]
1.2f. City [Narrative, 50 characters]
1.2g. State [Dropdown]
1.2h. Zip Code [Numerical Response, 5 digits]
1.2i. Work Telephone Number and Extension (if applicable) [Numerical Response, 10 – 15 digits to include extensions]
1.2j. Fax Number [Numerical Response, 10 digits]
1.2k. Email Address [Narrative, 150 characters]
1.2l. Lead Agency Website [Narrative, 200 characters]
1.3. Designation Letter: Attach the state’s official CSBG designation letter. A new designation letter is required if the chief executive officer of the state and/or designated agency has changed.
As the Authorized Official for CSBG, I confirm that there have been no changes within this state that will require a new designation letter, such as a change to the authorized official and/or authorized CSBG state lead agency.
1.4. CSBG Point of Contact: Provide the following information in relation to the designated state CSBG point of contact. The state CSBG point of contact should be the person that will be the main point of contact for CSBG within the state.
Has information regarding to the state point of contact changed since the last submission of the state plan? Yes No
1.4a. Agency Name [Narrative, 150 characters]
1.4b. Point of Contact Name [Narrative, 50 characters each]
Name Title
1.4c. Street Address [Narrative, 200 characters]
1.4d. City [Narrative, 50 characters]
1.4e. State [Dropdown]
1.4f. Zip Code [Numerical Response, 5 digits]
1.4g. Work Telephone Number [Numerical Response, 10 – 15 digits to include extensions]
1.4h. Fax Number [Numerical Response, 10 digits]
1.4i. Email Address [Narrative, 150 characters]
1.4j. Agency Website [Narrative, 200 characters]
For the purposes of the CARES Act, the Office of Community Services accepts the data submitted by the state in Section 2 of the most recently submitted CSBG State Plan (as dated in Section 1 of this Supplemental State Plan).
2.1 Emergency Legislation or Regulation (Optional): If applicable, please describe any special state legislation or regulation that directly impacts the implementation of CSBG CARES supplemental funding, including any emergency procedures to amend any existing legislation or regulation described in the accepted FFY2020 CSBG State plan (as dated in Section 1 of this state plan).
No, there is no special state legislation or regulation that directly impacts the implementation of CSBG CARES supplemental funding.
Yes, there is special state legislation or regulation that directly impacts the implementation of CSBG CARES supplemental funding as described below: [Narrative, 3000 characters]
For the purposes of the CARES Act, the Office of Community Services accepts the data submitted by the state in Section 3 of the most recently submitted CSBG State Plan (as dated in Section 1 of this Supplemental State Plan).
The following additional information is requested for CSBG CARES supplemental funding.
3.1. State Plan Goals: Describe the state’s specific goals for state administration of CSBG as it directly relates to the CSBG CARES funding. [Narrative, 3000 characters]
Note: For examples of “goals,” see State Accountability Measure 1Sa(i).
3.2. Eligible Entity Involvement: Describe the specific steps the state took in developing the CSBG CARES Supplemental State Plan to involve the eligible entities. [Narrative, 3000 Characters]
For the purposes of the CARES Act, the Office of Community Services accepts the data submitted by the state in Section 4 of the most recently submitted CSBG State Plan (as dated in Section 1 of this Supplemental State Plan).
The CSBG CARES Supplemental State Plan is considered to be a plan revision, consistent with Section 676(e) of the CSBG Act (Revisions and Inspection).
4.1. Public Inspection: Describe how the CSBG CARES Supplemental State Plan has been made available for public inspection within the state to facilitate public review and comment. [Narrative, 3000 characters].
Note: For the purposes of this CSBG CARES Supplemental State Plan, a public hearing is not required. However, the state should notify eligible entities and other known stakeholders that this plan is available for a public review and comment, and post publicly, e.g., on the state’s public website, for a reasonable timeframe.
Although, a reasonable timeframe is not specified in the statute, for purposes of the CSBG CARES Supplemental State Plan, OCS recommends a minimum of 10 business days.
For the purposes of the CARES Act, the Office of Community Services accepts the data submitted by the state in Section 5 of the most recently submitted CSBG State Plan (as dated in Section 1 of this Supplemental State Plan).
As the Authorized Official for CSBG, I confirm that there are no changes to the CSBG Eligible Entities as submitted in Section 5 of the most recently submitted CSBG State Plan (as dated in Section 1).
If there were changes to the CSBG Eligible Entity list, please update within Section 7.2 of this State Plan accordingly:
Designation and Re-Designation: add at the end of the table
De-Designations and Voluntary Relinquishments: do not remove the entity. Rather just add zero to the appropriate line.
Mergers: Do not remove the eligible entities. Rather just add zero to the appropriate line.
OCS reserves the opportunity to request more information at a later date.
5.1. CSBG Eligible Entities: In the table below, indicate whether eligible entity in the state public or private, the type(s) of entity, and the geographical area served by the entity.
CSBG Eligible Entity |
Geographical Area Served (by county) [Provide all counties] |
Public or Nonprofit
|
Type of Entity (choose all that apply) |
[READ-ONLY]
|
[Narrative, 550 characters] |
[Select Public or Nonprofit]
|
Community Action Agency Limited Purpose Agency Migrant or Seasonal Farmworker Organization Tribe or Tribal Organization |
THE ADD-A-ROW FUNCTION WILL NOT BE AVAILABLE ON THIS TABLE. ANY ADDITIONS/DELETIONS TO THE ELIGIBLE ENTITY LIST SHOULD BE MADE WITHIN THE MASTER LIST AND MUST APPLY TO BOTH REGULAR CSBG AND CARES ACT SUPPLEMENTAL FUNDING. |
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Note: Whether nonprofit or public, entities that receive CSBG funds are generally considered to be Community Action Agencies for the purpose of administering CSBG. The only specific exceptions outlined in the CSBG Act are Limited Purpose Agencies, Migrant and Seasonal Farmworker organizations, and Tribes and Tribal Organizations
Instructional Note: Limited Purpose Agency refers to an eligible entity that was designated as a limited purpose agency under Title II of the Economic Opportunity Act of 1964 for fiscal year 1981, that served the general purposes of a community action agency under Title II of the Economic Opportunity Act, that did not lose its designation as a limited purpose agency under Title II of the Economic Opportunity Act as a result of failure to comply with that Act and that has not lost its designation as an eligible entity under the CSBG Act.
Instructional Note: 90 percent funds are the funds a state provides to eligible entities to carry out the purposes of the CSBG Act, as described under Section 675C of the CSBG Act. A state must provide “no less than 90 percent” of their CSBG allocation, under Section 675B, to the eligible entities.
5.2. Total number of CSBG eligible entities: ## [This will automatically update based on Table 5.1.]
5.3. Special Circumstances [Optional]: If the state has any specific circumstances that will affect the allocation, such as a pending de-designation hearing for an eligible entity, please describe below: [Narrative, 3000 characters]
Please note: Additional information should be sent directly to your Program Specialist.
For the purposes of the CARES Act, the Office of Community Services accepts the data submitted by the state in Section 6 of the most recently submitted CSBG State Plan (as dated in Section 1 of this Supplemental State Plan), and seeks no additional information.
Eligible Entity Allocation (90 Percent Funds) [Section 675C(a) of the CSBG Act]
7.1. Formula: Select the method (formula) that best describes the current practice for allocating CSBG funds to eligible entities. [Check one and narrative where applicable]
Historic
Base + Formula
Formula Alone
Formula with Variables
Hold Harmless + Formula
Other
7.2. Planned Allocation: Specify the percentage of your CSBG planned allocation that will be funded to eligible entities and “not less than 90 percent funds” as described under Section 675C(a) of the CSBG Act. In the table, provide the planned allocation for each eligible entity receiving funds for the fiscal year(s) covered by this plan. [Numeric Response, specify dollar amount]
Planned CSBG 90 Percent Funds |
|
CSBG Eligible Entity |
Funding Amount $ |
Insert Eligible Entity |
Numeric response, specify dollar amount |
Total |
Auto-calculated |
Administrative Funds [Section 675C(b)(2) of the CSBG Act]
7.3. Allocated Funds: Specify the percentage of your CSBG planned allocation for administrative activities for the FFY(s) covered by this State Plan. [Numeric response, specify dollar amount]
7.4. State Staff: Provide the number of state staff positions to be funded in whole or in part with CSBG CARES funds for the FFY(s) covered by this State Plan. Numeric Response
7.5. State FTEs: Provide the number of state Full Time Equivalents (FTEs) to be funded with CSBG CARES funds for the FFY(s) covered by this State Plan? Numeric Response
Use of Remainder/Discretionary Funds [Section 675C(b) of the CSBG Act]
7.6. Remainder/Discretionary Funds Use: Does the state have remainder/discretionary funds, as described in Section 675C(b) of the CSBG Act? Yes No
If yes, provide the allocated percentage and describe the use of the remainder/discretionary funds in the table below. [Numeric Response, Insert Dollar Amount]
Use of Remainder/Discretionary Funds |
||
Remainder/Discretionary Fund Uses (See 675C(b)(1) of the CSBG Act) |
Planned $ |
Brief Description of Services and/or Activities |
7.6a. Training/technical assistance to eligible entities |
Enter either a planned $ for each item listed for the first FFY that this plan covers. |
These planned services/activities will be described in State Plan Item 8.1 [Read Only] |
7.6b. Coordination of State-operated programs and/or local programs |
[Narrative, 5000 characters] |
|
7.6c. Statewide coordination and communication among eligible entities |
[Narrative, 5000 characters] |
|
7.6d. Analysis of distribution of CSBG funds to determine if targeting greatest need |
[Narrative, 5000 characters] |
|
7.6e. Asset-building programs |
[Narrative, 5000 characters] |
|
7.6f. Innovation programs/activities by eligible entities or other neighborhood group |
[Narrative, 5000 characters] |
|
7.6g. State charity tax credits |
[Narrative, 5000 characters] |
|
7.6h. Other activities [Specify under Column 4] |
Specify the other activities funded through discretionary funds here. [Narrative, 5000 characters] |
|
Totals |
Auto-calculated |
|
7.7. Summary of State Allocations: Provide a total breakdown of planned amounts. Please note that this table will automatically populate with the totals from 7.2, 7.3, and 7.6 above.
90 Percent Funds |
Administrative Funds |
Discretionary Funds |
Total |
Populated from 7.2 |
Populated from 7.3 |
Populated from 7.6 |
Auto-calculated |
8.1. Training and Technical Assistance Plan: Describe the state’s plan for delivering CSBG-funded training and technical assistance to eligible entities under this State Plan by completing the table below. Add a row for each activity: indicate the timeframe; whether it is training, technical assistance or both; and the topic. (CSBG funding used for this activity is referenced under item 7.6a., Use of Remainder/Discretionary Funds.)
Note: This information is associated with State Accountability Measure 3Sc.
Planned Timeframe |
Training, Technical Assistance, or Both |
Topic |
Brief Description of “Other” |
Dropdown Options:
[Select one dropdown per row] |
Toggle Options:
[Select one dropdown per row] |
Dropdown Options:
[Select one dropdown per row] |
If other is selected in column 3, describe in this column
[Narrative, 500 characters] |
ADD A ROW function Note: Rows will be able to be added for each additional training |
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8.1a. Training and Technical Assistance Budget: The planned budget for the training and technical assistance plan (as indicated in the Remainder/Discretionary Funds table in item 7.6): Numeric Response, auto-populated
[Auto-populated with the budget allocation under 7.6a]
8.1b. Training and Technical Assistance Collaboration: Describe how the state will collaborate with the State Association and other stakeholders in the planning and delivery of training and technical assistance. [Narrative, 2500 characters]
8.2. Training and Technical Assistance Organizations: Indicate the types of organizations through which the state plans to provide training and/or technical assistance as described in Item 8.1, and briefly describe their involvement. (Check all that apply.) [Check all that applies and narrative where applicable]
CSBG eligible entities (if checked, provide the expected number of CSBG eligible entities to receive funds) [Numeric response, 0 – 100]
Other community-based organizations
State Community Action Association
Regional CSBG technical assistance provider(s)
National technical assistance provider(s)
Individual consultant(s)
Tribes and Tribal Organizations
Other [Narrative, 1000 characters]
Note: This section describes activities that the state may support with CSBG remainder/discretionary funds, described under Section 675C(b)(1) of the CSBG Act. The state may indicate planned use of remainder/discretionary funds for linkage/communication activities in Section 7, State Use of Funds, items 7.6(b) and (c).
Note: Only describe additional or unique partnerships related to CSBG CARES funding. Do not re-describe partnerships, linkages, and communications already noted in your regular CSBG State Plan.
9.1. State Linkages and Coordination at the State Level: Describe the linkages and coordination at the state level that the state intends to create or maintain to ensure increased access to CSBG services to low-income people and communities under this State Plan and avoid duplication of services (as required by the assurance under Section 676(b)(5)). Describe additional information as needed. [Check all that apply from the list below and provide a Narrative, 5000 Characters]
State Low Income Home Energy Assistance Program (LIHEAP) office
State Weatherization office
State Temporary Assistance for Needy Families (TANF) office
State Head Start office
State public health office
State education department
State Workforce Innovation and Opportunity Act (WIOA) agency
State budget office
Supplemental Nutrition Assistance Program (SNAP)
State child welfare office
State housing office
Emergency Management
Public Health/Disease Control
Other
9.2. Communication with Eligible Entities and the State Community Action Association: In the table below, detail how the state intends to communicate with eligible entities, the State Community Action Association, and other partners identified under this State Plan on the topics listed below.
For any topic that is not applicable, select Not Applicable under Expected Frequency.
Subject Matter |
Expected Frequency |
Format |
Brief Description of “Other” |
State Monitoring Plans and Policies |
[Dropdown Options:
|
[Select All That Apply:
|
If “Other” is selected in Columns 3, describe in this column.
[Narrative, 250 characters] |
Training and Technical Assistance (T/TA) Plans |
|||
State Interagency Coordination |
|||
CSBG CARES Funding and Activities |
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ADD A ROW function Note: Rows will be able to be added for each additional training |
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Monitoring of Eligible Entities (Section 678B(a) of the CSBG Act)
10.1. CSBG CARES Supplemental Monitoring Schedule: In the table below, provide how the state plans to monitor as it specifically relates to the CSBG CARES Supplemental.
The following schedule does not supersede or replace the Monitoring Schedule submitted in your FFY2020 CSBG State Plan as dated in Section 1 of this supplemental state plan.
Note: This information is associated with State Accountability Measure 4Sa(i).
CSBG Eligible Entity |
CSBG CARES Monitoring Approach |
Review Type |
Target Year |
This column will auto-populate from the CSBG Eligible Entity Master List |
[Dropdown Options:
|
[Dropdown Options:
|
[Dropdown Options:
|
10.2. CSBG CARES Supplemental Monitoring Approach: Describe how the state intends to implement monitoring policies and procedures as it relates directly to the CSBG CARES Supplemental. [Narrative, 3000 characters]
10.3. CSBG CARES Supplemental Initial Monitoring Reports: If the state monitors for CSBG CARES Supplemental only, provide the number of calendar days by which the state must disseminate an initial CSBG CARES Supplemental monitoring reports to local entities? [Insert a number from 1 – 100]
Note: This item is associated with State Accountability Measure 4Sa(ii).
Note: If the state is integrating all CSBG CARES Supplemental monitoring into the Regular CSBG Full On-Site, the state should include an additional section specific to the CSBG CARES Supplemental monitoring. If the state is conducting a CSBG CARES Supplemental only monitoring, the state must create a CSBG CARES Supplemental monitoring report.
Corrective Action, Termination and Reduction of Funding and Assurance Requirements (Section 678C of the Act)
10.4. Closing Findings: Is the state adding additional provisions to state monitoring procedures for addressing eligible entity findings/deficiencies, and the documenting closure of findings as it specifically relates to the CSBG CARES Supplemental?
Yes No
10.4a. Closing Findings Procedures: If yes, describe the additional provisions here. [Narrative, 2500 characters]
Fiscal Controls and Audits and Cooperation Assurance
10.5. Fiscal Controls and Accounting: As it relates specifically to the CSBG CARES Supplemental, describe any additional provisions to the state’s fiscal controls and accounting procedures that will a) permit preparation of the SF-425 Federal fiscal reports (FFR) and b) permit the tracing of expenditures adequate to ensure funds have been used appropriately under the block grant, as required by Block Grant regulations applicable to CSBG at 45 CFR 96.30(a). [Narrative, 3000 Characters]
10.6. Single Audit Management Decisions: As it relates specifically to the CSBG CARES Supplemental, describe any additional provisions to state procedures for issuing management decisions for eligible entity single audits, as required by Block Grant regulations applicable to CSBG at 45 CFR 75.521. [Narrative, 3000 Characters]
10.7. Assurance on Federal Investigations: The state will “permit and cooperate with Federal investigations undertaken in accordance with Section 678D” of the CSBG Act, as required by the assurance under Section 676(b)(7) of the CSBG Act. Yes No
For the purposes of the CARES Act, the Office of Community Services accepts the data submitted by the state in Section 11 of the most recently submitted CSBG State Plan (as dated in Section 1 of this Supplemental State Plan), and seeks no additional information now or at a later date.
12.1. Required Income Eligibility: Provide the income eligibility threshold for services in the state. [Select one item below and numeric response where applicable.]
200% of the HHS poverty line
125% of the HHS poverty line
X % of the HHS poverty line (fill in the threshold): % [Numeric response]
Varies by eligible entity [Narrative, 5000 characters]
12.1a. Describe any changes to the state policy and/or procedures for income eligibility, such as treatment of income and family/household composition as originally described in your FFY2020 CSBG State Plan [as dated in Section 1 of this Plan].
There is no change to state policy and/or procedures for income eligibility
There are changes to state policy and/or procedures for income eligibility as described below: [Narrative, 5000 Characters]
12.1b. The change in the income eligibility threshold will apply to:
CSBG CARES Supplemental ONLY
CSBG CARES Supplemental AND regular CSBG funds
12.2. Income Eligibility for General/Short Term Services: Describe how the state ensures eligible entities generally verify income eligibility for those services with limited in-take procedures (where individual income verification is not possible or practical). An example of these services is emergency food assistance.
There is no change to state policy and/or procedures for income eligibility
There are changes to state policy and/or procedures for income eligibility as described below: [Narrative, 5000 Characters]
12.3. Community-targeted Services: Describe how the state ensures eligible entities’ services target and benefit low-income communities for those services that provide a community-wide benefit (e.g., development of community assets/facilities, building partnerships with other organizations).
There is no change to state policy and/or procedures for income eligibility
There are changes to state policy and/or procedures for income eligibility as described below: [Narrative, 5000 Characters]
For the purposes of the CARES Act, the Office of Community Services accepts the information on the ROMA system submitted by the state in Section 13 of the most recently submitted CSBG State Plan (as dated in Section 1 of this Supplemental State Plan), and seeks no additional information on the state’s ROMA system.
Please note that the state may describe state discretionary expenditures or additional training and technical assistance related to documentation and performance management for CSBG CARES Supplemental funding in Sections 7 and 8 of this Supplemental State Plan.
(Section 676(b) of the CSBG Act)
14.1. Use of Funds Supporting Local Activities
14.1a. 676(b)(1)(A): Describe how the state will assure “that funds made available through grant or allotment will be used –
(A) to support activities that are designed to assist low-income families and individuals, including families and individuals receiving assistance under title IV of the Social Security Act, homeless families and individuals, migrant or seasonal farmworkers, and elderly low-income individuals and families, and a description of how such activities will enable the families and individuals--
(i) to remove obstacles and solve problems that block the achievement of self- sufficiency (particularly for families and individuals who are attempting to transition off a State program carried out under part A of title IV of the Social Security Act);
(ii) to secure and retain meaningful employment;
(iii) to attain an adequate education with particular attention toward improving literacy skills of the low-income families in the community, which may include family literacy initiatives;
(iv) to make better use of available income;
(v) to obtain and maintain adequate housing and a suitable living environment;
(vi) to obtain emergency assistance through loans, grants, or other means to meet immediate and urgent individual and family needs;
(vii) to achieve greater participation in the affairs of the communities involved, including the development of public and private grassroots partnerships with local law enforcement agencies, local housing authorities, private foundations, and other public and private partners to –
(I) document best practices based on successful grassroots intervention in urban areas, to develop methodologies for widespread replication; and
(II) strengthen and improve relationships with local law enforcement agencies, which may include participation in activities such as neighborhood or community policing efforts;
Please select the applicable response:
No change to the standard assurance in the CSBG State Plan.
Adaptations to the standard assurance in the CSBG State Plan for the disaster supplemental are described below: [Narrative, 3000 characters]
Needs of Youth
14.1b. 676(b)(1)(B) Describe how the state will assure “that funds made available through grant or allotment will be used –
(B) to address the needs of youth in low-income communities through youth development programs that support the primary role of the family, give priority to the prevention of youth problems and crime, and promote increased community coordination and collaboration in meeting the needs of youth, and support development and expansion of innovative community-based youth development programs that have demonstrated success in preventing or reducing youth crime, such as--
(i) programs for the establishment of violence-free zones that would involve youth development and intervention models (such as models involving youth mediation, youth mentoring, life skills training, job creation, and entrepreneurship programs); and
(ii) after-school child care programs.
Please select the applicable response:
No change to the standard assurance in the CSBG State Plan.
Adaptations to the standard assurance in the CSBG State Plan for the disaster supplemental are described below: [Narrative, 3000 characters]
Coordination of Other Programs
14.1c. 676(b)(1)(C) Describe how the state will assure “that funds made available through grant or allotment will be used –
(C) to make more effective use of, and to coordinate with, other programs related to the purposes of this subtitle (including state welfare reform efforts)
Please select the applicable response:
No change to the standard assurance in the CSBG State Plan
Adaptations to the standard assurance in the CSBG State Plan for the disaster supplemental are described below: [Narrative, 3000 characters]
State Use of Discretionary Funds
14.1d. 676(b)(2) Describe “how the state intends to use discretionary funds made available from the remainder of the grant or allotment described in section 675C(b) in accordance with this subtitle, including a description of how the state will support innovative community and neighborhood-based initiatives related to the purposes of this subtitle.”
Note: Any information provide in previous sections of this application will be considered to be a supplementary description of how the state plans to use funds as necessary for this assurance. Additional information does not need to be provided here.
Eligible Entity Service Delivery, Coordination, and Innovation
14.2. 676(b)(3)(A) Describe “the service delivery system, for services provided or coordinated with funds made available through grants made under 675C(a), targeted to low-income individuals and families in communities within the state;
Please select the applicable response:
No change to the standard assurance in the CSBG State Plan
Adaptations to the standard assurance in the CSBG State Plan for the disaster supplemental are described below: [Narrative, 3000 characters]
Eligible Entity Linkages – Approach to Filling Service Gaps
14.3a. 676(b)(3)(B) Describe “how linkages will be developed to fill identified gaps in the services, through the provision of information, referrals, case management, and follow-up consultations.”
Note: the state describes this assurance in the State Linkages and Communication section, item 9.3b of the regular CSBG State Plan.
Please select the applicable response:
No change to the standard assurance in the CSBG State Plan.
Adaptations to the standard assurance in the CSBG State Plan for the disaster supplemental are described below: [Narrative, 3000 characters]
Coordination of Eligible Entity Allocation 90 Percent Funds with Public/Private Resources
14.3b. 676(b)(3)(C) Describe how funds made available through grants made under 675C(a)will be coordinated with other public and private resources.”
Note: the state describes this assurance in the State Linkages and Communication section, item 9.7 of the regular CSBG State Plan.
Please select the applicable response:
No change to the standard assurance in the CSBG State Plan.
Adaptations to the standard assurance in the CSBG State Plan for the disaster supplemental are described below: [Narrative, 3000 characters]
Eligible Entity Innovative Community and Neighborhood Initiatives, Including Fatherhood/Parental Responsibility
14.3c. 676(b)(3)(D) Describe “how the local entity will use the funds [made available under 675C(a)] to support innovative community and neighborhood-based initiatives related to the purposes of this subtitle, which may include fatherhood initiatives and other initiatives with the goal of strengthening families and encouraging parenting.”
Note: The description above is about eligible entity use of 90 percent funds to support these initiatives. States may also support these types of activities at the local level using state remainder/discretionary funds, allowable under Section 675C(b)(1)(F). In this application, the state indicates funds allocated for these activities under item 7.9(f) of the regular CSBG State Plan.
Please select the applicable response:
No change to the standard assurance in the CSBG State Plan.
Adaptations to the standard assurance in the CSBG State Plan for the disaster supplemental are described below: [Narrative, 3000 characters]
Eligible Entity Innovative Community and Neighborhood Initiatives, Including Fatherhood/Parental Responsibility
14.3d. 676(b)(3)(D) Describe “how the local entity will use the funds [made available under 675C(a)] to support innovative community and neighborhood-based initiatives related to the purposes of this subtitle, which may include fatherhood initiatives and other initiatives with the goal of strengthening families and encouraging parenting.”
Note: The description above is about eligible entity use of 90 percent funds to support these initiatives. States may also support these types of activities at the local level using state remainder/discretionary funds, allowable under Section 675C(b)(1)(F). In this State Plan, the state indicates funds allocated for these activities under item 7.9(f).
Please select the applicable response:
No change to the standard assurance in the CSBG State Plan.
Adaptations to the standard assurance in the CSBG State Plan for the disaster supplemental are described below: [Narrative, 3000 characters]
Eligible Entity Emergency Food and Nutrition Services
14.4. 676(b)(4) Describe how the state will assure “that eligible entities in the state will provide, on an emergency basis, for the provision of such supplies and services, nutritious foods, and related services, as may be necessary to counteract conditions of starvation and malnutrition among low-income individuals.”
Please select the applicable response:
No change to the standard assurance in the CSBG State Plan.
Adaptations to the standard assurance in the CSBG State Plan for the disaster supplemental are described below: [Narrative, 3000 characters]
State and Eligible Entity Coordination/linkages and Workforce Innovation and Opportunity Act Employment and Training Activities
14.5. 676(b)(5) Describe how the state will assure “that the State and eligible entities in the State will coordinate, and establish linkages between, governmental and other social services programs to assure the effective delivery of such services, and [describe] how the State and the eligible entities will coordinate the provision of employment and training activities, as defined in section 3 of the Workforce Innovation and Opportunity Act, in the State and in communities with entities providing activities through statewide and local workforce development systems under such Act.”
Note: The state describes this assurance in the State Linkages and Communication section, items 9.1, 9.2, 9.3a, 9.4, 9.4a, and 9.4b of the regular CSBG State Plan.
Please select the applicable response:
No change to the standard assurance in the CSBG State Plan.
Adaptations to the standard assurance in the CSBG State Plan for the disaster supplemental are described below: [Narrative, 3000 characters]
State Coordination/Linkages and Low-income Home Energy Assistance
14.6. 676(b)(6) Provide “an assurance that the State will ensure coordination between antipoverty programs in each community in the State, and ensure, where appropriate, that emergency energy crisis intervention programs under title XXVI (relating to low-income home energy assistance) are conducted in such community.”
Note: The state describes this assurance in the State Linkages and Communication section, items 9.2 and 9.5 of the regular CSBG State Plan.
Please select the applicable response:
No change to the standard assurance in the CSBG State Plan.
Adaptations to the standard assurance in the CSBG State Plan for the disaster supplemental are described below: [Narrative, 3000 characters]
Federal Investigations
14.7. 676(b)(7) Provide “an assurance that the State will permit and cooperate with federal investigations undertaken in accordance with section 678D.”
Note: the state addresses this assurance in the Fiscal Controls and Monitoring section, item 10.13 of the regular CSBG State plan.
Please select the applicable response:
No change to the standard assurance in the CSBG State Plan.
Adaptations to the standard assurance in the CSBG State Plan for the disaster supplemental are described below: [Narrative, 3000 characters]
Funding Reduction or Termination (Not Applicable to CSBG CARES Supplemental Funds)
14.8. 676(b)(8) Provide “an assurance that any eligible entity in the State that received funding in the previous fiscal year through a community services block grant made under this subtitle will not have its funding terminated under this subtitle, or reduced below the proportional share of funding the entity received in the previous fiscal year unless, after providing notice and an opportunity for a hearing on the record, the State determines that cause exists for such termination or such reduction, subject to review by the Secretary as provided in section 678C(b).”
Note: the state addresses this assurance in the Fiscal Controls and Monitoring section, item 10.7 of the regular CSBG State Plan. This assurance is not applicable to the disaster supplemental because funds must be distributed to eligible entities based on needs directly related to the disaster.
Check to acknowledge that Section 676(b)(8) is not applicable to the CSBG CARES Supplemental and that funds must be distributed based on the CSBG formula.
Coordination with Faith-based Organizations, Charitable Groups, Community Organizations
14.9. 676(b)(9) Describe how the state will assure “that the State and eligible entities in the state will, to the maximum extent possible, coordinate programs with and form partnerships with other organizations serving low-income residents of the communities and members of the groups served by the State, including religious organizations, charitable groups, and community organizations.”
Note: the state describes this assurance in the State Linkages and Communication section, item 9.6 of the regular CSBG State Plan.
Please select the applicable response:
No change to standard assurance in the CSBG State Plan.
Adaptations to the standard assurance in the CSBG State Plan for the disaster supplemental are described below: [Narrative, 3000 characters]
Eligible Entity Tripartite Board Representation
14.10. 676(b)(10) Describe how “the State will require each eligible entity in the State to establish procedures under which a low-income individual, community organization, or religious organization, or representative of low-income individuals that considers its organization, or low-income individuals, to be inadequately represented on the board (or other mechanism) of the eligible entity to petition for adequate representation.”
Note: the state describes this assurance in the Eligible Entity Tripartite Board in Section 11.3 of the regular CSBG State Plan.
Please select the applicable response:
No change to standard assurance in the CSBG State Plan.
Adaptations to the standard assurance in the CSBG State Plan for the disaster supplemental are described below: [Narrative, 3000 characters]
Eligible Entity Community Action Plans and Community Needs Assessments
14.11. 676(b)(11) Provide “an assurance that the State will secure from each eligible entity in the State, as a condition to receipt of funding by the entity through a community services block grant made under this subtitle for a program, a community action plan (which shall be submitted to the Secretary, at the request of the Secretary, with the State plan) that includes a community-needs assessment for the community served, which may be coordinated with community-needs assessments conducted for other programs.”
Please select the applicable response:
No change to standard assurance in the CSBG State Plan.
Adaptations to the standard assurance in the CSBG State Plan for the disaster supplemental are described below: [Narrative, 3000 characters]
State and Eligible Entity Performance Measurement: ROMA or Alternate system
14.12. 676(b)(12) Provide “an assurance that the State and all eligible entities in the State will, not later than fiscal year 2001, participate in the Results Oriented Management and Accountability System, another performance measure system for which the Secretary facilitated development pursuant to section 678E(b), or an alternative system for measuring performance and results that meets the requirements of that section, and [describe] outcome measures to be used to measure eligible entity performance in promoting self-sufficiency, family stability, and community revitalization.”
Note: The state describes this assurance in the ROMA section, items 13.1, 13.2, 13.3, and 13.4 of the regular CSBG State Plan.
Please select the applicable response:
No change to standard assurance in the CSBG State Plan.
Adaptations to the standard assurance in the CSBG State Plan for the disaster supplemental are described below: [Narrative, 3000 characters]
Validation for CSBG Eligible Entity Programmatic Narrative Sections
14.13. 676(b)(13) Provide “information describing how the State will carry out the assurances described in this section.”
Note: The state provides information for each of the assurances directly in section 14 or in corresponding items throughout the State Plan.
Please select the applicable response:
No change to standard assurance in the CSBG State Plan.
Adaptations to the standard assurance in the CSBG State Plan for the disaster supplemental are described below: [Narrative, 3000 characters]
By checking this box and signing the Cover Sheet SF-424M, the state CSBG authorized official is certifying the assurances set out above.
The box after each certification must be checked by the State CSBG authorized official.
15.1. Lobbying
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
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 an agency, a Member of Congress, an officer or employee of Congress, or an employee of 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.
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.
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.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief, that:
If 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.
By checking this box, the state CSBG authorized official is providing the certification set out above.
15.2. Drug-Free Workplace Requirements
This certification is required by the regulations implementing the Drug-Free Workplace Act of 1988: 45 CFR Part 76, Subpart, F. Sections 76.630(c) and (d)(2) and 76.645 (a)(1) and (b) provide that a Federal agency may designate a central receipt point for STATE-WIDE AND STATE AGENCY-WIDE certifications, and for notification of criminal drug convictions. For the Department of Health and Human Services, the central point is: Division of Grants Management and Oversight, Office of Management and Acquisition, Department of Health and Human Services, Room 517-D, 200 Independence Avenue, SW Washington, DC 20201.
Certification Regarding Drug-Free Workplace Requirements (Instructions for Certification)
By signing and/or submitting this application or grant agreement, the grantee is providing the certification set out below.
The certification set out below is a material representation of fact upon which reliance is placed when the agency awards the grant. If it is later determined that the grantee knowingly rendered a false certification, or otherwise violates the requirements of the Drug-Free Workplace Act, the agency, in addition to any other remedies available to the Federal Government, may take action authorized under the Drug-Free Workplace Act.
For grantees other than individuals, Alternate I applies.
For grantees who are individuals, Alternate II applies.
Workplaces under grants, for grantees other than individuals, need to be identified on the certification. If known, they may be identified in the grant application. If the grantee does not identify the workplaces at the time of application, or upon award, if there is no application, the grantee must keep the identity of the workplace(s) on file in its office and make the information available for Federal inspection. Failure to identify all known workplaces constitutes a violation of the grantee’s drug-free workplace requirements.
Workplace identifications must include the actual address of buildings (or parts of buildings) or other sites where work under the grant takes place. Categorical descriptions may be used (e.g., all vehicles of a mass transit authority or State highway department while in operation, State employees in each local unemployment office, performers in concert halls or radio studios).
If the workplace identified to the agency changes during the performance of the grant, the grantee shall inform the agency of the change(s), if it previously identified the workplaces in question (see paragraph five).
Definitions of terms in the Nonprocurement Suspension and Debarment common rule and Drug-Free Workplace common rule apply to this certification. Grantees’ attention is called, in particular, to the following definitions from these rules:
Controlled substance means a controlled substance in Schedules I through V of the Controlled Substances Act (21 U.S.C. 812) and as further defined by regulation (21 CFR 1308.11 through 1308.15);
Conviction means a finding of guilt (including a plea of nolo contendere) or imposition of sentence, or both, by any judicial body charged with the responsibility to determine violations of the Federal or State criminal drug statutes;
Criminal drug statute means a Federal or non-Federal criminal statute involving the manufacture, distribution, dispensing, use, or possession of any controlled substance;
Employee means the employee of a grantee directly engaged in the performance of work under a grant, including: (i) All direct charge employees; (ii) All indirect charge employees unless their impact or involvement is insignificant to the performance of the grant; and, (iii) Temporary personnel and consultants who are directly engaged in the performance of work under the grant and who are on the grantee’s payroll. This definition does not include workers not on the payroll of the grantee (e.g., volunteers, even if used to meet a matching requirement; consultants or independent contractors not on the grantee’s payroll; or employees of subrecipients or subcontractors in covered workplaces).
Certification Regarding Drug-Free Workplace Requirements
Alternate I. (Grantees Other Than Individuals)
The grantee certifies that it will or will continue to provide a drug-free workplace by:
Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantee’s workplace and specifying the actions that will be taken against employees for violation of such prohibition;
Establishing an ongoing drug-free awareness program to inform employees about - -
The dangers of drug abuse in the workplace;
The grantee’s policy of maintaining a drug-free workplace;
Any available drug counseling, rehabilitation, and employee assistance programs; and
The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;
Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a);
Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will - -
Abide by the terms of the statement; and
Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction;
Notifying the agency in writing, within 10 calendar days after receiving notice under paragraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to every grant officer or other designee on whose grant activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification number(s) of each affected grant;
Taking one of the following actions, within 30 calendar days of receiving notice under paragraph (d)(2), with respect to any employee who is so convicted - -
Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or
Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency;
Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f).
The grantee may insert in the space provided below the site(s) for the performance of work done in connection with the specific grant:
Place of Performance (Street address, city, county, state, zip code) [Narrative, 2500 characters]
Check if there are workplaces on file that are not identified here. Alternate II. (Grantees Who Are Individuals)
The grantee certifies that, as a condition of the grant, he or she will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the grant;
If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any grant activity, he or she will report the conviction, in writing, within 10 calendar days of the conviction, to every grant officer or other designee, unless the Federal agency designates a central point for the receipt of such notices. When notice is made to such a central point, it shall include the identification number(s) of each affected grant.
[55 FR 21690, 21702, May 25, 1990]
By checking this box, the state CSBG authorized official is providing the certification set out above.
15.3. Debarment
CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS
Certification Regarding Debarment, Suspension, and Other Responsibility Matters - - Primary Covered Transactions
Instructions for Certification
By signing and submitting this proposal, the prospective primary participant is providing the certification set out below.
The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency’s determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction.
The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default.
The prospective primary participant shall provide immediate written notice to the department or agency to which this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.
The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations.
The prospective primary participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction.
The prospective primary participant further agrees by submitting this proposal that it will include the clause titled “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusive-Lower Tier Covered Transaction,” provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.
A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the List of Parties Excluded from Federal Procurement and Nonprocurement Programs.
Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.
Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under 48 CFR part 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default.
************
Certification Regarding Debarment, Suspension, and Other Responsibility Matters - -
Primary Covered Transactions
The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals:
Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or agency;
Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;
Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and
Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default.
Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - - Lower Tier Covered Transactions
Instructions for Certification
By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out below.
The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment.
The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or had become erroneous by reason of changed circumstances.
The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meaning set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations.
The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated.
The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transaction,” without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.
A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, ineligible, or voluntarily excluded from covered transactions, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the List of Parties Excluded from Federal Procurement and Nonprocurement Programs.
Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.
Except for transactions authorized under paragraph five of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under 48 CFR part 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment.
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Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - - Lower Tier Covered Transactions
The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.
Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.
By checking this box, the state CSBG authorized official is providing the certification set out above.
15.4. Environmental Tobacco Smoke
Public Law 103227, Part C Environmental Tobacco Smoke, also known as the Pro Children Act of 1994, requires that smoking not be permitted in any portion of any indoor routinely owned or leased or contracted for by an entity and used routinely or regularly for provision of health, day care, education, or library services to children under the age of 18, if the services are funded by Federal programs either directly or through State or local governments, by Federal grant, contract, loan, or loan guarantee. The law does not apply to children’s services provided in private residences, facilities funded solely by Medicare or Medicaid funds, and portions of facilities used for inpatient drug or alcohol treatment. Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1000 per day and/or the imposition of an administrative compliance order on the responsible entity by signing and submitting this application the applicant/grantee certifies that it will comply with the requirements of the Act.
The applicant/grantee further agrees that it will require the language of this certification be included in any subawards which contain provisions for the children’s services and that all subgrantees shall certify accordingly.
By checking this box, the state CSBG authorized official is providing the certification set out above.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | CSBG Model State Plan Final |
| Author | Windows User |
| File Modified | 0000-00-00 |
| File Created | 2021-01-14 |