HUD Form 50070 Certification for a Drug Free Workplace

Certification for
a Drug-Free Workplace

U.S. Department of Housing
and Urban Development

Applicant Name

Program/Activity Receiving Federal Grant Funding

Acting on behalf of the above named Applicant as its Authorized Official, I make the following certifications and agreements to
the Department of Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue
to provide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use
of a controlled substance is prohibited in the Applicant's workplace and specifying the actions that will be taken against
employees for violation of such prohibition.
b. Establishing an on-going drug-free awareness program to
inform employees --(1)

The dangers of drug abuse in the workplace;

(2) The Applicant's policy of maintaining a drug-free
workplace;
(3) Any available drug counseling, rehabilitation, and
employee assistance programs; and
(4) The penalties that may be imposed upon employees
for drug abuse violations occurring in the workplace.
c. 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.;
d. Notifying the employee in the statement required by paragraph a. that, as a condition of employment under the grant, the
employee will ---

(1)

Abide by the terms of the statement; and

(2) 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;
e. Notifying the agency in writing, within ten calendar days
after receiving notice under subparagraph 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 Federalagency has designated a central point for the
receipt of such notices. Notice shall include the identification
number(s) of each affected grant;
f. Taking one of the following actions, within 30 calendar
days of receiving notice under subparagraph d.(2), with respect
to any employee who is so convicted --(1) 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
(2) 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;
g. Making a good faith effort to continue to maintain a drugfree workplace through implementation of paragraphs a. thru f.

2. Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with the
HUD funding of the program/activity shown above: Place of Performance shall include the street address, city, county, State, and zip code.
Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.)

Check here

if there are workplaces on file that are not identified on the attached sheets.

I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate.
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties.
(18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Name of Authorized Official

Signature

Title

Date

X
form HUD-50070 (3/98)
ref. Handbooks 7417.1, 7475.13, 7485.1 & .3