Form 1 PA

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR CHILDREN AND FAMILIES

Program Office:	Administration on Children, Youth, and Families (ACYF), Family and Youth Services Bureau (FYSB)
Program Announcement Number:	HHS-2009-ACF-ACYF-FVPS-XXXX
Announcement Title:	Family Violence Prevention and Services/Grants for Domestic Violence Shelters/Grants to Native American Tribes (including Alaska Native Villages) and Tribal Organizations
CFDA Number:	93.671
Due Date for Applications:	(Insert date 30 days from date of publication in the Federal Register)

Executive Summary: This announcement governs the proposed award of formula grants under the Family Violence Prevention and Services Act (FVPSA) to Native American Tribes (including Alaska Native Villages) and Tribal organizations. The purpose of these grants is to assist Tribes in establishing, maintaining, and expanding programs and projects to prevent family violence (i.e. domestic violence) and to provide immediate shelter and related assistance for victims of domestic violence and their dependents (42 U.S.C. 10401).

This announcement sets forth the application requirements, the application process, and other administrative and fiscal requirements for grants in Fiscal Year (FY) 2009. Grantees are to be mindful that although the expenditure period for grants is a two-year period, an application is required every year to provide continuity in the provision of services. (See Section II. Award Information, Expenditure Periods.)

I. DESCRIPTION

Legislative Authority: The Family Violence Prevention and Services Act (42 U.S.C. 10401 et. seq.).

Background

The purpose of this legislation is to assist Tribes or Tribal organizations and States in supporting the establishment, maintenance, and expansion of programs and projects to prevent incidents of family violence and to provide immediate shelter and related assistance for victims of family violence and their dependents. Tribes face unique circumstances and obstacles when responding to domestic violence. The particular legal relationship of the United States to Indian Tribes creates a Federal trust responsibility to assist Tribal governments in safeguarding the lives of Indian victims of domestic violence.

During FY 2008, the Department of Health and Human Services (HHS) made 257 grants to States and Tribes or Tribal organizations. HHS also made 53 family violence prevention grant awards to non-profit State Domestic Violence Coalitions. In addition, HHS supports the Sacred Circle, National Resource Center to End Violence Against Native Women.

General Grant Program Requirements For Tribes Or Tribal Organizations

Client Confidentiality

FVPSA programs must establish or implement policies and protocols for maintaining the safety and confidentiality of the adult victims of domestic violence and their children whom they serve.  It is essential that the confidentiality of individuals receiving FVPSA services be protected.  Consequently, when providing statistical data on program activities and program services, individual identifiers of client records will not be used by Tribes, Tribal organizations, the State, or other FVPSA grantees or subgrantees. The address or location of any FVPSA-funded shelter facility will, except with written authorization of the person or persons responsible for the operation of such shelter, not be made public and the confidentiality of records pertaining to any individual provided domestic violence services by any FVPSA-funded program will be strictly maintained (42 U.S.C. 10402(a)(2)(E)).

Confidentiality requirements have been strengthened and clarified with the passage of the Violence Against Women and Department of Justice Reauthorization Act of 2005 (Public Law 109-162).  In the interest of establishing a consistent Federal standard for domestic violence programs, HHS follows the confidentiality provisions and definition of “personally identifying information” in sections 40002(b)(2) and 40002(a)(18) of the Violence Against Women Act of 1994 (42 U.S.C. 13925(b)(2) and 42 U.S.C. 13925(a)(18)) as a more detailed guidance for grantees about how to comply with the FVPSA confidentiality statute, and requires FVPSA-funded programs to comply with the VAWA confidentiality provisions.  Included in the confidentiality provisions are grant conditions regarding the disclosure of personally identifying information, confidentiality, information sharing, and when release of information is compelled.

In FY 2009 guidance, the FVPSA Program requires that grantees only collect unduplicated data for each program, and that information not be unduplicated across programs or statewide. No client-level data may be shared with a third party, regardless of encryption, hashing or other data security measures, without a written, time-limited release as described in section 40002(b)(2) of the Violence Against Women Act of 1994 (42 U.S.C. 13925(b)(2)).

The Importance of Coordinated, Accessible Services

The impacts of domestic violence may include physical injury and death of primary or secondary victims, psychological trauma, isolation from family and friends, harm to children living with a parent or caretaker who is either experiencing or perpetrating domestic violence, increased fear, reduced mobility, damaged credit, employment and financial instability, homelessness, substance abuse, chronic illnesses, and a host of other health and related mental health consequences. The physical and cultural obstacles existing in much of Indian country compound the basic dynamics of domestic violence. Barriers such as the isolation of vast rural areas, the concern for safety in isolated settings, lack of housing and shelter options, and the transportation requirements over long distances heighten the need for the coordination of the services through an often limited delivery system.

In a project intended to broaden the reach of the Native American domestic violence community, the Indian Health Service (IHS) and the FVPSA Program have collaborated to oversee the development of domestic violence community projects. These projects are designed to develop improved health care responses to domestic violence and to facilitate collaboration between the local health care system and local American Indian and Alaskan Native domestic violence advocacy programs. In this effort, IHS also is collaborating with Tribal and national domestic violence organizations to provide training, technical assistance, and oversight to the pilot projects.

To help bring about a more effective response to the problem of domestic violence, HHS urges Tribes and Tribal organizations receiving funds under this grant announcement to coordinate activities funded under this grant with other new and existing resources for the prevention of domestic violence and related issues.

To serve victims most in need and to comply with Federal law, services must be widely accessible. Services must not discriminate on the basis of age, handicap, sex, race, color, national origin or religion (42 U.S.C. 10406). HHS Office for Civil Rights provides guidance to grantees in complying with these requirements. Services must also be provided on a voluntary basis; receipt of shelter or housing must not be conditioned on participation in supportive services.

National Data Collection and Outcomes Measurement

In collaboration with partners at the State FVPSA programs, State Domestic Violence Coalitions (Coalitions), Tribes and Tribal organizations, Sacred Circle, the National Resource Center on Domestic Violence, and experts on both data collection and domestic violence prevention issues, the FVPSA Program continues to develop informative, succinct, and non-burdensome reporting formats that safely measure quantifiable outputs and outcomes. During FY 2007, the FVPSA Program revised and defined the program services reporting components for recipients of FVPSA State Formula Grant funds. In FY 2008, the FVPSA Program worked with Tribal representatives to assess the applicability of the proposed program reporting procedures and outcome measures for FVPSA Tribal grantees. In FY 2009, the FVPSA Program is requiring Tribal grantees and States to use standardized reporting forms to facilitate the collection of uniform, aggregate data on FVPSA-supported program services, as described in Section VI.

Annual Tribal Grantee Meeting

FVPSA grant administrators are expected to attend the annual Tribal Grantee Meeting. Subsequent correspondence will advise the Tribal FVPSA Administrators of the date, time, and location of the grantee meeting.

Definitions

Tribes and Tribal organizations should use the following definitions in carrying out their programs. The definitions are found in 42 U.S.C. 10421.

Family Violence: Any act, or threatened act, of violence, including any forceful detention of an individual, which (a) results or threatens to result in physical injury and (b) is committed by a person against another individual (including an elderly person) to whom such person is, or was, related by blood or marriage, or otherwise legally related, or with whom such person is, or was, lawfully residing. In this program announcement, domestic violence and family violence are used interchangeably.

Indian Tribe: “Indian tribe” means any Indian tribe, band, nation, or other organized group or community, including any Alaska Native village or regional or village corporation as defined in or established pursuant to the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et seq.), which is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians (25 U.S.C. 450b(e)).

Tribal Organization: “Tribal Organization” means the recognized governing body of any Indian tribe; any legally established organization of Indians which is controlled, sanctioned, or chartered by such governing body or which is democratically elected by the adult members of the Indian community to be served by such organization and which includes the maximum participation of Indians in all phases of its activities. In any case where a contract is let or grant made to an organization to perform services benefiting more than one Indian tribe, the approval of each such Indian tribe shall be a prerequisite to the letting or making of such contract or grant (25 U.S.C. 450b(l)).

Shelter: The provision of temporary refuge and related assistance in compliance with applicable State law and regulation governing the provision, on a regular basis, of shelter, safe homes, meals, and related assistance to victims of family violence and their dependents.

Related assistance: The provision of direct assistance to victims of family violence and their dependents for the purpose of preventing further violence, helping such victims to gain access to civil and criminal courts and other community services, facilitating the efforts of such victims to make decisions concerning their lives in the interest of safety, and assisting such victims in healing from the effects of the violence. Related assistance includes:

1. Prevention services such as outreach and prevention services for victims and their children, assistance to children who witness domestic violence, employment training, parenting, and other educational services for victims and their children, preventive health services within domestic violence programs (including services promoting nutrition, disease prevention, exercise, and prevention of substance abuse), domestic violence prevention programs for school-age children, family violence public awareness campaigns, and violence prevention counseling services to abusers;

2. Counseling with respect to family violence, counseling or other supportive services by peers individually or in groups, and referral to community social services;

3. Transportation, technical assistance with respect to obtaining financial assistance under Federal and State programs, and referrals for appropriate health-care services (including alcohol and drug abuse treatment), but shall not include reimbursement for any health-care services;

4. Legal advocacy to provide victims with information and assistance through the civil and criminal courts, and legal assistance; or

5. Children’s counseling and support services, child care services for children who are victims of family violence or the dependents of such victims, and children who witness domestic violence.

II. FUNDS AVAILABLE

In accordance with 42 U.S.C. 10409(b), in FY 2009, HHS will make 10 percent of the amount appropriated under 42 U.S.C. 10409(a)(1), which is not reserved under42 U.S.C. 10409(a)(2) available for grants to the Tribes and Tribal organizations for the establishment and operation of shelters, safe houses, and the provision of related services.

Native American Tribal Allocations

In computing Tribal allocations, the FVPSA Program will use the latest available population figures from the Census Bureau. To view the Census’ latest populations go to their website at www.census.gov. Where Census Bureau data are unavailable, the FVPSA Program will use figures from the Bureau of Indian Affairs’ (BIA’s) Indian Population and Labor Force Report.

The funding formula for the allocation of family violence funds is based upon the Tribe’s population. Funds shall be allotted to each Tribal grantee on the same ratio as the population of the Tribe to the population of all applicant Tribes. However, subject to the availability of funds, each Tribe with a population of 10,000 members or less shall receive the minimum funding shown below:

Population Minimum Funding Award:

• Less than 1,500 $30,000

• 1,501-3,000 $50,000

• 3,001-4,500 $70,000

• 4,501-7,000 $100,000

• 7,001-10,000 $125,000

Once the minimum amounts have been distributed to the Tribes that have applied for FVPSA funding, the ratio of the Tribe’s population to the total population of all of the applicant Tribes is then considered in allocating the remainder of the funds. By establishing base amounts with distribution of proportional amounts for larger Tribes, the FVPSA Program is balancing the need for basic services for all Tribes with the greater demand for services among Tribes with larger populations. In FY 2008, actual grant awards ranged from $26,541 to $2,322,308.

Tribes are encouraged to apply for FVPSA funding as a consortium. Tribal consortia consist of groups of Tribes who agree to apply for and administer a single FVPSA grant with one Tribe or Tribal organization responsible for grant administration. In a Tribal consortium, the population of the Tribal Trust Land for all of the Tribes involved will be used to calculate the award amount. The allocations for each of the Tribes included in the consortium will be combined to determine the total grant for the Consortium.

Expenditure Periods

The FVPSA funds may be used for expenditures on and after October 1 of each fiscal year for which they are granted, and will be available for expenditure through September 30 of the following fiscal year; i.e., FY 2009 funds may be used for expenditures from October 1, 2008 through September 30, 2010.

Re-allotted funds, if any, are available for expenditure until the end of the fiscal year following the fiscal year that the funds became available for reallotment. FY 2009 grant funds that are made available to Tribes and Tribal organizations through reallotment must be expended by the grantee no later than September 30, 2010.

III. ELIGIBILITY

Tribes and Tribal organizations are eligible for funding under this program if they meet the definition of “Indian Tribe” or “Tribal organization” set forth in section 450B of Title 25 and if they are able to demonstrate their capacity to carry out a family violence prevention and services program. Any Tribe or Tribal organization that believes it meets the eligibility criteria and should be included in the list of eligible Tribes should provide supportive documentation and a request for inclusion in its application. (See Application Content Requirements below.) Tribes may apply singularly or as a consortium. In addition, a non-profit private organization or Tribal organization, approved by a Tribe for the operation of a family violence shelter or program on a reservation is eligible for funding.

Additional Information on Eligibility

D-U-N-S Requirement

All applicants must have a D&B Data Universal Numbering System (D-U-N-S) number.  On June 27, 2003, the Office of Management and Budget (OMB) published in the Federal Register a new Federal policy applicable to all Federal grant applicants.  The policy requires Federal grant applicants to provide a D-U-N-S number when applying for Federal grants or cooperative agreements on or after October 1, 2003.  The D-U-N-S number will be required whether an applicant is submitting a paper application or using the government-wide electronic portal, www.Grants.gov.   A D-U-N-S number will be required for every application for a new award or renewal/continuation of an award, including applications or plans under formula, entitlement, and block grant programs, submitted on or after October 1, 2003.

Please ensure that your organization has a D-U-N-S number.  You may acquire a D-U-N-S number at no cost by calling the dedicated toll-free D-U-N-S number request line at 1-866-705-5711 or you may request a number on-line at http://www.dnb.com.

IV. APPLICATION REQUIREMENTS FOR TRIBES AND TRIBAL ORGANIZATIONS

The Paperwork Reduction Act of 1995 (P.L. 104-13)

Public reporting burden for this collection of information is estimated to average ten hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection information. The project description is approved under OMB control number 0970-0280, which expires October 31, XXXX. 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.

Content of Application Submission

The application from the Tribe or Tribal organization must be signed by the Chief Executive Officer or Tribal Chairperson of the applicant organization.

The cover letter of the application should include the following information:

1. The name of the Tribe or Tribal organization applying for the FVPSA grant and the mailing address.

2. The name of the Chief Program Official designated as responsible for administering funds under FVPSA, and the telephone number, fax number, and if available, an e-mail address.

3. The name of the program person designated to administer coordination of the related programs, and the telephone number, fax number, and if available, an e-mail address.

4. The Employee Identification Number (EIN) of the applicant organization submitting the application.

5. The D-U-N-S number of the applicant organization submitting the application. See preceding D-U-N-S Requirement section for additional information.

The content of the application should include the following:

1. A copy of a current resolution stating that the designated organization or agency has the authority to submit an application on behalf of the individuals in the Tribe(s) and to administer programs and activities funded under this program (42 U.S.C. 10402(b)(2)). Please Note: New applicants and Consortia applicants must submit new resolutions. Ongoing applicants must submit a copy of active resolutions covering FY 2009.

2. A description of the procedures designed to involve knowledgeable individuals and interested organizations in providing services under FVPSA (42 U.S.C. 10402(b)(2)). For example, knowledgeable individuals and interested organizations may include: Tribal officials or social services staff involved in child abuse or family violence prevention, Tribal law enforcement officials, representatives of State Coalitions Against Domestic Violence, and operators of domestic violence shelters and service programs.

3. A description of the applicant’s operation of and/or capacity to carry out a family violence prevention and services program. This might be demonstrated in ways such as the following:

1. The current operation of a shelter, safe house, or family violence prevention program;

2. The establishment of joint or collaborative service agreements with a local public agency or a private non-profit agency for the operation of family violence prevention activities or services; or

3. The operation of social services programs as evidenced by receipt of “638” contracts with BIA; Title II Indian Child Welfare grants from BIA; Child Welfare Services grants under Title IV-B of the Social Security Act; or Family Preservation and Family Support grants under title IV-B of the Social Security Act.

4. A description of the services to be provided, how the applicant organization plans to use the grant funds to provide the direct services, to whom the services will be provided, and the expected results of the services.

5. Documentation of the policies and procedures to ensure that individual identifiers of client records will not be used when providing statistical data on program activities and program services and that the confidentiality of records pertaining to any individual provided domestic violence prevention or treatment services by any FVPSA-supported program will be strictly maintained (42 U.S.C. 10402(a)(2)(E)).

Assurances (See Appendix A): All applications must submit and comply with the required FVPSA specific assurances contained in Appendix A.

Each applicant must assure that:

1. Not less than 70 percent of the funds shall be used for immediate shelter and related assistance, as defined in 42 U.S.C. 10421(4) and (5), for victims of family violence and their dependents and not less than 25 percent of the funds distributed shall be used to provide related assistance as defined in 42 U.S.C. 10421(5) (42 U.S.C. 10402(g)).

2. Grant funds made available under FVPSA will not be used as direct payment to any victim or dependent of a victim of family violence (42 U.S.C. 10402(d)).

3. No income eligibility standard will be imposed on individuals receiving assistance or services supported with funds appropriated to carry out FVPSA (42 U.S.C. 10402(e)).

4. The address or location of any shelter or facility assisted under FVPSA will not be made public, except with the written authorization of the person or persons responsible for the operations of such shelter (42 U.S.C. 10402(a)(2)(E)).

5. The applicant will comply with FVPSA confidentiality requirements and must provide assurances that individual identifiers of client records will not be used when providing statistical data on program activities and program services and that the confidentiality of records pertaining to any individual provided domestic violence prevention or treatment services by any FVPSA-supported program will be strictly maintained (42 U.S.C. 10402(a)(2)(E)).

6. That a law or procedure, such as a process for obtaining an order of protection, has been implemented for the eviction of an abusing spouse from a shared household (42 U.S.C. 10402(a)(2)(F)).

7. That all grants, programs or other activities funded in whole or in part with funds made available under FVPSA will prohibit discrimination on the basis of age, handicap, sex, race, color, national origin or religion (42 U.S.C. 10406).

8. That the applicant will comply with the applicable Departmental recordkeeping and reporting requirements and general requirements for the administration of grants under 45 CFR Part 92.

Certifications

All applications must submit or comply with the required certifications found in Appendices B – D as follows:

Anti-Lobbying Certification and Disclosure Form (See Appendix B): Applicants must furnish prior to award an executed copy of the SF-LLL, Certification Regarding Lobbying, when applying for an award in excess of $100,000. Applicants who have used non-Federal funds for lobbying activities in connection with receiving assistance under this announcement shall complete a disclosure form, if applicable, with their applications (approved by OMB under control number 0348-0046). Applicants should sign and return the certification with their application.

Certification Regarding Environmental Tobacco Smoke (See Appendix C): Applicants must also understand they will be held accountable for the smoking prohibition included within P.L. 103-227, Title XII Environmental Tobacco Smoke (also known as the PRO-KIDS Act of 1994). A copy of the Federal Register notice which implements the smoking prohibition is included with forms. By signing and submitting the application, applicants are accepting and agreeing to all terms and conditions of the certification.

Certification Regarding Drug-Free Workplace Requirements (See Appendix D): The signature on the application by the chief program official attests to the applicant’s intent to comply with the Drug-Free Workplace requirements and compliance with the Debarment Certification. By signing and submitting the application, applicants are accepting and agreeing to all terms and conditions of the certification.

These certifications can be found at www.acf.hhs.gov/programs/ofs/forms.htm.

Notification Under Executive Order 12372

The review and comment provisions of the Executive Order (E.O.) and Part 100 do not apply. Federally recognized Tribes are exempt from all provisions and requirements of E.O. 12372.

Applications should be sent to:

Family Violence Prevention and Services Program

Family and Youth Services Bureau

Administration on Children, Youth, and Families

Administration for Children and Families

Attention: Shena Williams/Millicent Crawford

1250 Maryland Avenue, S.W., Suite 800

Washington, DC 20024

V. APPROVAL/DISAPPROVAL OF A TRIBAL OR TRIBAL ORGANIZATION APPLICATION

The Secretary of HHS will approve any application that meets the requirements of FVPSA and this announcement. The Secretary will not disapprove an application except after reasonable notice of the Secretary’s intention to disapprove has been provided to the applicant and after a six-month period providing an opportunity for applicant to correct any deficiencies. The notice of intention to disapprove will be provided to the applicant within 45 days of the date of the application.

VI. REPORTING REQUIREMENTS

Performance Reports

A Program Performance Report (SF-PPR) must be filed with HHS describing the activities carried out, and including an assessment of the effectiveness of those activities in achieving the purposes of the grant (see Appendix E). A section of this performance report must be completed by each grantee or sub-grantee that performed the direct services contemplated in the application certifying performance of such services. Consortia grantees should compile performance reports into a comprehensive report for submission.

The Performance Report must include the following data elements:

Funding – The total amount of the FVPSA grant award. Total domestic violence program budgets for programs that received FVPSA grants or subgrants. The number of domestic violence programs with residential facilities funded. The number of non-residential programs funded.

Volunteers –The total number of volunteers working in FVPSA-supported programs, total volunteer hours.

Narrative Questions – For services or activities supported in whole or in part by FVPSA funding, provide examples or summaries that describe:

• Stories concerning individual clients, services, or community initiatives;

• Activities that the FVPSA grant allows grantees to do that they wouldn’t be able to do without this funding;

• Describe, if applicable, any efforts supported in whole or in part by the FVPSA grant to meet the unique needs of the community and any on-going challenges in meeting these needs, e.g., Tribal shelters not available; accessibility of non-Native shelters; transportation; teen services; etc.

• Describe significant prevention and outreach activities supported in whole or in part by your FVPSA grant during the program year.

• Any additional information that the grantees would like to share about their FVPSA-supported domestic violence programs and their effectiveness, the unmet needs of victims in the community and what would be required to meet those needs, or service trends that are emerging in their communities.

People Served –

• An unduplicated count (unduplicated by program) of non-residential clients who are women, men, children, and youth who are intimate partner violence victims

• An unduplicated count (unduplicated by program) of residential clients who are women, men, children and youth, and youth who are intimate partner violence victims

Demographics – For Unduplicated Clients, include the following demographic categories:

• Race/Ethnicity: Black or African American; American Indian/Alaska Native; Asian; Hispanic or Latino; Native Hawaiian/Other Pacific Islander; White; Unknown/Other

• Gender: Female; Male; or Not Specified

• Age: 0-17; 18-24; 25-59; 60+; Unknown

Residential Services –

• The number of shelter nights

• Number of unmet requests for shelter

Related services and assistance – List the related services and assistance provided to victims and their family members by indicating the number of hours and or number of service contacts in each of the following categories:

• Crisis/hotline calls (number of calls)

• Supportive Counseling and Advocacy: Individual and Group

• Children’s Services

• Supportive Counseling and Advocacy: Individual and Group

• Children’s Activities: Individual and Group

• Batterer Intervention Services (if funded through FVPSA): Individual and Group

Community Education and Public Awareness – Report the number of presentations and participants that attended presentations/training for:

• Adults/General Population

• Youth Targeted

• Community Awareness Activities (Number of events only)

Performance reports for Tribes and Tribal organizations are due on an annual basis at the end of the calendar year (December 29). Performance reports should be sent to:

Family Violence Prevention and Services Program

Family and Youth Services Bureau

Administration on Children, Youth and Families

Administration for Children and Families

Attn: Shena Williams/ Millicent Crawford

1250 Maryland Avenue, S.W., Room 800

Washington, DC 20024

Financial Status Reports

Grantees must submit annual Financial Status Reports. The first SF-269A is due December 29, 2009. The final SF-269A is due December 29, 2010. SF 269A can be found at http://www.whitehouse.gov/omb/grants/grantsforms.html.

Completed reports may be mailed to:

Frederick Griefer

Division of Mandatory Grants

Office of Grants Management

Administration for Children and Families

370 L’Enfant Promenade, S.W.

6^th Floor

Washington, DC 20447

Grantees are encouraged to submit their reports online through the Online Data Collection (OLDC) system at the following address: https://extranet.acf.hhs.gov/oldc/.

Failure to submit reports on time may be a basis for withholding grant funds, suspension, or termination of the grant. In addition, all funds reported after the obligation period will be recouped.

VII. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

Grantees are subject to the requirements in 45 CFR Part 74 (non-governmental) or 45 CFR Part 92 (governmental).

Direct Federal grants, sub-award funds, or contracts under this ACF program shall not be used to support inherently religious activities such as religious instruction, worship, or proselytization. Therefore, organizations must take steps to separate, in time or location, their inherently religious activities from the services funded under this program.   Regulations pertaining to the Equal Treatment for Faith-Based Organizations, which includes the prohibition against Federal funding of inherently religious activities, can be found at the HHS web site at http://www.hhs.gov/fbci/waisgate21.pdf.

A faith-based organization receiving HHS funds retains its independence from Federal, State, and local governments and may continue to carry out its mission, including the definition, practice, and expression of its religious beliefs.  For example, a faith-based organization may use space in its facilities to provide secular programs or services funded with Federal funds without removing religious art, icons, scriptures, or other religious symbols.  In addition, a faith-based organization that receives Federal funds retains its authority over its internal governance, and it may retain religious terms in its organization’s name, select its board members on a religious basis, and include religious references in its organization’s mission statements and other governing documents in accordance with program requirements, statutes, and other applicable requirements governing the conduct of HHS funded activities.

Faith-based and community organizations may reference the “Guidance to Faith-Based and Community Organizations on Partnering with the Federal Government” at http://www.whitehouse.gov/government/fbci/guidance/index.html.

HHS Grants Policy Statement

The HHS Grants Policy Statement (GPS) is the Department of Human Services new single policy guide for discretionary grants and cooperative agreements.  Unlike previous HHS policy documents, the GPS is intended to be shared with and used by grantees.  It became effective October 1, 2006 and is applicable to all Operating Divisions (OPDIVS), such as ACF, except the national Institutes of Health (NIH).  The GPS covers basic grant processes, standard terms and conditions and points of contact as well as important OPDIV-specific requirements.  Appendices include a glossary of terms and a list of standard abbreviations for ease of reference.  The GPS may be accessed as http:///www.acf.hhs.gov/grants/grants_resources.html.

VIII. OTHER INFORMATION

For Further Information Contact: Shena Williams at (202) 205-5932 or e-mail at shena.williams@acf.hhs.gov; or Millicent Crawford at (202) 205-7746 or e-mail at millicent.crawford@acf.hhs.gov

Date: ______________________ ___________________________

Joan E. Ohl

Commissioner

Administration on Children, Youth

and Families

Appendices: Required Assurances and Certifications:

A. Assurances

B. Certification Regarding Lobbying

C. Certification Regarding Environmental Tobacco Smoke

D. Drug-Free Workplace Requirements

E. Performance Progress Report (SF-PPR)

Appendix A

ASSURANCES OF COMPLIANCE WITH GRANT REQUIREMENTS

The grantee certifies that it will comply with the following:

1. Not less than 70 percent of the funds distributed shall be used for immediate shelter and related assistance, as defined in 42 U.S.C. 10421(4) and (5), to victims of family violence and their dependents and not less than 25 percent of the funds distributed shall be used to provide related assistance as defined in 42 U.S.C. 10421(5) (42 U.S.C. 10402(g)).

2. Grant funds made available under FVPSA will not be used as direct payment to any victim or dependent of a victim of family violence (42 U.S.C. 10402(d)).

3. No income eligibility standard will be imposed on individuals receiving assistance or services supported with funds appropriated to carry out FVPSA (42 U.S.C. 10402(e)).

4. The address or location of any shelter or facility assisted under FVPSA will not be made public, except with the written authorization of the person or persons responsible for the operations of such shelter (42 U.S.C. 10402(a)(2)(E)).

5. The applicant will comply with FVPSA confidentiality requirements and must provide assurances that individual identifiers of client records will not be used when providing statistical data on program activities and program services and that the confidentiality of records pertaining to any individual provided domestic violence prevention or treatment services by any FVPSA-supported program will be strictly maintained (42 U.S.C. 10402(a)(2)(E)).

6. That a law or procedure, such as a process for obtaining an order of protection, has been implemented for the eviction of an abusing spouse from a shared household (42 U.S.C. 10402(a)(2)(F)).

7. That all grants, programs or other activities funded by the State in whole or in part with funds made available under FVPSA will prohibit discrimination on the basis of age, handicap, sex, race, color, national origin or religion (42 U.S.C. 10406).

8. That the applicant will comply with the applicable Departmental recordkeeping and reporting requirements and general requirements for the administration of grants under 45 CFR Part 92.

_________________________________

Chief Program Official

__________________________________

Title

_________________________________

Organization

Appendix B

CERTIFICATION REGARDING LOBBYING

Certification for Contracts, Grants, Loans, and Cooperative Agreements

The undersigned certifies, to the best of his or her knowledge and belief, that:

1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of 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.

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

(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

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.

____________________________________________

Signature

____________________________________________
Title

____________________________________________
Organization

Appendix C

CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE

Public Law 103227, Part C Environmental Tobacco Smoke, also known as the Pro Children Act of 1994 (Act), 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.

Appendix D

CERTIFICATION REGARDING 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)

1. By signing and/or submitting this application or grant agreement, the grantee is providing the certification set out below.

2. 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.

3. For grantees other than individuals, Alternate I applies.

4. For grantees who are individuals, Alternate II applies.

5. Workplaces under grants, for grantees other than individuals, need not 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.

6. 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).

7. 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).

8. 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:

(1) 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;

(2) Establishing an ongoing drug-free awareness program to inform employees about –

(a) The dangers of drug abuse in the workplace;

(b) The grantee’s policy of maintaining a drug-free workplace;

(c) Any available drug counseling, rehabilitation, and employee assistance programs; and

(d) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;

(3) 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);

(4) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will –

(a) Abide by the terms of the statement; and

(b) 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;

(5) 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;

(6) 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 –

(a) 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

(b) 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;

(7) 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)

                                                                                                                                

                                                                                                                                

Check if there are workplaces on file that are not identified here.

Alternate II. (Grantees Who Are Individuals)

1. 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;

2. 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.

   
   

Appendix E

SF-PPR

Family Violence Prevention & Services Program

Family & Youth Services Bureau/Administration for Children and Families

U.S. Department of Health and Human Services

Native American Tribal Programs

				Page	of Pages
1. Federal Agency and Organization Element to Which Report is Submitted FVPSP/FYSB/ACYF/ACF/HHS	2a. Total Domestic Violence Budget 2b. FVPSA Grant Amount			3a. DUNS Number
				3b. EIN
4. Recipient Organization (Name and Complete Address Including Zip Code)				5a. # of Shelter Programs with Residential Facilities 5b. # of Non-Residential Domestic Violence Programs
6. Project/Grant Period				7. Number of Volunteers
Start Date: (Month, Day, Year)	End Date: (Month, Day, Year)			8. Number of Volunteer Hours
9. Performance Narrative (attach performance narrative as instructed by the awarding Federal Agency) For services supported in whole or in part by your FVPSA grant, share a story about a client, service or community initiative. What does your FVPSA grant allow you to do that you wouldn’t be able to do without this funding? Describe, if applicable, any efforts supported in whole or in part by your FVPSA grant to meet the unique needs of your community and any on-going challenges in meeting these needs. For example: Tribal shelters not available; accessibility of non-native shelters; transportation; teen services; etc. Describe significant prevention and outreach activities supported in whole or in part by your FVPSA grant during the program year. (Optional) Provide any additional information that you would like us to know about your FVPSA-supported domestic violence program and its effectiveness, the unmet needs of victims in your community and what would be required to meet them, or service trends that are emerging in your community.
10. Other Attachments (attach other documents as needed or as instructed by the awarding Federal Agency)
11. Certification: I certify to the best of my knowledge and belief that this report is correct and complete for performance of activities for the purposes set forth in the award documents.
12a. Typed or Printed Name and Title of Authorized Certifying Official		12c. Telephone (area code, number and extension)
		12d. Email Address
12b. Signature of Authorized Certifying Official		12e. Date Report Submitted (Month, Day, Year)
		13. Agency Use Only

SF-PPR-D

Table of Activity Results

						Page
1. Federal Agency and Organization Element to Which Report is Submitted FVPSP/FYSB/ACYF/ACF/HHS		2. Name of Recipient Organization			3a. DUNS
					3b. EIN
Section A—People Served (Unduplicated) Indicate the number of all clients served by gender, ethnicity, and age. Do not include clients served only in Batterers Intervention Services; count them in Section E.
	Residential	Women	Men	Children	Youth IPV Victim
FV-A-100	Unduplicated Count of Clients Served
	Non-Residential	Women	Men	Children	Youth IPV Victim
FV-A-200	Unduplicated Count of Clients Served
	Race	Black or African American	American Indian/ Alaska Native	Asian	Hispanic or Latino	Native Hawaiian/ Other Pacific Islander	White		Unknown/ Other
FV-A-300	Clients
	Gender	Female	Male	Not Specified
FV-A-400	Clients
	Age	0-17	18-24	25-59	60+	Unknown
FV-A-500	Clients
Section B—Residential Services Indicate the number of service contacts and/or hours provided regardless of length. For Tribal programs using time increments, report total hours in “Number of Hours” column.
FV-B-100	Shelter Nights
FV-B-200	Unmet Request for Shelter

SF-PPR-D

Page

of Pages

1. Federal Agency and Organization Element to Which Report is Submitted FVPSP/FYSB/ACYF/ACF/HHS

2. Name of Recipient Organization

3a. DUNS

3b. EIN

Section C—Related Services and Assistance Indicate the number of service contacts and/or hours provided regardless of length. For Tribal programs using time increments, report total hours in “Number of Hours” column.

Crisis/Hotline Calls

Total Calls

FV-C-100

Crisis/Hotline Calls

Supportive Counseling

Number of Hours

Number of Service Contacts

FV-C-200

Individual Supportive Counseling & Advocacy

FV-C-201

Group Supportive Counseling & Advocacy

Section D—Related Services and Assistance for Children Indicate the number of service contacts and/or hours provided regardless of length. For Tribal programs using time increments, report total hours in “Number of Hours” column provided.

Supportive Counseling

Number of Hours

Number of Service Contacts

FV-D-100

Individual

FV-D-101

Group

Activities for Children & Youth

Number of Hours

Number of Service Contacts

FV-D-200

Individual

FV-D-201

Group

Section E—Batterer Intervention Services Indicate the number of hours and/or service contacts provided. Report only if these services are funded by FVPSA.

Intervention/Counseling Services

Number of Clients

Number of Service Contacts

Number of Hours

FV-E-100

Individual

FV-E-101

Group

Section F—Community Education and Public Awareness Indicate the total number of training and community education presentations. Indicate the total number of individuals attending.

Community Education

Number of Presentations

Number of Participants

FV-F-100

Adults/General Population

FV-F-101

Youth Targeted

Community Awareness Activities

Number of Activities

FV-F-200

Awareness Activities

42