Fvpsa Tribal Program Announcement

Administration for Children and Families
Administration on Children, Youth and Families (ACYF)/
Family and Youth Services Bureau (FYSB)
Family Violence Prevention and Services/Grants for Domestic Violence
Shelters/Grants to Native American Tribes (including Alaska Native Villages) and
Tribal Organizations
HHS-2011-ACF-ACYF-FVPS-0165
Application Due Date: May 13, 2011

DEPARTMENT OF HEALTH AND HUMAN SERVICES
ADMINISTRATION FOR CHILDREN AND FAMILIES
Program Office:
Program Announcement Number:
Announcement Title:

Administration on Children, Youth and Families (ACYF),
Family and Youth Services Bureau (FYSB)
HHS-2011-ACF-ACYF-FVPS-0165
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:

May 13, 2011

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 efforts to
increase public awareness about, and primary and secondary prevention of, family violence,
domestic violence, and dating violence, and to provide immediate shelter and supportive services
for victims of family violence, domestic violence, or dating violence, and their dependents. (42
U.S.C. § 10401 et seq.).
This announcement sets forth the application requirements, the application process, and other
administrative and fiscal requirements for grants in fiscal year (FY) 2011. The FVPSA was
reauthorized in December 2010 and therefore has been significantly reorganized with many new
legal requirements. Due to these changes, applicants should be aware that this funding
announcement has significantly changed from the ones in years past. Some, but not all of the
changes are highlighted below. A link to the legislation is at: http://www.gpo.gov/fdsys/pkg/PLAW111publ320/pdf/PLAW-111publ320.pdf.
Related FOA Change explanation
Section

FVPSA
Legislation

Section I.
Definitions

The classification of victims to be served was clarified to
include victims of domestic and dating violence.

42 U.S.C. §
10401

Section I.
Background

The classification of victims to be served was clarified to
include adult and youth victims.

42 U.S.C. §
10408(a)

Section I.
Background

The purpose of the grant was expanded to include
providing specialized services for children.

42 U.S.C. §
10406

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Related FOA Change explanation
Section

FVPSA
Legislation

Section I.
Definitions

The term supportive services replaced related assistance
and was more clearly defined.

Section I.
Definitions

New definitions have been added for personally identifying 42 U.S.C. §
information, shelter, tribally designated official, and
10402
underserved populations.

Section IV.
Content of
Application
Submission

A clearer emphasis on documenting the effectiveness of
the programming was added.

42 U.S.C. §
10409(a)

Attachment A

Clarifications were made to the confidentiality provisions
referencing non-disclosure of confidential or private
information.

42 U.S.C.
§§10406(b)(1)
and
10408(b)(2)

Section I.
Background

Clarification that no fees will be levied for assistance or
services provided with funds appropriated to carry out
the FVPSA.

42 U.S.C. §
10406(c)(3)

Section I.
Background

Clarification that receipt of supportive services under the
FVPSA will be voluntary. No condition can be applied
for the receipt of emergency shelter.

42 U.S.C. §
10408(d)(2)

Attachment A

A clarification on funding distribution was provided in that 42 U.S.C. §
70 percent of the funds shall be for providing immediate
10406(b)(1)
shelter and supportive services, while 25 percent shall be to
provide supportive services and not more than 5 percent of
the funds can be used for administrative costs.

Section I.
Background

A requirement for tribal consultation for this grant program 42 U.S.C §
was added.
10409(a)

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42 U.S.C. §
10402

I. Description
Legislative Authority
Fiscal year (FY) 2011 grant awards are authorized by the Family Violence Prevention and Services
Act (42 U.S.C. § 10401 et seq.).
Background
The purpose of these grants is to:
(1) prevent incidents of family violence, domestic violence, and dating violence;
(2) provide immediate shelter, supportive services, and access to community-based programs for
victims of family violence, domestic violence, or dating violence, and their dependents; and
(3) provide specialized services for children exposed to family violence, domestic violence, or
dating violence; underserved populations; and victims who are members of racial and ethnic
minority populations.
Tribes face unique circumstances and obstacles when responding to family 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 family violence. 42 U.S.C. §
10409 (a) states that the Department of Health and Human Services (HHS) will consult with tribal
governments regarding this grant and the issue of violence against women. In 2010, the
Administration for Children and Families (ACF) consulted with tribal governments on all of the
grant programs administered by ACF. In addition, representatives from the Division of Family
Violence Prevention within the Family and Youth Services Bureau (FYSB) in ACF attended the
Department of Justice Tribal Consultation on Violence Against Women Issues. Throughout FY
2011, ACF is scheduling multiple opportunities for consultation with tribal leaders.
During FY 2010, HHS awarded FVPSA grants to 137 Tribes or tribal organizations, 52 States and
Territories, and made 53 family violence 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 and other resource centers and culturally-specific institutes.
Definitions
Tribes and tribal organizations should use the following definitions in carrying out their programs.
The definitions are found in 42 U.S.C. § 10402 or as otherwise cited.
Data Universal Numbering System (DUNS) Number: The nine-digit number established and
assigned by Dun and Bradstreet, Inc. to uniquely identify business entities.
Dating Violence: Violence committed by a person who is or has been in a social relationship of a
romantic or intimate nature with the victim and where the existence of such a relationship shall be
determined based on a consideration of the length of the relationship, the type of relationship, and
the frequency of interaction between the persons involved in the relationship (42 U.S.C § 13925(a)).
Domestic Violence: Felony or misdemeanor crimes of violence committed by a current or former
spouse of the victim, by a person with whom the victim shares a child in common, by a person who

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is cohabitating with or has cohabitated with the victim as a spouse, by a person similarly situated to
a spouse of the victim under the domestic or family violence laws of the jurisdiction receiving grant
monies, or by any other person against an adult or youth victim who is protected from that person's
acts under the domestic or family violence laws of the jurisdiction (42 U.S.C. § 13925(a)).
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.
Indian Tribe: 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)).
Personally Identifying Information or Personal Information: Any individually identifying
information for or about an individual including information likely to disclose the location of a
victim of domestic violence, dating violence, sexual assault, or stalking, including: a first and last
name, a home or other physical address, contact information (including a postal, e-mail or Internet
protocol address, or telephone or facsimile number), a social security number and any other
information, including date of birth, racial or ethnic background, or religious affiliation, that, in
combination with any of the above identifiers would serve to identify any individual (42 U.S.C. §
13925(a)).
Shelter: The provision of temporary refuge and supportive services in compliance with applicable
State law and regulation governing the provision, on a regular basis, of shelter, safe homes, meals,
and supportive services to victims of family violence, domestic violence, or dating violence, and
their dependents.
Supportive Services: Services for adult and youth victims of family violence, domestic violence, or
dating violence, and dependents exposed to family violence, domestic violence, or dating violence,
that are designed to meet the needs of such victims of family violence, domestic violence, or dating
violence, and their dependents, for short-term, transitional, or long-term safety and provide
counseling, advocacy, or assistance for victims of family violence, domestic violence, or dating
violence, and their dependents. These services may include:
(1) assistance in developing safety plans, and supporting efforts of victims of family violence,
domestic violence, or dating violence to make decisions related to their ongoing safety and
well-being;
(2) provision of individual and group counseling, peer support groups, and referral to
community-based services to assist family violence, domestic violence, and dating violence
victims, and their dependents, in recovering from the effects of the violence;
(3) provision of services, training, technical assistance, and outreach to increase awareness of
family violence, domestic violence, and dating violence and increase the accessibility of
family violence, domestic violence, and dating violence services;

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(4) provision of culturally and linguistically appropriate services;
(5) provision of services for children exposed to family violence, domestic violence, or dating
violence, including age-appropriate counseling, supportive services, and services for the
nonabusing parent that support that parent’s role as a caregiver, which may, as appropriate,
include services that work with the nonabusing parent and child together;
(6) provision of advocacy, case management services, and information and referral services,
concerning issues related to family violence, domestic violence, or dating violence
intervention and prevention, including—
a. assistance in accessing related Federal and State financial assistance programs;
b. legal advocacy to assist victims and their dependents;
c. medical advocacy, including provision of referrals for appropriate health care
services (including mental health, alcohol, and drug abuse treatment), but which
shall not include reimbursement for any health care services;
d. assistance locating and securing safe and affordable permanent housing and
homelessness prevention services;
e. provision of transportation, child care, respite care, job training and employment
services, financial literacy services and education, financial planning, and related
economic empowerment services; and
(7) parenting and other educational services for victims and their dependents;
(8) prevention services, including outreach to underserved populations (42 U.S.C. §§
110402(12) and 10408(b)).
Tribal Consortium: 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 all of the Tribes involved is used to calculate the award amount. The allocations
for each of the Tribes included in the consortium is combined to determine the total grant for the
consortium.
Tribally Designated Official: An individual designated by an Indian Tribe, tribal organization,
or nonprofit private organization authorized by an Indian Tribe, to administer a grant under 42
U.S.C. § 10409).
Tribal Organization: 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)).
Underserved Populations: Populations underserved because of geographic location, underserved
racial and ethnic populations, populations underserved because of special needs (such as language
barriers, disabilities, alienage status, or age), and any other population determined to be underserved
by the Attorney General or by the Secretary of Health and Human Services, as appropriate (42
U.S.C. § 13925(a)).

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General Grant Program Requirements
Client Confidentiality
FVPSA programs must establish or implement policies and protocols for maintaining the safety and
confidentiality of the victims of family violence, domestic violence, and dating violence, and their
dependants served by the programs. It is essential that the confidentiality and privacy of individuals
receiving FVPSA services be protected. Confidential information in the possession of the grantee
shall be safeguarded by maintaining this information in locked locations not accessible to those
without a need to know and limiting access to only those staff with a need to know. Grantees may
not disclose any personally identifying information (see Section I. Definitions) collected in
connection with services requested (including services utilized or denied), through grantees’
programs (42 U.S.C. § 10406(c)(5)(B)(i)).
Grantees may not reveal personally identifying information without informed, written, reasonably
time-limited consent by the person for whom information is sought (42 U.S.C. § 10406(c)(5)(B)(ii).
Consent shall be given by the person, except as provided in the case of an unemancipated minor
where consent shall be given by the minor and the minor’s parent or guardian; or in the case of an
individual with a guardian where consent shall be given by the individual’s guardian (42 U.S.C. §
10406(c)(5)(B)(ii)(I)). In addition, consent may not be given by the abuser or suspected abuser of
the minor or individual with a guardian, or the abuser or suspected abuser of the other parent of the
minor guardian (42 U.S.C. § 10406(c)(5)(B)(ii)(II)). Informed consent should include informing
the client about the possible risks of releasing information to the third party in question. If
release of information is compelled by statutory or court mandate, grantees shall make
reasonable attempts to provide notice to victims affected by the release of the information and
take steps necessary to protect the privacy and safety of the persons affected by the release of the
information (42 U.S.C. § 10406(c)(5)(C). Additionally, all consents must be voluntary and
cannot be or appear to be a precondition for receiving services.
When providing statistical data on program activities and program services, no personally
identifying client-level data may be shared with a third party, including Tribes, tribal
organizations, the State, or other FVPSA grantees, regardless of encryption, hashing, or other data
security measures, without first obtaining a written, reasonably time-limited consent to release as
described in the Violence Against Women Act of 1994 (42 U.S.C. § 40002(b)(2)). 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 (42 U.S.C. § 10406
(c)(5)(H)).
Further, as part of its Performance Progress Report, FYSB requires only that grantees collect
unduplicated client data for each program. The count should be within a single program only.
FYSB acknowledges the count of individuals served may be duplicated across programs.
Grantees may share aggregate data and non-identifying demographic information.

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The Importance of Coordinated, Accessible Services
The impacts of family 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 family 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. In
tribal communities, these dynamics may be compounded by 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. These factors heighten the need for the
coordination of the services through an often limited delivery system. To help bring about a
more effective response to the problem of family violence, HHS urges Tribes and tribal
organizations receiving funds under this grant announcement to coordinate activities funded
under this grant with other resources for the prevention of family violence and related issues and
to consider joining a consortium of Tribes to coordinate service delivery where appropriate.
To serve victims most in need and to comply with Federal law, programs and activities funded in
whole or in part with FVPSA funds must not discriminate on the basis of age, disability, sex,
race, color, national origin, or religion (42 U.S.C. § 10406(c)(2)(A) & (B)).The HHS Office for
Civil Rights provides guidance to grantees in complying with these nondiscrimination
requirements. Moreover, in addition to being widely accessible, all assistance must be provided
on a voluntary basis; receipt of shelter or housing must not be conditioned on participation in
supportive services (42 U.S.C. § 10408(d)(2)).
Annual Tribal Grantee Meeting
At least one FVPSA grant administrator per Tribe or tribal organization should expect to attend the
annual FVPSA Tribal Grantee Meeting and plan for funds to be available to travel. Subsequent
correspondence will advise the Tribal FVPSA Administrators of the date, time, and location of the
grantee meeting.

II. Funds Available
Subject to the availability of Federal appropriations and as authorized by law, in FY 2011, HHS will
make available to Tribes and tribal organizations grant funds as described in this announcement. In
separate announcements, HHS will make available funds to: States to support local domestic
violence programs to provide immediate shelter and supportive services for adult and youth victims
of family violence, domestic violence, or dating violence (and their dependents); and State
Domestic Violence Coalitions to provide technical assistance and training, advocacy services, and
other activities.
Tribal Allocations
In computing tribal allocations, ACF will use the latest available population figures from the Census
Bureau. The latest Census population counts may be viewed at: www.census.gov. Where Census
Bureau data are unavailable, ACF will use figures from the Bureau of Indian Affairs’ (BIA’s)

8

Indian Population and Labor Force Report, which is available at:
http://www.bia.gov/WhatWeDo/Knowledge/Reports/index.htm. The funding formula for the
allocation of family violence funds is based upon the Tribe’s population. The formula has two
parts, the tribal population base allocation and a population category allocation.
The base allocations are determined by a Tribe’s population and a funds allocation schedule.
Tribes with populations between 1 and 50,000 people receive a $2,500 base allocation for the
first 1,500 people. For each additional 1,000 people above the 1,500 person minimum, a Tribe’s
base allocation is increased $1,000. Tribes with populations between 50,001 to 100,000 people
receive base allocations of $125,000 and Tribes with a population of 100,001 to 150,000 receive
a base allocation of $175,000.
Once the base allocations have been distributed to the Tribes that have applied for FVPSA funding,
the ratio of the tribal population category allocation to the total of all base allocations is then
considered in allocating the remainder of the funds. By establishing base amounts with distribution
of proportional amounts for larger Tribes, FYSB is balancing the need for basic services for all
Tribes with the greater demand for services among Tribes with larger populations. In FY 2010,
actual grant awards ranged from $26,232 to $2,295,289.
Tribes are encouraged to apply for FVPSA funding as a consortium (see Section I. Definitions).
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 project period under this program announcement is 24 months. 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 2011 funds
may be used for expenditures from October 1, 2010, through September 30, 2012. For example:
Award Year
(Federal Fiscal
Year (FY))
FY 2010

Project Period
(24 Months)

FY 2011

10/01/2010 –
9/30/2012

FY 2012

10/01/2011 –
9/30/2013

10/01/2009 –
9/30/2011

Application Requirements
&
Expenditure Periods
Regardless of the date the award is received, these
funds may be expended by the grantee for obligations
incurred since October 1, 2009. The funds may be
expended through September 30, 2011.
Regardless of the date the award is received, these
funds may be expended by the grantee for obligations
incurred since October 1, 2010. The funds may be
expended through September 30, 2012.
Regardless of the date the award is received, these
funds may be expended by the grantee for obligations
incurred since October 1, 2011. The funds may be
expended through September 30, 2013.

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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 re-allotment. FY 2011 grant funds that are made
available to Tribes and tribal organizations through re-allotment must be expended by the grantee
no later than September 30, 2012.

III. Eligibility
Tribes, tribal organizations and nonprofit private organizations authorized by a Tribe, as defined in
Section I of this Announcement, are eligible for funding under this program. . A Tribe has the
option to authorize a tribal organization or a nonprofit private organization to submit an application
and administer the grant funds awarded under this grant. Tribes may apply singularly or as a
consortium with other Tribes.
DUNS Number Requirement
All applicants for grants and cooperative agreements must have a DUNS number (Data
Universal Numbering System) at the time of application. A DUNS number is required whether
an applicant is submitting a paper application or using the Government-wide electronic portal:
http://www.Grants.gov. A DUNS number is 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. A DUNS number may be acquired at no cost online at:
http://www.dnb.com . To acquire a DUNS number by phone, which takes between 5 and 10
minutes, contact the D&B Government Customer Response Center:
U.S. and U.S Virgin Islands: 1-866-705-5711
Alaska and Puerto Rico: 1-800-234-3867 (Select Option 2, then Option 1)
Monday - Friday 7 a.m. to 8 p.m. CST.
Central Contractor Registration (CCR) Registration Requirement
Central Contractor Registration (CCR): The Federal registrant database and repository into which
an entity must provide information required for the conduct of business as a recipient. CCR,
managed by the General Services Administration, collects, validates, stores, and disseminates data
in support of agency financial assistance missions.
Effective October 1, 2010, HHS requires all grantees that plan to apply for and ultimately receive
Federal grant funds from any HHS Operating/Staff Division (OPDIV) or receive subawards directly
from recipients of those grant funds to:
•
Be registered in the CCR prior to submitting an application of plan;
•
Maintain an active CCR registration with current information at all times during which it has
an active award or an application or plan under consideration by an OPDIV;
•
Provide its DUNS number in each application or plan it submits to the OPDIV.
An award cannot be made until an applicant has complied with these requirements. At the time an
award is ready to be made, if the intended recipient has not complied with these requirements, the
OPDIV;
•
May determine that the applicant is not qualified to receive an award; and
•
May use that determination as a basis for making an award to another applicant.

10

Additionally, all first-tier subaward recipients (i.e., direct subrecipient) must have a DUNS number
at the time the subaward is made.
CCR registration may be made online at: https://www.bpn.gov/ccr or by phone at 1-877-252-2700.
Due to the possibility of heavy traffic at the CCR website, applicants are strongly encouraged to
register at the CCR well in advance of the application due date.

IV. Application Requirements
Content of Application Submission
The content of the application should include the following:
A. Cover Letter
The cover letter of the application should include the following information:
(1) The name of the Tribe, tribal organization, or nonprofit private organization applying for
the FVPSA grant and the mailing address.
(2) A brief summary of the services to be provided with these grant funds and a description
of how the funds are to be spent. For example, a half time Domestic Violence Advocate
and costs for transportation to shelter.
(3) The name of the Tribally Designated Official authorized to administer this grant, along
with the telephone number, fax number and e-mail address.
(4) The name of a Program Contact designated to administer coordination of the
programming, including the telephone number, fax number, and e-mail address.
(5) The Employee Identification Number (EIN) of the applicant organization submitting the
application.
(6) The D-U-N-S number of the applicant organization submitting the application (see
Section III. Eligibility).
(7) The signature of the Tribally Designated Official (see Section I. Definitions).
B. Involvement of Individuals and Organizations
A description of the procedures designed to involve knowledgeable individuals and
interested organizations in providing services under FVPSA (42 U.S.C. § 10409). 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 or Tribal Domestic Violence Coalitions,
and operators of domestic violence shelters and service programs.
C. Capacity
A description of the applicant’s operation of and/or capacity to carry out a FVPSA program.
This might be demonstrated in ways such as the following:
(1) The current operation of a shelter, safe house, or domestic and dating violence
prevention program;

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(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 other social services programs.
D. Services to be Provided
A description of the activities and services to be provided, including:
(1) How the grant funds will be used to provide shelter, supportive services, and prevention
services.
(2) How the services are designed to reduce family violence, domestic violence, and dating
violence.
(3) An explanation of how the program plans to evaluate the services to determine
effectiveness.
E. Involvement of Community-based Organizations
(1) A description of how the applicant will involve community-based organizations, whose
primary purpose is to provide culturally appropriate services to underserved populations.
(2) A description of how these community-based organizations can assist the Tribe in
addressing the unmet needs of such populations.
F. Current Signed Tribal Resolution
A copy of a current tribal resolution or an equivalent document that:
(1) Covers the entirety of FY 2011, including a date when the resolution or equivalent
document expires, which can be no more than 5 years.
(2) States that the Tribe or tribal organization has the authority to submit an application on
behalf of the individuals in the Tribe(s) and to administer programs and activities funded
pursuant to 42 U.S.C. § 10409.
NOTE: An applicant that received no funding in the immediately preceding fiscal year must
submit a new tribal resolution or its equivalent. An applicant funded as part of a consortium
in the immediately preceding year that is now seeking funds as a single Tribe must also
submit a new resolution or its equivalent. Likewise, an applicant funded as a single Tribe in
the immediately preceding fiscal year that is now seeking funding as a part of a consortium
must submit a new resolution or its equivalent.
G. Policies and Procedures
Written documentation of the policies and procedures developed and implemented,
including copies of the policies and procedures, to ensure that the safety and
confidentiality of clients and their dependants served is maintained. These documents
should include:
(1) The policies and/or procedures that ensure client confidentiality per Section I. of this
document
(2) The policies, procedures, and/or laws in place that assure compliance with the listed
assurances in Attachment A.
H. Assurances

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Each application must sign and include in the application as an attachment the assurances in
Attachment A.
I. Certifications
All applications must submit or comply with the required certifications found in
Attachments B, C, and D or online at: www.acf.hhs.gov/programs/ofs/forms.htm as follows:
(1) Anti-Lobbying Certification and Disclosure Form (See Attachment B): Applicants
should sign and return the certification with their application.
(2) Certification Regarding Environmental Tobacco Smoke (See Attachment C): By
signing and submitting the application, applicants are accepting and agreeing to all
terms and conditions of the certification.
(3) Certification Regarding Drug-Free Workplace Requirements (See Attachment D): By
signing and submitting the application, applicants are accepting and agreeing to all
terms and conditions of the certification.
Paperwork Reduction Act of 1995, Pub. L. 104-13
The public reporting burden for the project description is estimated to average 10 hours per
response, including the time for reviewing instructions, gathering and maintaining the data
needed, and reviewing the collection information. The Application Requirements and
Performance Progress Reports information collection is approved under OMB control number
0970-0280, which expires on December 31, 2011. 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.
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: Tribal Grant Team
1250 Maryland Avenue, SW., Suite 8217
Washington, DC 20024

V. Approval/ Disapproval of an Application
The Secretary of HHS shall approve any application that meets the requirements of FVPSA and this
announcement. The Secretary shall not disapprove an application unless the Secretary gives the
applicant reasonable notice of the Secretary’s intention to disapprove and a 6-month period
providing an opportunity for correction of any deficiencies. The Secretary shall give such notice

13

within 45 days after the date of submission of the application if any of the provisions of the
application have not been satisfied. If the Tribe does not correct the deficiencies in such application
within the 6-month period following the receipt of the Secretary’s notice, the Secretary shall
withhold payment of any grant funds to such Tribe until such date as the Tribe provides
documentation that the deficiencies have been corrected.

VI. Reporting Requirements
Performance Progress Reports
ACF grantees must submit a Performance Progress Report (PPR) using the standardized format
provided by FVPSA and approved by the Office of Management and Budget (0970-0280). This
report will describe the grant activities carried out during the year, report the number of people
served and contain an evaluation of the effectiveness of such activities (42 U.S.C. § 10406(d)).
Consortia grantees should compile the information into a comprehensive PPR for submission. A
copy of the PPR is available on the FYSB website at:
http://www.acf.hhs.gov/programs/fysb/content/forms/reportforms/fv/ACF_FYSB_FVPSA_Tribal_
SF_PPR_v1_0.pdf .
PPRs for Tribes and tribal organizations are due on an annual basis at the end of the calendar year
(December 30) and will cover from October 1 through September 30. PPRs 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: Tribal Grant Team
1250 Maryland Avenue, SW., Room 8217
Washington, DC 20024
Federal Financial Reports (FFR)
As of February 1, 2011, the Department of Health and Human Services (HHS) began the transition
from use of the SF-269, Financial Status Report (Short Form or Long Form) to the use of the SF425 Federal Financial Report for expenditure reporting. SF-269s will no longer be accepted for
expenditure reports due after that date. If an SF-269 is submitted, the Administration for Children
and Families (ACF) will return it and require the recipient to complete the SF-425. The transition
strategy is allowing individual HHS Operating Divisions (OPDIVs) to select--from a limited
number of options--the approach that best fits their programs and business process. This transition
does not affect completion or submission of the cash reporting to the HHS Division of Payment
Management's Payment Management System (PMS). The primary features of this transition for
recipients are that OPDIVs that previously required electronic submission of the SF-269 will receive
the SF-425 expenditure reports electronically and, until further notice, OPDIVs that have been
receiving expenditure reports in hard copy will continue to do so.
All expenditure reports will be due on one of the standard due dates by which cash reporting is
required to be submitted to PMS OR at the end of a calendar quarter as determined by the Operating

14

Division. As a result, a recipient that receives awards from more than one OPDIV may be subject to
more than one approach, but will not be required to change its current means of submission or be
subjected to more than eight standard due dates.
Beginning with budget periods which end from January 1 - March 31, 2011, and for all budget
periods thereafter, all affected ACF grantees will be required to submit an SF-425 report as
frequently as is required in the terms and conditions of their award using due dates for reports to
PMS.
For budget periods ending in
the months of:

The FFR (SF-425) is
due to ACF on:

October 01 through December
31

January 30

January 01 through March 31

April 30

April 01 through June 30

July 30

July 01 through September 30

October 30

Fillable versions of the SF-425 form in Adobe PDF and MS-Excel formats, along with instructions,
are available at: http://www.whitehouse.gov/omb/grants_forms, www.forms.gov, and on the ACF
Funding Opportunity website Forms page.
Final program performance and financial reports are due 90 days after the close of the project
period. Final reports may be mailed to:
Kalika France
Division of Mandatory Grants
Office of Grants Management
Administration for Children and Families
370 L’Enfant Promenade, SW., 6th Floor
Washington, DC 20447
(202) 401-5677
Kalika.France@acf.hhs.gov
Further instructions will be provided, as necessary, with award terms and conditions that will
address specific reporting periods and due dates on an award-by-award basis. Additional
information on frequency of reporting is available on the ACF Funding Opportunities web site at:
http://www.acf.hhs.gov/grants/msg_sf425.html.
Awards issued as a result of this funding opportunity may be subject to the Transparency Act
subaward and executive compensation reporting requirements of 2 C.F.R. Part 170. See ACF's
Award Term for Federal Financial Accountability and Transparency Act (FFATA) Subaward and

15

Executive Compensation Reporting Requirement implementing this requirement and additional
award applicability information.
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
Prohibition Against Profit
Grantees are subject to the limitations set forth in 45 C.F.R. Part 74, Subpart E-Special Provisions
for Awards to Commercial Organizations (45 C.F.R. §74.81 Prohibition against profit), which states
that, "...no HHS funds may be paid as profit to any recipient even if the recipient is a commercial
organization. Profit is any amount in excess of allowable direct and indirect costs."
http://edocket.access.gpo.gov/cfr_2009/octqtr/pdf/45cfr74AppE.pdf .
Equal Treatment for Faith-Based Organizations
Grantees are also subject to the requirements of 45 C.F.R. Part 87, Equal Treatment for Faith-Based
Organizations: "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 all program requirements, statutes,
and other applicable requirements governing the conduct of HHS funded activities." Additional
information on "Understanding the Regulations Related to the Faith-Based and Community
Initiative" can be found at: http://www.hhs.gov/fbci/regulations/index.html .
The Code of Federal Regulations (C.F.R.) is available at: http://www.gpoaccess.gov/cfr.
Award Term and Condition under the Trafficking Victims Protection Act of 2000
Awards issued under this announcement are subject to the requirements of Section 106 (g) of the
Trafficking Victims Protection Act of 2000, as amended (22 U.S.C. 7104). For the full text of the
award term, go to: http://www.acf.hhs.gov/grants/award_term.html. If you are unable to access this
link, please contact the Grants Management Contact identified in Section VI. Agency Contacts of
this announcement to obtain a copy of the Term.

16

VIII. Other Information
For Further Information Contact: Rebecca K. Odor at (202) 205-7746 or e-mail at:
Rebecca.Odor@acf.hhs.gov.

Attachments:
A. Assurances
B. Certification Regarding Lobbying
C. Certification Regarding Environmental Tobacco Smoke
D. Drug-Free Workplace Requirements

17

Attachment A
ASSURANCES OF COMPLIANCE WITH GRANT REQUIREMENTS
The grantee certifies that it will comply with the following assurances under 42 U.S.C. § 10401,
et. seq.:
(1) Family Violence Prevention and Services Act (FVPSA) grant funds will be used to provide
shelter, supportive services, or prevention services to adult and youth victims of family violence,
domestic violence, or dating violence, and their dependents. 42 U.S.C. § 10408(b)(1).
(2) Not less than 70 percent of the funds distributed shall be for the primary purpose of providing
immediate shelter and supportive services as defined in 42 U.S.C. § 10402(9) and (12) to adult
and youth victims of family violence, domestic violence, or dating violence as defined in 42
U.S.C. § 10402(2),(3), and (4), and their dependents. 42 U.S.C. § 10408(b)(2).
(3) Not less than 25 percent of the funds distributed shall be for the purpose of providing
supportive services and prevention services as described in 42 U.S.C. § 10408(b)(1)(B) through
(H), to victims of family violence, domestic violence, or dating violence, and their dependents.
42 U.S.C. § 10408(b)(2).
(4) Not more than 5 percent of the funds will be used for administrative costs. 42 U.S.C. §
10407(a)(2)(B)(i).
(5) Grant funds will not be used as direct payment to any victim of family violence, domestic
violence, or dating violence, or to any dependent of such victim. 42 U.S.C. § 10408(d)(1).
(6) No income eligibility standard will be imposed on individuals with respect to eligibility for
assistance or services supported with funds appropriated to carry out the FVPSA. 42 U.S.C.§
10406(c)(3).
(7) No fees will be levied for assistance or services provided with funds appropriated to carry out
the FVPSA. 42 U.S.C. § 10406(c)(3).
(8) The address or location of any shelter or facility assisted under the FVPSA that otherwise
maintains a confidential location will, except with written authorization of the person or persons
responsible for the operation of such shelter, not be made public. 42 U.S.C. § 10406(c)(5)(H).
(9) Procedures are established to ensure compliance with the provisions of 42 U.S.C. §
10406(c)(5) regarding non-disclosure of confidential of private information. 42 U.S.C. §
10407(a)(2)(A).
(10) Pursuant to 42 U.S.C. § 10406(c)(5), the FVPSA provisions regarding non-disclosure of
confidential or private information, the applicant will comply with requirements imposed by that
section which include, but are not limited to: (1) grantees shall not disclose any personally
identifying information collected in connection with services requested (including services

18

utilized or denied), through grantee’s funded activities or reveal personally identifying
information without informed, written, reasonably time-limited consent that satisfies the
requirements of 42 U.S.C. § 10406(c)(5)(B)(ii); (2) grantees releasing information compelled by
statutory or court mandate shall adhere to the requirements of 42 U.S.C. § 10406(c)(5)(C); (3)
grantees may share non-personally identifying information in the aggregate for the purposes
enunciated in 42 U.S.C. § 10406(c)(5)(D)(i); and (4) grantees may share personally identifying
information as provided in 42 U.S.C. § 10406(c)(5)(D)(ii) and (iii).
(11) Grant funds awarded to the Tribe under the FVPSA will be used in accordance with 42
U.S.C. § 10406(c)(2) that prohibits discrimination on the basis of age, disability, sex, race, color,
national origin, or religion.
(12) Funds made available under the FVPSA will be used to supplement and not supplant other
Federal, State, and local public funds expended to provide services and activities that promote
the objectives of the FVPSA. 42 U.S.C. § 10406(c)(6).
(13) Receipt of supportive services under the FVPSA will be voluntary. No condition will be
applied for the receipt of emergency shelter as described in 42 U.S.C. § 10408(b)(1)(A). 42
U.S.C. § 10408(d)(2).
(14) The Tribe has a law or procedure to bar an abuser from a shared household or a household
of the abused person, which may include eviction laws or procedures. 42 U.S.C. §
10407(a)(2)(H).
_________________________________
Tribally Designated Official

_________________________________
Tribe or Tribal Organization

_________________________________
Title

19

Attachment 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

20

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

21

Attachment C
CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE
The Pro-Children Act of 2001, 20 U.S.C. 7181 through 7184, imposes restrictions on
smoking in facilities where Federally-funded children’s services are provided. HHS
grants are subject to these requirements only if they meet the Act’s specified coverage.
The Act specifies that smoking is prohibited in any indoor facility (owned, leased, or
contracted for) used for the routine or regular provision of kindergarten, elementary, or
secondary education or library services to children under the age of 18. In addition,
smoking is prohibited in any indoor facility or portion of a facility (owned, leased, or
contracted for) used for the routine or regular provision of federally-funded health care,
day care, or early childhood development, including Head Start services to children under
the age of 18. The statutory prohibition also applies if such facilities are constructed,
operated, or maintained with Federal funds. The statute does not apply to children’s
services provided in private residences, facilities funded solely by Medicare or Medicaid
funds, portions of facilities used for inpatient drug or alcohol treatment, or facilities
where WIC coupons are redeemed. Failure to comply with the provisions of the law may
result in the imposition of a civil monetary penalty of up to $1,000 per violation and/or
the imposition of an administrative compliance order on the responsible entity.

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Attachment 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 STATEWIDE 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).

23

(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;

24

(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.

25