Form 1 Tribal FOA

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-2013-ACF-ACYF-FVPS-0561
Application Due Date: May 6, 2013

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)

Funding Opportunity Title:

Family Violence Prevention and Services/Grants for
Domestic Violence Shelters/Grants to Native
American Tribes (including Alaska Native Villages)
and Tribal Organizations

Announcement Type:

Mandatory

Funding Opportunity Number:

HHS-2013-ACF-ACYF-FVPS-0561

CFDA Number:

93.671

Due Date for Applications:

May 6, 2013

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: 1) assist
Tribes in efforts to increase public awareness about, and primary and secondary prevention
of, family violence, domestic violence, and dating violence; and 2) assist Tribes in efforts 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.).
I. FUNDING OPPORTUNITY DESCRIPTION
Statutory Authority
The statutory authority for this program is 42 U.S.C. § 10401, et, seq, hereinafter cited by
section number only.
Description
The Administration on Children, Youth and Families (ACYF) is committed to facilitating
healing and recovery and promoting the social and emotional well-being of victims,
children, youth, and families who have experienced domestic violence, maltreatment,
exposure to violence, and trauma. This FVPSA funding opportunity announcement,
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administered through ACYF’s Family and Youth Services Bureau (FYSB) is designed to
assist Tribes in their efforts to support the establishment, maintenance, and expansion of
programs and projects: 1) to prevent incidents of family violence, domestic violence, and
dating violence; 2) to 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) to 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
(section 10406 (a).
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.
The Department of Health and Human Services (HHS) consulted with Tribal governments
regarding this grant program and the issue of violence against women. In FY 2012, the
Administration for Children and Families (ACF) consulted with Tribal governments on all
of the grant programs administered by ACF. In addition, ACYF representatives consulted
during the Inter-Departmental Tribal Justice Safety and Wellness Consultation on FVPSA
issues.
During FY 2012, HHS awarded FVPSA grants to 141 Tribes or Tribal organizations in
support of 224 Tribes; 55 States and Territories; and 55 non-profit State Domestic Violence
Coalitions. In addition, HHS awarded FVPSA grants to one National Indian Resource
Center addressing Domestic Violence and Safety for Indian Women, and other national,
special issue and culturally specific resource centers, and the National Domestic Violence
Hotline.
Ensuring the Well-Being of Vulnerable Children and Families/Adults
ACYF is committed to facilitating healing and recovery and promoting the social and
emotional well-being of children, youth, and families/adults who have experienced
maltreatment, exposure to violence, and/or trauma. This funding opportunity
announcement and other spending this fiscal year are designed to ensure that effective
interventions are in place to build skills and capacities that contribute to the healthy,
positive, and productive functioning of families.
Children, youth, adults and families who have experienced maltreatment, exposure to
violence, and/or trauma are impacted along several domains, each of which must be
addressed in order to foster social and emotional well-being and promote healthy,
positive functioning:
Understanding Experiences: A fundamental aspect of the human experience is
the development of a world view through which one’s experiences are
understood. Whether that perspective is generally positive or negative impacts

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how experiences are interpreted and integrated. For example, one is more likely to
approach a challenge as a surmountable, temporary obstacle if his or her frame
includes a sense that “things will turn out alright.” On the contrary, negative
experiences can color how future experiences are understood. Ongoing exposure
to family violence might lead children, youth, and families/adults to believe that
relationships are generally hostile in nature and affect their ability to enter into
and stay engaged in safe and healthy relationships. Interventions should seek to
address how children, youth, adults and families frame what has happened to
them in the past and shape their beliefs about the future.
Developmental Tasks: People grow physically and psychosocially along a fairly
predictable course, encountering normal challenges and establishing competencies
as they pass from one developmental stage to another. However, adverse events
have a marked effect on the trajectory of normal social and emotional
development, delaying the growth of certain capacities, and, in many cases,
accelerating the maturation of others. Intervention strategies must be attuned to
the developmental impact of negative experiences and address related strengths
and deficits to ensure children, youth, adults and families develop along a healthy
trajectory.
Coping Strategies: The methods that children, youth, adults and families develop
to manage challenges both large and small are learned in childhood, honed in
adolescence, and practiced in adulthood. Those who have been presented with
healthy stressors and opportunities to overcome them with appropriate
encouragement and support are more likely to have an array of positive,
productive coping strategies available to them as they go through life. For
children, youth, adults and families who grow up in or currently live in unsafe,
unpredictable environments, the coping strategies that may have been protective
in that context may not be appropriate for safer, more regulated situations.
Interventions should help children, youth, adults and families transform
maladaptive coping methods into healthier, more productive strategies.
Protective Factors: A wealth of research has demonstrated that the presence of
certain contextual factors (e.g., supportive relatives, involvement in after-school
activities) and characteristics (e.g., self-esteem, relationship skills) can moderate
the impacts of past and future negative experiences. These protective factors are
fundamental to resilience; building them is integral to successful intervention with
children, youth, adults and families.
The skills and capacities in these areas support children, youth, adults and families as
challenges, risks, and opportunities arise. In particular, each domain impacts the capacity
of children, youth, adults and families to establish and maintain positive relationships
with caring adults and supportive peers. The necessity of these relationships to social and
emotional well-being and lifelong success in school, community, and at home cannot be
overstated and should be central to all interventions with vulnerable children, youth,
adults and families.

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An important component of promoting social and emotional well-being includes
addressing the impact of trauma, which can have a profound effect on the overall
functioning of children, youth, adults and families. ACYF promotes a trauma-informed
approach, which involves understanding and responding to the symptoms of chronic
interpersonal trauma and traumatic stress across the domains outlined above, as well as
the behavioral and mental health consistency of trauma.
ACYF anticipates a continued focus on social and emotional well-being as a critical
component of its overall mission to ensure positive outcomes for all children, youth,
adults and families. Tribal grantees have a critical role in incorporating ACYF priorities
by helping to ensure trauma-informed interventions are embedded within the service
provision framework of all services funded by FVPSA. Tribes and Tribal organizations
are strongly encouraged to leverage the expertise of the FVPSA-funded National
Indigenous Women’s Resource Center on Domestic Violence and the National Center on
Domestic Violence, Trauma and Mental Health to infuse programs with best and
promising practices on trauma-informed interventions to support the social and emotional
well-being of families seeking shelter and supportive services.
Use of Funds
Grantees should ensure that not less than 70 percent of the funds distributed are used for
the primary purpose of providing immediate shelter and supportive services to adult and
youth victims of family violence, domestic violence, or dating violence and their
dependents; not less than 25 percent of the funds will be used for the purpose of
providing supportive services and prevention services (section 10408(b)).
FVPSA funds awarded to grantees should be used for activities described in (section
10408(b)):
Shelter
Provision of immediate shelter and related supportive services to adult and youth
victims of family violence, domestic violence, or dating violence, and their
dependents, including paying for the operating and administrative expenses of the
facilities for such shelter.
Supportive Services
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.
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.
Provision of culturally and linguistically appropriate services.
Provision of services for children exposed to family violence, domestic violence, or
dating violence, including age-appropriate counseling, supportive services, and
services for the non-abusing parent that support that parent’s role as a caregiver,

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which may, as appropriate, include services that work with the non-abusing parent
and child together.
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: 1) assistance in accessing related
Federal and State financial assistance programs; 2) legal advocacy to assist victims
and their dependents; 3) 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; 4)
assistance locating and securing safe and affordable permanent housing and
homelessness prevention services; 5) transportation, child care, respite care, job
training and employment services, financial literacy services and education, financial
planning and related economic empowerment services; and 6) parenting and other
educational services for victims and their dependents.
Provision of prevention services, including outreach to underserved populations.
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.
Annual FVPSA Tribal Grantee Meeting
FVPSA Tribal grantees must plan to attend the annual grantee meeting and may use grant
funding to support the travel of up to two participants. The meeting is a training and
technical assistance activity focusing on FVPSA administrative issues as well as the
promotion of evidence informed and promising practices to address family violence,
domestic violence and dating violence. Subsequent correspondence will advise the FVPSA
Tribal grantees of the date, time and location of their grantee meeting.
Client Confidentiality
In order to ensure the safety of adult, youth, and child victims of family violence,
domestic violence, or dating violence, and their families, FVPSA-funded programs must
establish and implement policies and protocols for maintaining the confidentiality of
records pertaining to any individual provided domestic violence services. Consequently,
when providing statistical data on program activities and program services, individual
identifiers of client records will not be used (section 10406(c)(5)).
In the annual grantee Performance Progress Report (PPR), grantees must collect
unduplicated data from each program. No client level data should 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 10406(c)(5). The address or location
of any FVPSA-supported shelter facility shall, except with written authorization of the
person or persons responsible for the operation of such shelter, not be made public
(section 10406(c)(5)(H)) and the confidentiality of records pertaining to any individual
provided domestic violence services by any FVPSA-supported program will be strictly
maintained.

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Coordinated and 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, domestic violence, or dating
violence, HHS urges Tribes and Tribal organizations receiving funds under this grant
announcement to coordinate activities and related issues and to consider joining a
consortium of Tribes to coordinate service delivery where appropriate.
It is essential that community service providers are involved in the design and
improvement of intervention and prevention activities. Coordination and collaboration
among victim services providers; community-based, culturally specific, and faith-based
services providers; housing and homeless services providers; and Tribal, Federal, State,
and local public officials and agencies are needed to provide more responsive and
effective services to victims of family violence, domestic violence, and dating violence,
and their families.
To promote a more effective response to family violence, domestic violence, and dating
violence, HHS requires States receiving FVPSA funds to collaborate with State Domestic
Violence Coalitions, Tribes, Tribal organizations, service providers, and communitybased organizations to address the needs of family violence, domestic violence, and
dating violence victims, particularly for those who are members of racial and ethnic
minority populations and underserved populations (section 10407(a)(2)).
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, disability, sex, race, color,
national origin, or religion (section 10406(c)(2)). The HHS Office for Civil Rights
provides guidance to grantees in complying with civil rights laws that prohibit
discrimination on these bases. Please see
www.hhs.gov/ocr/civilrights/understanding/index.html. HHS also provides guidance to
recipients of federal financial assistance on meeting the legal obligation to take
reasonable steps to provide meaningful access to federally assisted programs by persons
with limited English proficiency. Please see
www.hhs.gov/ocr/civilrights/resources/laws/revisedlep.html. Additionally, HHS
provides guidance regarding access to HHS-funded services for immigrant survivors of
domestic violence. Please see
www.hhs.gov/ocr/civilrights/resources/specialtopics/origin/domesticviolencefactsheet.ht
ml.

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Services must also be provided on a voluntary basis; receipt of emergency shelter or
housing must not be conditioned on participation in supportive services (section
10408(d)).
Definitions
Tribes and Tribal organizations should use the following definitions in carrying out their
programs.
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.
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 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.
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.
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.
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,

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safe homes, meals, and supportive services to victims of family violence, domestic violence,
or dating violence, and their dependents.
State Domestic Violence Coalition: A statewide nonprofit private domestic violence service
organization that has a membership that includes a majority of the primary-purpose
domestic violence service providers in the State; has board membership representative of
primary purpose domestic violence service providers and the communities in which the
services are being provided in the State; has as its purpose to provide education, support, and
technical assistance to such service providers to enable the providers to establish and
maintain shelter and supportive services for victims of domestic violence and their
dependents; and serves as an information clearinghouse, primary point of contact, and
resource center on domestic violence for the State and supports the development of policies,
protocols and procedures to enhance domestic violence intervention and prevention in the
State.
Supportive Services: Services for adult and youth victims of family violence, domestic
violence, or dating violence, and their dependents. Such services are designed to meet the
needs of such victims 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.
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 are 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.
Tribal Organization: The recognized governing body of any Indian Tribe; any legally
established organization of Indians that 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 that 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.
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 HHS, as
appropriate.

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II. AWARD INFORMATION
Subject to the availability of Federal appropriations and as authorized by law, in FY
2013, ACYF will allocate 10 percent of the appropriation available under section
10403(a) to Tribes and Tribal organizations for the establishment and operation of
shelters, safe houses, and the provision of supportive services for victims of family
violence, domestic violence, or dating violence, and their dependents.
HHS will also 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; State Domestic
Violence Coalitions to provide technical assistance and training, advocacy services, among
other activities with local domestic violence programs; the national resource centers, special
issue resource centers and culturally specific resource centers; the National Domestic
Violence Hotline; and to support discretionary projects including training and technical
assistance, collaborative projects with advocacy organizations and service providers, data
collection efforts, public education activities, research, and other demonstration projects.
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) Indian Population and Labor Force Report, which is available at:
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 2012, actual grant awards ranged from $14,897- $1,675,967.
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.

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Length of Project Periods
FVPSA Tribal formula grant awards are for a 2-year period. The project period for this
award is from October 1, 2012-September 30, 2014.
Expenditure Period
The project period under this program announcement is 24 months. The FVPSA funds may
be used for expenditures starting 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 2013 funds may be used for expenditures from October 1, 2012, through September 30,
2014. For example:
Award Year
(Federal Fiscal
Year (FY))
FY 2013

Project Period
(24 Months)
10/01/2012 –
9/30/2014

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, 2012. The
funds may be expended through September 30,
2014.

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 2013 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, 2014.
III. ELIGIBILITY INFORMATION
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 (section
10409(b)). Tribes may apply singularly or as a consortium with other Tribes.
Additional Information on Eligibility
DUNS Number Requirement
Data Universal Numbering System (DUNS) Number is the nine-digit, or thirteendigit (DUNS + 4), number established and assigned by Dun and Bradstreet, Inc. (D&B)
to uniquely identify business entities.
All applicants and sub-recipients must have a DUNS number at the time of application in
order to be considered for a grant or cooperative agreement. A DUNS number is required
whether an applicant is submitting a paper application or using the Government-wide

11

electronic portal, 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://fedgov.dnb.com/webform. To acquire a DUNS
number by phone, 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
The process to request a DUNS Number by telephone will take between 5 and 10
minutes.
SAM Requirement (www.Sam.gov)
The System for Award Management (SAM) at www.sam.gov is a new system that
consolidates the capabilities of a number of systems that support Federal procurement
and award processes. Phase 1 of SAM includes the capabilities previously provided via
Central Contractor Registration (CCR)/Federal Agency Registration (FedReg), Online
Representations and Certifications Application (ORCA), and the Excluded Parties List
System (EPLS).
SAM is the Federal registrant database and repository into which an entity must provide
information required for the conduct of business as a recipient. The former CCR website
is no longer be available. All information previously held in the Central Contractor
Registration (CCR) system has been migrated to SAM.gov.
Applicants may register at www.sam.gov or by phone at 1-866-606-8220. Registration
assistance is available through the “Help” tab at www.sam.gov or by phone at 1-866-6068220.
Applicants are strongly encouraged to register at SAM well in advance of the
application due date. Registration at SAM.gov must be updated annually.
Note: It can take 24 hours or more for updates to registrations at SAM.gov to take effect.
An entity’s registration will become active after 3-5 days. Therefore, check for active
registration well before the application due date and deadline. An applicant can view
their registration status by visiting http://www.bpn.gov/CCRSearch/Search.aspx and
searching by their organization’s DUNS number.
See the SAM Quick Guide for Grantees at
https://www.sam.gov/sam/transcript/SAM_Quick_Guide_Grants_Registrations-v1.6.pdf.
HHS requires all entities that plan to apply for, and ultimately receive, Federal grant
funds from any HHS Agency, or receive subawards directly from recipients of those
grant funds to:
Be registered in at Sam.gov prior to submitting an application or plan;

12

Maintain an active registration at www.sam.gov with current information at all
times during which it has an active award or an application or plan under
consideration by an HHS agency; and
Provide its active DUNS number in each application or plan it submits to an
HHS agency.
ACF is prohibited from making an award to an applicant that has not complied with these
requirements. If, at the time an award is ready to be made, if the intended recipient has
not complied with these requirements, ACF:
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.
IV. APPLICATION AND SUBMISSION INFORMATION
Forms, Assurances, Certifications, and Policy
Applicants seeking financial assistance under this announcement must submit the listed
Standard Forms (SFs), assurances, certifications and policy. All required Standard
Forms, assurances, and certifications are available at ACF Funding Opportunities
Forms or at the Grants.gov Forms Repository unless specified otherwise.

Forms/Certifications
Certification
Regarding Lobbying

SF-LLL - Disclosure
of Lobbying
Activities

Survey on Ensuring
Equal Opportunity
for Applicants

Description
Required of all applicants at the time of
their application. If not available with
the application, it must be submitted
prior to the award of the grant.
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
applicant shall complete and submit the
SF-LLL, "Disclosure Form to Report
Lobbying," in accordance with its
instructions. Applicants must furnish an
executed copy of the Certification
Regarding Lobbying prior to award.
Non-profit private organizations (not
including private universities) are
encouraged to submit the survey with
their applications. Submission of the

Where Found
Available at www.acf.hhs.gov
/grants/grantsresources.html.

"Disclosure
Form to Report
Lobbying" is
available at
http://
www.acf.hhs.gov
/grants/grants_re
sources.html.

Available at
www.acf.hhs.gov
/grants/grantsres
ources.html.
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The needs of lesbian,
gay, bisexual,
transgender, and
questioning youth
are taken into
consideration in
applicants program
design.

survey is voluntary. Applicants
applying electronically may submit the
survey along with the application as
part of an appendix or as a separate
document. Hard copy submissions
should include the survey in a separate
envelope.
See Appendix B for submission
requirements.

See Appendix B
for the complete
policy
description.

Assurances and Policy
Each applicant must provide signed copy of both the assurance and policy. (See
Appendices A and B)
The Project Description
The content of the application should include the following in this order:
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) The name of the Tribally Designated Official authorized to administer this grant,
along with the telephone number, fax number, and e-mail address.
(3) The name of a Program Contact designated to administer coordination of the
programming, including the telephone number, fax number, and 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 Section III. Eligibility).
(6) The signature of the Tribally Designated Official (see Section I. Definitions).

B. Program and Project Description
(1) A description of the service area(s) and population(s) to be served.

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(2) A description of the services to be provided with FVPSA funds.
(3) A description of barriers that challenge the effectiveness of the operation of the
program and/or services provided to victims of domestic violence, family
violence and dating violence and their dependents.
(4) A description of the technical assistance needed to address the described
barriers.
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;
(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,
domestic violence, or dating violence 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 for victims of family violence, domestic violence, and dating
violence. Please note that for the purposes of this grant, domestic violence does
not include services targeted solely to address child abuse and neglect.
(2) How the services are designed to reduce family violence, domestic violence, and
dating violence.
(3) A plan describing how the organization will provide specialized services for
children exposed to family violence, domestic violence, or dating violence.
(4) An explanation of how the program plans to evaluate the services to determine
effectiveness.
(5) A description of how the funds are to be spent. For example, a half-time
Domestic Violence Advocate and costs for transportation to shelter.
E. Involvement of Individuals and Organizations
A description of the procedures designed to involve knowledgeable individuals and
interested organizations in providing services under FVPSA. For example, knowledgeable
individuals and interested organizations may include Tribal officials or social services staff
involved in family violence prevention, Tribal law enforcement officials, representatives of
State or Tribal Domestic Violence Coalitions, and operators of domestic violence shelters
and service programs.

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F. 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.
G. Current Signed Tribal Resolution
A copy of a current Tribal Resolution or an equivalent document that:
(1) Covers the entirety of FY 2013, 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.
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. In addition to 1 and 2 above, new
resolutions should state the Tribal service area and the primary services to be provided by
the Tribe or Tribal organization under this grant.
H. 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 dependents served is maintained as described in
Section I.
Paperwork Reduction Disclaimer
As required by the Paperwork Reduction Act, 44 U.S.C. §§ 3501-3520, 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 of information. The Project Description information
collection is approved under OMB control number 0970-0280, which expires November
30, 2014. 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.

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Intergovernmental Review of Federal Programs
The review and comment provisions of the Executive Order (E.O.) 12372 and Part 100 do
not apply. Federally recognized Tribes are exempt from all provisions and requirements of
E.O. 12372.
Funding Restrictions
The Consolidated Appropriations Act, 2012 (Pub.L. 112-74), enacted December 23,
2011, limited the salary amount that could be awarded and charged to ACF mandatory
and discretionary grants. Public Law 112-175 extended this salary limitation through
the earlier of March 27, 2013 or enactment of the relevant FY 2013 appropriations
statue(s). Accordingly, award funds issued under this announcement may not be used
to pay the salary, or any percentage of salary, to an individual at a rate in excess of
Executive Level II. The Executive Level II salary of the Federal Executive Pay scale is
$179,700 (www.opm.gov/oca/12tables/html/ex.asp). This amount reflects an
individual’s base salary exclusive of fringe benefits and any income that an individual
may be permitted to earn outside of the duties to the applicant organization. This salary
limitation also applies to subawards/subcontracts under an ACF mandatory and
discretionary grant.
Application Submission
Applications should be sent or delivered 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 R. Williams
1250 Maryland Avenue, S.W., Suite 8213
Washington, D.C. 20024
V. AWARD ADMINISTRATION INFORMATION
Administrative and National Policy Requirements
Awards issued under this announcement are subject to the uniform administrative
requirements and cost principles of 45 CFR § 74 (Uniform Administrative Requirements
for Awards and Subawards to Institutions of Higher Education, Hospitals, Other
Nonprofit Organizations, and Commercial Organizations) or 45 CFR§ 92 (Uniform
Administrative Requirements for Grants and Cooperative Agreements to State, Local,
and Tribal Governments). The Code of Federal Regulations (CFR) is available at
www.gpo.gov.
An application funded with the release of Federal funds through a grant award, does not
constitute, or imply, compliance with Federal regulations. Funded organizations are

17

responsible for ensuring that their activities comply with all applicable federal
regulations.
Equal Treatment for Faith-Based Organizations
Grantees are also subject to the requirements of 45 C.F.R. Part 87.1(c), Equal Treatment
for Faith-Based Organizations, which says, "Organizations that receive direct financial
assistance from the [Health and Human Services] Department under any Department
program may not engage in inherently religious activities such as religious instruction,
worship, or proselytization as part of the programs or services funded with direct
financial assistance from the Department." Therefore, organizations must take steps to
completely separate the presentation of any program with religious content from the
presentation of the Federally funded program by time or location in such a way that it is
clear that the two programs are separate and distinct. If separating the two programs by
time but presenting them in the same location, one program must completely end before
the other program begins.
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.
Regulations pertaining to the Equal Treatment for Faith-Based Organizations, which
includes the prohibition against Federal funding of inherently religious
activities, Understanding the Regulations Related to the Faith-Based and Neighborhood
Partnerships Initiative" are available
at http://www.hhs.gov/partnerships/about/regulations/. Additional information, resources,
and tools for faith-based organizations is available through The Center for Faith-based
and Neighborhood Partnerships website at
http://www.hhs.gov/partnerships/index.html and at the Administration for Children &
Families: Toolkit for Faith-based and Community Organizations.
Requirements for Drug-Free Workplace
The Drug-Free Workplace Act of 1988 (41 U.S.C. § 8102 et seq.) requires that all
organizations receiving grants from any Federal agency agree to maintain a drug-free
workplace. By signing the application, the Authorizing Official agrees that the grantee
will provide a drug-free workplace and will comply with the requirement to notify ACF if
an employee is convicted of violating a criminal drug statute. Failure to comply with

18

these requirements may be cause for debarment. Government wide requirements for
Drug-Free Workplace for Financial Assistance are found in 2 CFR part 182; HHS
implementing regulations are set forth in 2 CFR part 382.400. All recipients of ACF grant
funds must comply with the requirements in Subpart B - Requirements for Recipients
Other Than Individuals, 2 CFR part 382.225. The rule is available at
http://ecfr.gpoaccess.gov/cgi/t/text/textidx?c=ecfr;sid=18b5801410be6af416dc258873ffb7ec;rgn=div2;view=text;node=200911
12%3A1.1;idno=49;cc=ecfr.
Debarment and Suspension
HHS regulations published in 2 CFR part 376 implement the government-wide
debarment and suspension system guidance (2 CFR part 180) for HHS' non-procurement
programs and activities. "Non-procurement transactions" include, among other things,
grants, cooperative agreements, scholarships, fellowships, and loans. ACF implements
the HHS Debarment and Suspension regulations as a term and condition of award.
Grantees may decide the method and frequency by which this determination is made and
may check the Excluded Parties List System (EPLS) located at www.sam.gov, although
checking the EPLS is not required. More information is available at
www.acf.hhs.gov/grants/grants_resources.html.
Pro-Children Act
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.
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

19

Secretary shall give such notice 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
Performance Progress Reports (PPR)
ACF grantees must submit a PPR using the standardized format provided by FVPSA and
approved by OMB (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. Consortia grantees should compile the information into a
comprehensive PPR for submission. A copy of the PPR is available on the FYSB Website
at: www.acf.hhs.gov/programs/fysb/resource/ppr-tribal-fvpsa.
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.
Grantees should submit their reports online through the Online Data Collection (OLDC)
system at the following address: https://extranet.acf.hhs.gov/ssi with a copy 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 R. Williams
1250 Maryland Avenue, S.W., Room 8213
Washington, D.C. 20024
Phone: (202) 205-5932
Email: Shena.Williams@acf.hhs.gov
Federal Financial Reports (FFR)
Grantees must submit annual Financial Status Reports. The first SF-425A is due
December 30, 2012. The final SF-425A is due December 30, 2013. SF-425A can be
found at: www.whitehouse.gov/omb/grants/grants_forms.html, www.forms.gov.
Completed reports may be mailed to:
Deborah Bell
Division of Mandatory Grants
Office of Grants Management
Administration for Children and Families
370 L’Enfant Promenade, SW, 6th Floor
Washington, D.C. 20447

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Grantees have the option of submitting their reports online through the Online Data
Collection (OLDC) system at the following address: https://extranet.acf.hhs.gov/ssi.
Failure to submit reports on time may be a basis for withholding grant funds, or
suspension or termination of the grant. All funds reported as unobligated after the
obligation period will be recouped.
VII. FFATA Subaward and Executive Compensation
Awards issued as a result of this funding opportunity may be subject to the
Transparency Act subaward and executive compensation reporting requirements of 2
CFR § 170. See ACF's Award Term for Federal Financial Accountability and
Transparency Act (FFATA) Subaward and Executive Compensation Reporting
Requirement implementing this requirement and additional award applicability
information.
ACF has implemented the use of the SF-428 Tangible Property Report and the SF-429
Real Property Status Report for all grantees. Both standard forms are available
at www.whitehouse.gov/omb/grants_forms/.
VIII. AGENCY CONTACT
Program Office Contact
Shena R. Williams, Program Specialist at (202) 205-5932 or e-mail at
Shena.Williams@acf.hhs.gov
Grants Management Contact
Deborah Bell, Division of Mandatory Grants at (202) 401-4611 or email at
Deborah.Bell@acf.hhs.gov
IX. Appendices
A. Assurances of Compliance with Grant Requirements
B. LGBTQ (also known as “Two-Spirited”) Accessibility Policy

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Appendix A
ASSURANCES OF COMPLIANCE WITH GRANT REQUIREMENTS
The grantee certifies that it will comply with the following assurances under the Family
Violence Prevention and Services Act, 42 U.S.C. § 10401, et seq. (cited herein by the
applicable section number only):
(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 (section
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 section 10402(9) and
(12) to adult and youth victims of family violence, domestic violence or dating violence
as defined in section 10402(2), (3) and (4), and their dependents (section 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 section 10408(b)(1)(B)
through (H), to victims of family violence, domestic violence, or dating violence, and
their dependents (section 10408(b)(2)).
(4) 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 (section
10408(d)(1)).
(5) 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 (section 10406(c)(3)).
(6) No fees will be levied for assistance or services provided with funds appropriated to
carry out the FVPSA (section 10406(c)(3)).
(7) 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
(section 10406(c)(5)(H)).
(8) Procedures are established to ensure compliance with the provisions of section
10406(c)(5) regarding non-disclosure of confidential of private information (section
10407(a)(2)(A)).
(9) Pursuant to Section 10406(c)(5), comply with the new FVPSA provisions regarding
non-disclosure of confidential or private information. As such, the applicant will comply
with additional requirements imposed by that section which include but are not limited

22

to: (A) grantees shall not disclose any personally identifying information collected in
connection with services requested (including services utilized or denied), through
grantee’s funded activities or reveal personally identifying information without informed,
written, reasonably time-limited consent by the person about whom information is
sought, whether for the FVPSA funded activities or any other Federal or State program
(additional consent requirements have been omitted but see section 10406(c)(5)(B)(ii)(I)
for further requirements); (B) grantees may not release information compelled by
statutory or court order unless adhering to the requirements of section 10406(c)(5)(C);
(C) grantees may share non-personally identifying information in the aggregate for the
purposes enunciated in section 10406(c)(5)(D)(i) as well as for other purposes found in
section 10406(c)(5)(D)(ii) and (iii).
(10) As prescribed by section 10406(c)(2) of the FVPSA, the Tribe will use grant funds
in a manner which avoids prohibited discrimination on the basis of age, disability, sex,
race, color, national origin, or religion.
(11) 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 (section 10406(c)(6)).
(12) Receipt of supportive services under the FVPSA will be voluntary. No condition
will be applied for the receipt of emergency shelter (section 10408(d)(2)).
(13) 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 (section
10407(a)(2)(H)).

_________________________________
Tribally Designated Official
_________________________________
Tribe or Tribal Organization

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Appendix B
LGBTQ (also known as “Two-Spirited”) Accessibility Policy
As the Authorized Organizational Representative (AOR) signing this application on
behalf of
[Insert full, formal name of applicant organization]
I hereby attest and certify that:
The needs of lesbian, gay, bisexual, transgender, and questioning (also known as “TwoSpirited”) program participants are taken into consideration in applicant’s program
design. Applicant considered how its program will be inclusive of and non-stigmatizing
toward such participants. If not already in place, awardee and, if applicable, sub-awardees
must establish and publicize policies prohibiting harassment based on race, sexual
orientation, gender, gender identity (or expression), religion, and national origin. The
submission of an application for this funding opportunity constitutes an assurance that
applicants have or will put such policies in place within 12 months of the award.
Awardees should ensure that all staff members are trained to prevent and respond to
harassment or bullying in all forms during the award period. Programs should be
prepared to monitor claims, address them seriously, and document their corrective
action(s) so all participants are assured that programs are safe, inclusive, and nonstigmatizing by design and in operation. In addition, any sub-awardees or subcontractors:
Have in place or will put into place within 12 months of the award policies
prohibiting harassment based on race, sexual orientation, gender, gender identity
(or expression), religion, and national origin;
Will enforce these policies;
Will ensure that all staff will be trained during the award period on how to
prevent and respond to harassment or bullying in all forms, and;
Have or will have within 12 months of the award, a plan to monitor claims,
address them seriously, and document their corrective action(s).
Insert Date of Signature:
Print Name and Title of the AOR:
Signature of AOR:

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