Standard Forms

DISCLOSURE OF LOBBYING ACTIVITIES

Approved by OMB

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
0348-0046
(See reverse for public burden disclosure.)
1. Type of Federal Action:
2. Status of Federal Action:
3. Report Type:
a. contract
a. bid/offer/application
a. initial filing
b. grant
b. initial award
b. material change
c. cooperative agreement
c. post-award
For Material Change Only:
d. loan
year _________ quarter _________
e. loan guarantee
date of last report ______________
f. loan insurance
4. Name and Address of Reporting Entity:
5. If Reporting Entity in No. 4 is a Subawardee, Enter Name
Subawardee
and Address of Prime:
Prime
Tier ______, if known :

Congressional District, if known : 4c
6. Federal Department/Agency:

Congressional District, if known :
7. Federal Program Name/Description:

CFDA Number, if applicable : _____________
8. Federal Action Number, if known :

9. Award Amount, if known :
$

10. a. Name and Address of Lobbying Registrant
( if individual, last name, first name, MI ):

b. Individuals Performing Services (including address if
different from No. 10a )
( last name, first name, MI ):

requested through this form is authorized by title 31 U.S.C. section
11. Information
1352. This disclosure of lobbying activities is a material representation of fact

Signature:

upon which reliance was placed by the tier above when this transaction was made
or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This
information will be available for public inspection. Any person who fails to file the
required disclosure shall be subject to a civil penalty of not less than $10,000 and
not more than $100,000 for each such failure.

Print Name:
Title:
Telephone No.: _______________________ Date:

Federal Use Only:

PRINT

Authorized for Local Reproduction
Standard Form LLL (Rev. 7-97)

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal
action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make
payment to any lobbying entity for influencing or attempting to influence an officer or employeeof any agency, a Member of Congress, an officer or employee of
Congress, or an employeeof a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material
change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported, enter
the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal
action.
4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriateclassification
of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee,e.g., the first subawardee
of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, State and zip code of the prime Federal
recipient. Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizationallevel below agency name, if known. For
example, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance
(CFDA) number for grants, cooperative agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number;
Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number
assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan
commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting
entity identified in item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and
Middle Initial (MI).
11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB Control
Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is
estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington,
DC 20503.

OMB Number: 4040-0004

View Burden Statement

Expiration Date: 8/31/2016

Application for Federal Assistance SF-424
* 1. Type of Submission:

* 2. Type of Application:

Preapplication

New

Application

Continuation

Changed/Corrected Application

Revision

* 3. Date Received:

* If Revision, select appropriate letter(s):

* Other (Specify):

4. Applicant Identifier:

5a. Federal Entity Identifier:

5b. Federal Award Identifier:

State Use Only:
6. Date Received by State:

7. State Application Identifier:

8. APPLICANT INFORMATION:
* a. Legal Name:
* b. Employer/Taxpayer Identification Number (EIN/TIN):

* c. Organizational DUNS:

d. Address:
* Street1:
Street2:
* City:
County/Parish:

* State:
Province:
* Country:

USA: UNITED STATES

* Zip / Postal Code:
e. Organizational Unit:
Department Name:

Division Name:

f. Name and contact information of person to be contacted on matters involving this application:
Prefix:

* First Name:

Middle Name:
* Last Name:
Suffix:
Title:
Organizational Affiliation:

* Telephone Number:
* Email:

Fax Number:

Application for Federal Assistance SF-424
* 9. Type of Applicant 1: Select Applicant Type:

Type of Applicant 2: Select Applicant Type:

Type of Applicant 3: Select Applicant Type:

* Other (specify):

* 10. Name of Federal Agency:

11. Catalog of Federal Domestic Assistance Number:

CFDA Title:

* 12. Funding Opportunity Number:

* Title:

13. Competition Identification Number:

Title:

14. Areas Affected by Project (Cities, Counties, States, etc.):

Add Attachment

* 15. Descriptive Title of Applicant's Project:

Attach supporting documents as specified in agency instructions.

Add Attachments

Delete Attachments

View Attachments

Delete Attachment

View Attachment

Application for Federal Assistance SF-424
16. Congressional Districts Of:
* a. Applicant

* b. Program/Project

Attach an additional list of Program/Project Congressional Districts if needed.

Add Attachment

Delete Attachment

View Attachment

17. Proposed Project:
* a. Start Date:

* b. End Date:

18. Estimated Funding ($):
* a. Federal
* b. Applicant
* c. State
* d. Local
* e. Other
* f. Program Income
* g. TOTAL
* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?
.

a. This application was made available to the State under the Executive Order 12372 Process for review on
b. Program is subject to E.O. 12372 but has not been selected by the State for review.
c. Program is not covered by E.O. 12372.
* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.)

Yes

No

If "Yes", provide explanation and attach
Add Attachment

Delete Attachment

View Attachment

21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements
herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to
comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may
subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001)

** I AGREE
** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency

specific instructions.
Authorized Representative:
Prefix:

* First Name:

Middle Name:

* Last Name:
Suffix:

* Title:
* Telephone Number:

Fax Number:

* Email:
* Signature of Authorized Representative:

* Date Signed:

INSTRUCTIONS FOR THE SF-424
This is a standard form required for use as a cover sheet for submission of pre-applications and applications and related information under
discretionary programs. Some of the items are required and some are optional at the discretion of the applicant or the federal agency (agency).
Required fields on the form are identified with an asterisk (*) and are also specified as “Required” in the instructions below. In addition to these
instructions, applicants must consult agency instructions to determine other specific requirements.
Item
1.

2.

Entry:
Type of Submission: (Required) Select one type of
submission in accordance with agency instructions.
• Pre-application
• Application
• Changed/Corrected Application – Check if this submission
is to change or correct a previously submitted application.
Unless requested by the agency, applicants may not use this
form to submit changes after the closing date.
Type of Application: (Required) Select one type of application
in accordance with agency instructions.
• New – An application that is being submitted to an agency
for the first time.
• Continuation - An extension for an additional funding/budget
period for a project with a projected completion date. This
can include renewals.
• Revision - Any change in the federal government’s financial
obligation or contingent liability from an existing obligation. If
a revision, enter the appropriate letter(s). More than one may
be selected. If "Other" is selected, please specify in text box
provided.

3.

4.

5a.
5b.

6.
7.
8.

A. Increase Award
D. Decrease Duration
B. Decrease Award
E. Other (specify)
C. Increase Duration
Date Received: Leave this field blank. This date will be
assigned by the Federal agency.

Applicant Identifier: Enter the entity identifier assigned buy
the Federal agency, if any, or the applicant’s control number
if applicable.
Federal Entity Identifier: Enter the number assigned to your
organization by the federal agency, if any.
Federal Award Identifier: For new applications, enter NA.
For a continuation or revision to an existing award, enter the
previously assigned federal award identifier number. If a
changed/corrected application, enter the federal identifier in
accordance with agency instructions.
Date Received by State: Leave this field blank. This date will
be assigned by the state, if applicable.
State Application Identifier: Leave this field blank. This
identifier will be assigned by the state, if applicable.
Applicant Information: Enter the following in accordance with
agency instructions:

a. Legal Name: (Required) Enter the legal name of applicant
that will undertake the assistance activity. This is the
organization that has registered with the Central Contractor
Registry (CCR). Information on registering with CCR may be
obtained by visiting www.Grants.gov.
b. Employer/Taxpayer Number (EIN/TIN): (Required) Enter
the employer or taxpayer identification number (EIN or TIN)
as assigned by the Internal Revenue Service. If your
organization is not in the US, enter 44-4444444.

Item:
10.

Entry:
Name Of Federal Agency: (Required) Enter the name of the
federal agency from which assistance is being requested with
this application.

11.

Catalog Of Federal Domestic Assistance Number/Title:
Enter the Catalog of Federal Domestic Assistance number and
title of the program under which assistance is requested, as
found in the program announcement, if applicable.

12.

Funding Opportunity Number/Title: (Required) Enter the
Funding Opportunity Number (FON) and title of the opportunity
under which assistance is requested, as found in the program
announcement.

13.

Competition Identification Number/Title: Enter the competition
identification number and title of the competition under which
assistance is requested, if applicable.

14.

Areas Affected By Project: This data element is intended for
use only by programs for which the area(s) affected are likely
to be different than the place(s) of performance reported on the
SF-424 Project/Performance Site Location(s) Form. Add
attachment to enter additional areas, if needed.

15.

Descriptive Title of Applicant’s Project: (Required) Enter a brief
descriptive title of the project. If appropriate, attach a map
showing project location (e.g., construction or real property
projects). For pre-applications, attach a summary description
of the project.

16.

Congressional Districts Of: 16a. (Required) Enter the
applicant’s congressional district. 16b. Enter all district(s)
affected by the program or project. Enter in the format: 2
characters state abbreviation – 3 characters district number,
e.g., CA-005 for California 5th district, CA-012 for California 12
district, NC-103 for North Carolina’s 103 district. If all
congressional districts in a state are affected, enter “all” for the
district number, e.g., MD-all for all congressional districts in
Maryland. If nationwide, i.e. all districts within all states are
affected, enter US-all. If the program/project is outside the US,
enter 00-000. This optional data element is intended for use
only by programs for which the area(s) affected are likely to be
different than place(s) of performance reported on the SF-424
Project/Performance Site Location(s) Form. Attach an
additional list of program/project congressional districts, if
needed.
Proposed Project Start and End Dates: (Required) Enter the
proposed start date and end date of the project.

17.

18.

Estimated Funding: (Required) Enter the amount requested, or
to be contributed during the first funding/budget period by each
contributor. Value of in-kind contributions should be included
on appropriate lines, as applicable. If the action will result in a
dollar change to an existing award, indicate only the amount of
the change. For decreases, enclose the amounts in
parentheses.

9.

c. Organizational DUNS: (Required) Enter the organization’s
DUNS or DUNS+4 number received from Dun and
Bradstreet. Information on obtaining a DUNS number may be
obtained by visiting www.Grants.gov.

19.

d. Address: Enter address: Street 1 (Required); city
(Required); County/Parish, State (Required if country is US),
Province, Country (Required), 9-digit zip/postal code
(Required if country US).

20.

e. Organizational Unit: Enter the name of the primary
organizational unit, department or division that will undertake
the assistance activity.

21.

f. Name and contact information of person to be contacted on
matters involving this application: Enter the first and last name
(Required); prefix, middle name, suffix, title. Enter
organizational affiliation if affiliated with an organization other
than that in 7.a. Telephone number and email (Required);
fax number.
Type of Applicant: (Required) Select up to three applicant
type(s) in accordance with agency instructions.
A. State Government
M. Nonprofit
B. County Government
N. Private Institution of
C. City or Township
Higher Education
O. Individual
Government
D. Special District
P. For-Profit
Government
Organization (Other
E. Regional Organization
than Small Business)
F. U.S. Territory or
Q. Small Business
R. Hispanic-serving
Possession
G. Independent School
Institution
S. Historically Black
District
H. Public/State
Colleges and
Controlled Institution of
Universities (HBCUs)
T. Tribally Controlled
Higher Education
I.
Indian/Native
Colleges and
American Tribal
Universities (TCCUs)
U. Alaska Native and
Government (Federally
Recognized)
Native Hawaiian
J. Indian/Native
Serving Institutions
V. Non-US Entity
American Tribal
W. Other (specify)
Government (Other
than Federally
Recognized)
K. Indian/Native
American Tribally
Designated
Organization
L. Public/Indian Housing
Authority

Is Application Subject to Review by State Under Executive
Order 12372 Process? (Required) Applicants should contact the
State Single Point of Contact (SPOC) for Federal Executive
Order 12372 to determine whether the application is subject to
the State intergovernmental review process. Select the
appropriate box. If “a.” is selected, enter the date the
application was submitted to the State.
Is the Applicant Delinquent on any Federal Debt?
(Required) Select the appropriate box. This question applies to
the applicant organization, not the person who signs as the
authorized representative. Categories of federal debt include;
but, may not be limited to: delinquent audit disallowances,
loans and taxes. If yes, include an explanation in an
attachment.
Authorized Representative: To be signed and dated by the
authorized representative of the applicant organization. Enter
the first and last name (Required); prefix, middle name, suffix.
Enter title, telephone number, email (Required); and fax
number. A copy of the governing body’s authorization for you
to sign this application as the official representative must be on
file in the applicant’s office. (Certain federal agencies may
require that this authorization be submitted as part of the
application.)

[U.S Department of Education note: As of spring, 2010, the FON discussed in Block 12 of the instructions can be found via the
following URL: http://www.grants.gov/applicants/find_grant_opportunities.jsp.]

U.S. Department of Education
Supplemental Information for the SF-424
1. Project Director:
Prefix:

* First Name:

Middle Name:

* Last Name:

Suffix:

Address:
* Street1:
Street2:
* City:
County:
* State:

* Zip Code:

* Phone Number (give area code):

Country:
Fax Number (give area code):

* Email Address:

2. Novice Applicant:
Are you are a novice applicant as defined in the regulations in 34 CFR 75.225 (and included in the
definitions page in the attached instructions)?
Yes

No

3. Human Subjects Research:
a. Are any research activities involving human subjects planned at any time during the
proposed Project Period?
Yes

No

b. Are ALL the research activities proposed designated to be exempt from the regulations?
Yes

Provide Exemption(s) # (s):  1  2  3  4  5  6

No

Provide Assurance #(s), if available:

c. If applicable, please attach your “Exempt Research” or “Nonexempt Research” narrative to this form
as indicated in the definitions page in the attached instructions.
OMB Number: 1894-0007
Expiration Date: 8/31/2017

Instructions for U.S. Department of Education
Supplemental Information for the SF-424
1. Project Director. Name, address, telephone and fax numbers, and e-mail address of the person to be contacted on matters involving this
application. Items marked with an asterisk (*) are mandatory.
2. Novice Applicant. Check “Yes” if you meet the definition for novice applicants specified in the regulations in 34 CFR 75.225 and included
on the attached page entitled “Definitions for U.S. Department of Education Supplemental Information for the SF-424”). By checking “Yes”
the applicant certifies that it meets these novice applicant requirements. Check “No” if you do not meet the definition for novice applicants.
This novice applicant information will be used by ED to: 1) determine the amount and type of technical assistance that a novice might need, if
funded, and 2) determine novice applicant eligibility in discretionary grant competitions that give special consideration to novice applications.
Certain ED discretionary grant programs give special consideration to novice applications, either by establishing a special competition for
novice applicants or by giving competitive preference to novice applicants under the procedures in 34 CFR 75.105(c)(2). If special
consideration is being given to novice applications under a particular discretionary grant competition, the application notice for the competition
published in the Federal Register will specify this information
3. Human Subjects Research. (See I. A. “Definitions” in attached page entitled “Definitions for U.S. Department of Education Supplemental
Information for the SF-424.”)
3a. If Not Human Subjects Research. Check “No” if research activities involving human subjects are not planned at any time during the
proposed project period. The remaining parts of Item 3 are then not applicable.
3a. If Human Subjects Research. Check “Yes” if research activities involving human subjects are planned at any time during the proposed
project period, either at the applicant organization or at any other performance site or collaborating institution. Check “Yes” even if the
research is exempt from the regulations for the protection of human subjects. (See I. B. “Exemptions” in attached page entitled “Definitions for
U.S. Department of Education Supplemental Information for SF-424.”)
3b. If Human Subjects Research is Exempt from the Human Subjects Regulations. Check “Yes” if all the research activities proposed are
designated to be exempt from the regulations. Check the exemption number(s) corresponding to one or more of the six exemption categories
listed in I. B. “Exemptions.” In addition, follow the instructions in II. A. “Exempt Research Narrative” in the attached page entitled
“Definitions for U.S. Department of Education Supplemental Information for the SF-424.”
3b. If Human Subjects Research is Not Exempt from Human Subjects Regulations. Check “No” if some or all of the planned research
activities are covered (not exempt). In addition, follow the instructions in II. B. “Nonexempt Research Narrative” in the attached page entitled
“Definitions for U.S. Department of Education Supplemental Information for the SF-424.”
3b. Human Subjects Assurance Number. If the applicant has an approved Federal Wide Assurance (FWA) on file with the Office for
Human Research Protections (OHRP), U.S. Department of Health and Human Services, that covers the specific activity, insert the number in
the space provided. (A list of current FWAs is available at: http://ohrp.cit.nih.gov/search/search.aspx?styp=bsc) If the applicant does not
have an approved assurance on file with OHRP, enter “None.” In this case, the applicant, by signature on the SF-424, is declaring that it will
comply with 34 CFR 97 and proceed to obtain the human subjects assurance upon request by the designated ED official. If the application is
recommended/selected for funding, the designated ED official will request that the applicant obtain the assurance within 30 days after the
specific formal request.
3c. If applicable, please attach your “Exempt Research” or “Nonexempt Research” narrative to your submission of the U.S Department of
Education Supplemental Information for the SF-424 form as instructed in item II, “Instructions for Exempt and Nonexempt Human Subjects
Research Narratives” in the attached page entitled “Definitions for U.S. Department of Education Supplemental Information for the SF-424.”
Note about Institutional Review Board Approval. ED does not require certification of Institutional Review Board approval with the
application. However, if an application that involves non-exempt human subjects research is recommended/selected for funding, the designated
ED official will request that the applicant obtain and send the certification to ED within 30 days after the formal request.
No covered human subjects research can be conducted until the study has ED clearance for protection of human
subjects in research.
Public Burden Statement:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection
displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 20 minutes per
response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. The obligation to respond to this collection is required to obtain or retain benefit (20 USC 3474
General Education Provisions Act). Send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20210-4537 or
email ICDocketMgr@ed.gov and reference the OMB Control Number 1894-0007. Note: Please do not return the completed ED SF 424
Supplemental Form to this address.

Definitions for U.S. Department of Education
Supplemental Information for the SF-424
Definitions:

—Human Subject

Novice Applicant (See 34 CFR 75.225)

The regulations define human subject as “a living individual
about whom an investigator (whether professional or student)
conducting research obtains (1) data through intervention or
interaction with the individual, or (2) identifiable private
information.” (1) If an activity involves obtaining information
about a living person by manipulating that person or that
person’s environment, as might occur when a new instructional
technique is tested, or by communicating or interacting with the
individual, as occurs with surveys and interviews, the definition
of human subject is met. (2) If an activity involves obtaining
private information about a living person in such a way that the
information can be directly or indirectly linked to that
individual), the definition of human subject is met [Private
information includes information about behavior that occurs in a
context in which an individual can reasonably expect that no
observation or recording is taking place, and information which
has been provided for specific purposes by an individual and
which the individual can reasonably expect will not be made
public (for example, a school health record).]

For discretionary grant programs, novice applicant means any
applicant for a grant from ED that—
•

Has never received a grant or subgrant under the
program from which it seeks funding;

•

Has never been a member of a group application,
submitted in accordance with 34 CFR 75.127-75.129,
that received a grant under the program from which it
seeks funding; and

•

Has not had an active discretionary grant from the
Federal government in the five years before the
deadline date for applications under the program. For
the purposes of this requirement, a grant is active until
the end of the grant’s project or funding period,
including any extensions of those periods that extend
the grantee’s authority to obligate funds.

B. Exemptions.
In the case of a group application submitted in accordance with
34 CFR 75.127-75.129, a group includes only parties that meet
the requirements listed above.

PROTECTION OF HUMAN SUBJECTS IN RESEARCH
I. Definitions and Exemptions
A. Definitions.
A research activity involves human subjects if the activity is
research, as defined in the Department’s regulations, and the
research activity will involve use of human subjects, as defined
in the regulations.
—Research
The ED Regulations for the Protection of Human Subjects, Title
34, Code of Federal Regulations, Part 97, define research as “a
systematic investigation, including research development,
testing and evaluation, designed to develop or contribute to
generalizable knowledge. Activities which meet this definition
constitute research whether or not they are conducted or
supported under a program that is considered research for other
purposes. For example, some demonstration and service
programs may include research activities.

Research activities in which the only involvement of human
subjects will be in one or more of the following six categories of
exemptions are not covered by the regulations:
(1) Research conducted in established or commonly accepted
educational settings, involving normal educational practices,
such as (a) research on regular and special education
instructional strategies, or (b) research on the effectiveness of or
the comparison among instructional techniques, curricula, or
classroom management methods. If an educational practice is
being introduced to the site and is not widely used for similar
populations, it is not covered by this exemption.
(2) Research involving the use of educational tests (cognitive,
diagnostic, aptitude, achievement), survey procedures, interview
procedures or observation of public behavior, unless: (a)
information obtained is recorded in such a manner that human
subjects can be identified, directly or through identifiers linked
to the subjects; and (b) any disclosure of the human subjects’
responses outside the research could reasonably place the
subjects at risk of criminal or civil liability or be damaging to
the subjects’ financial standing, employability, or reputation. If
the subjects are children, exemption 2 applies only to research
involving educational tests and observations of public behavior
when the investigator(s) do not participate in the activities
being observed.
Exemption 2 does not apply if children are surveyed or
interviewed or if the research involves observation of public
behavior and the investigator(s) participate in the activities
being observed. [Children are defined as persons who have not
attained the legal age for consent to treatments or procedures

involved in the research, under the applicable law or jurisdiction
in which the research will be conducted.]
(3) Research involving the use of educational tests (cognitive,
diagnostic, aptitude, achievement), survey procedures, interview
procedures or observation of public behavior that is not exempt
under section (2) above, if the human subjects are elected or
appointed public officials or candidates for public office; or
federal statute(s) require(s) without exception that the
confidentiality of the personally identifiable information will be
maintained throughout the research and thereafter.
(4) Research involving the collection or study of existing data,
documents, records, pathological specimens, or diagnostic
specimens, if these sources are publicly available or if the
information is recorded by the investigator in a manner that
subjects cannot be identified, directly or through identifiers
linked to the subjects. [This exemption applies only to
retrospective studies using data collected before the initiation
of the research.]

(5) Research and demonstration projects which are conducted
by or subject to the approval of department or agency heads, and
which are designed to study, evaluate, or otherwise examine:
(a) public benefit or service programs; (b) procedures for
obtaining benefits or services under those programs; (c) possible
changes in or alternatives to those programs or procedures; or
(d) possible changes in methods or levels of payment for
benefits or services under those programs. [The standards of
this exemption are rarely met because it was designed to apply
only to specific research conducted by the Social Security
Administration and some Federal welfare benefits programs.]

(6) Taste and food quality evaluation and consumer acceptance
studies, (a) if wholesome foods without additives are consumed
or (b) if a food is consumed that contains a food ingredient at or
below the level and for a use found to be safe, or agricultural
chemical or environmental contaminant at or below the level
found to be safe, by the Food and Drug Administration or
approved by the Environmental Protection Agency or the Food
Safety and Inspection Service of the U.S. Department of
Agriculture.
II. Instructions for Exempt and Nonexempt Human
Subjects Research Narratives
If the applicant marked “Yes” for Item 3.b. of the U.S.
Department of Education Supplemental Information for the SF
424, the applicant must attach a human subjects “exempt
research” or “nonexempt research” narrative to the U.S.
Department of Education Supplemental Information for the SF424 form. If you have multiple projects and need to provide
more than one narrative, be sure to label each set of responses as
to the project they address.

A. Exempt Research Narrative.

If you marked “Yes” for item 3.b. and designated exemption
numbers(s), attach the “exempt research” narrative to the U.S.
Department of Education Supplemental Information for the SF424. The narrative must contain sufficient information about the
involvement of human subjects in the proposed research to
allow a determination by ED that the designated exemption(s)
are appropriate. The narrative must be succinct.
B. Nonexempt Research Narrative.
If you marked “No” for item 3.b. you must attach the
“nonexempt research” narrative to the U.S. Department of
Education Supplemental Information for the SF-424. The
narrative must address the following seven points. Although no
specific page limitation applies to this section of the application,
be succinct.
(1) Human Subjects Involvement and Characteristics:
Provide a detailed description of the proposed involvement of
human subjects. Describe the characteristics of the subject
population, including their anticipated number, age range, and
health status. Identify the criteria for inclusion or exclusion of
any subpopulation. Explain the rationale for the involvement of
special classes of subjects, such as children, children with
disabilities, adults with disabilities, persons with mental
disabilities, pregnant women, prisoners, institutionalized
individuals, or others who are likely to be vulnerable
(2) Sources of Materials: Identify the sources of research
material obtained from individually identifiable living human
subjects in the form of specimens, records, or data. Indicate
whether the material or data will be obtained specifically for
research purposes or whether use will be made of existing
specimens, records, or data.
(3) Recruitment and Informed Consent: Describe plans for
the recruitment of subjects and the consent procedures to be
followed. Include the circumstances under which consent will
be sought and obtained, who will seek it, the nature of the
information to be provided to prospective subjects, and the
method of documenting consent. State if the Institutional
Review Board (IRB) has authorized a modification or waiver of
the elements of consent or the requirement for documentation of
consent.
(4) Potential Risks: Describe potential risks (physical,
psychological, social, legal, or other) and assess their likelihood
and seriousness. Where appropriate, describe alternative
treatments and procedures that might be advantageous to the
subjects.
(5) Protection Against Risk: Describe the procedures for
protecting against or minimizing potential risks, including risks
to confidentiality, and assess their likely effectiveness. Where
appropriate, discuss provisions for ensuring necessary medical
or professional intervention in the event of adverse effects to the
subjects. Also, where appropriate, describe the provisions for
monitoring the data collected to ensure the safety of the
subjects.
(6) Importance of the Knowledge to be Gained: Discuss the
importance of the knowledge gained or to be gained as a result

of the proposed research. Discuss why the risks to subjects are
reasonable in relation to the anticipated benefits to subjects and
in relation to the importance of the knowledge that may
reasonably be expected to result.
(7) Collaborating Site(s): If research involving human subjects
will take place at collaborating site(s) or other performance
site(s), name the sites and briefly describe their involvement or
role in the research.
Copies of the Department of Education’s Regulations for the
Protection of Human Subjects, 34 CFR Part 97 and other

pertinent materials on the protection of human subjects in
research are available from the Office of the Chief Financial
Officer, U.S. Department of Education, Washington, D.C.
20202-4331, telephone: (202) 245-8090, and on the U.S.
Department of Education’s Protection of Human Subjects in
Research Web Site:
http://www.ed.gov/about/offices/list/ocfo/humansub.html
NOTE: The State Applicant Identifier on the SF-424 is for
State Use only. Please complete it on the SF-424 in the upper
right corner of the form (if applicable).

OMB Control No. 1894-0005 (Exp. 03/31/2017)

NOTICE TO ALL APPLICANTS
The purpose of this enclosure is to inform you about
a new provision in the Department of Education's
General Education Provisions Act (GEPA) that
applies to applicants for new grant awards under
Department programs. This provision is Section 427
of GEPA, enacted as part of the Improving America's
Schools Act of 1994 (Public Law (P.L.) 103-382).
To Whom Does This Provision Apply?
Section 427 of GEPA affects applicants for new grant
awards under this program. ALL APPLICANTS
FOR NEW AWARDS MUST INCLUDE
INFORMATION IN THEIR APPLICATIONS
TO ADDRESS THIS NEW PROVISION IN
ORDER TO RECEIVE FUNDING UNDER THIS
PROGRAM.
(If this program is a State-formula grant program, a
State needs to provide this description only for
projects or activities that it carries out with funds
reserved for State-level uses. In addition, local
school districts or other eligible applicants that apply
to the State for funding need to provide this
description in their applications to the State for
funding. The State would be responsible for ensuring
that the school district or other local entity has
submitted a sufficient section 427 statement as
described below.)
What Does This Provision Require?
Section 427 requires each applicant for funds (other
than an individual person) to include in its
application a description of the steps the applicant
proposes to take to ensure equitable access to, and
participation in, its Federally-assisted program for
students, teachers, and other program beneficiaries
with special needs. This provision allows applicants
discretion in developing the required description.
The statute highlights six types of barriers that can
impede equitable access or participation: gender,
race, national origin, color, disability, or age. Based
on local circumstances, you should determine
whether these or other barriers may prevent your
students, teachers, etc. from such access or
participation in, the Federally-funded project or
activity. The description in your application of steps
to be taken to overcome these barriers need not be
lengthy; you may provide a clear and succinct
description of how you plan to address those barriers
that are applicable to your circumstances.
In
addition, the information may be provided in a single

narrative, or, if appropriate, may be discussed in
connection with related topics in the application.
Section 427 is not intended to duplicate the
requirements of civil rights statutes, but rather to
ensure that, in designing their projects, applicants for
Federal funds address equity concerns that may affect
the ability of certain potential beneficiaries to fully
participate in the project and to achieve to high
standards. Consistent with program requirements and
its approved application, an applicant may use the
Federal funds awarded to it to eliminate barriers it
identifies.
What are Examples of How an Applicant Might
Satisfy the Requirement of This Provision?
The following examples may help illustrate how an
applicant may comply with Section 427.
(1) An applicant that proposes to carry out an
adult literacy project serving, among others,
adults with limited English proficiency, might
describe in its application how it intends to
distribute a brochure about the proposed project
to such potential participants in their native
language.
(2) An applicant that proposes to develop
instructional materials for classroom use might
describe how it will make the materials available
on audio tape or in braille for students who are
blind.
(3) An applicant that proposes to carry out a
model science program for secondary students
and is concerned that girls may be less likely
than boys to enroll in the course, might indicate
how it intends to conduct "outreach" efforts to
girls, to encourage their enrollment.
(4) An applicant that proposes a project to
increase school safety might describe the special
efforts it will take to address concern of lesbian,
gay, bisexual, and transgender students, and
efforts to reach out to and involve the families of
LGBT students
We recognize that many applicants may already be
implementing effective steps to ensure equity of
access and participation in their grant programs, and
we appreciate your cooperation in responding to the
requirements of this provision.

Estimated Burden Statement for GEPA Requirements
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless such collection displays a valid OMB control number.
Public reporting burden for this
collection of information is estimated to average 1.5 hours per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. The obligation to respond to this collection is required to obtain or
retain benefit (Public Law 103-382. Send comments regarding the burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to the U.S. Department of Education,
400 Maryland Ave., SW, Washington, DC 20210-4537 or email ICDocketMgr@ed.gov and reference the OMB Control Number
1894-0005.

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 of Lobbying Activities,'' 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 $10,00 0 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 of Lobbying
Activities,'' in accordance with its instructions. Submission of this statement is a prerequisite for making or
entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the
required statement shall be subjec t to a civil penalty of not less than $10,000 and not more than $100,000
for each such failure.

* APPLICANT'S ORGANIZATION

* PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE
Prefix:

* First Name:

Middle Name:
Suffix:

* Last Name:
* Title:
* SIGNATURE:

* DATE:

OMB Approval No. 0348-0040

ASSURANCES - NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such
is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1.

Has the legal authority to apply for Federal assistance
and the institutional, managerial and financial capability
(including funds sufficient to pay the non-Federal share
of project cost) to ensure proper planning, management
and completion of the project described in this
application.

2.

Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine all records, books, papers, or
documents related to the award; and will establish a
proper accounting system in accordance with generally
accepted accounting standards or agency directives.

3.

Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.

4.

Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding
agency.

5.

Will comply with the Intergovernmental Personnel Act of
1970 (42 U.S.C. §§4728-4763) relating to prescribed
standards for merit systems for programs funded under
one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).

6.

Will comply with all Federal statutes relating to
nondiscrimination. These include but are not limited to:
(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color
or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C. §§16811683, and 1685-1686), which prohibits discrimination on
the basis of sex; (c) Section 504 of the Rehabilitation

Act of 1973, as amended (29 U.S.C. §794), which
prohibits discrimination on the basis of handicaps; (d)
the Age Discrimination Act of 1975, as amended (42
U.S.C. §§6101-6107), which prohibits discrimination
on the basis of age; (e) the Drug Abuse Office and
Treatment Act of 1972 (P.L. 92-255), as amended,
relating to nondiscrimination on the basis of drug
abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the
Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made; and, (j) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.
7.

Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform
Relocation Assistance and Real Property Acquisition
Policies Act of 1970 (P.L. 91-646) which provide for
fair and equitable treatment of persons displaced or
whose property is acquired as a result of Federal or
federally-assisted programs. These requirements apply
to all interests in real property acquired for project
purposes regardless of Federal participation in
purchases.

8.

Will comply, as applicable, with provisions of the
Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328)
which limit the political activities of employees whose
principal employment activities are funded in whole or
in part with Federal funds.

Previous Edition Usable

Standard Form 424B (Rev. 7-97)

Authorized for Local Reproduction

Prescribed by OMB Circular A-102

9.

10.

11.

Will comply, as applicable, with the provisions of the DavisBacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. §§327333), regarding labor standards for federally-assisted
construction subagreements.
Will comply, if applicable, with flood insurance purchase
requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-234) which requires
recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of
insurable construction and acquisition is $10,000 or more.
Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-190) and
Executive Order (EO) 11514; (b) notification of violating
facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in
floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management
program developed under the Coastal Zone Management
Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of
Federal actions to State (Clean Air) Implementation Plans
under Section 176(c) of the Clean Air Act of 1955, as
amended (42 U.S.C. §§7401 et seq.); (g) protection of
underground sources of drinking water under the Safe
Drinking Water Act of 1974, as amended (P.L. 93-523);
and, (h) protection of endangered species under the
Endangered Species Act of 1973, as amended (P.L. 93205).

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL

APPLICANT ORGANIZATION

12.

Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.

13.

Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. §470), EO 11593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. §§469a-1 et seq.).

14.

Will comply with P.L. 93-348 regarding the protection of
human subjects involved in research, development, and
related activities supported by this award of assistance.

15.

Will comply with the Laboratory Animal Welfare Act of
1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et
seq.) pertaining to the care, handling, and treatment of
warm blooded animals held for research, teaching, or
other activities supported by this award of assistance.

16.

Will comply with the Lead-Based Paint Poisoning
Prevention Act (42 U.S.C. §§4801 et seq.) which
prohibits the use of lead-based paint in construction or
rehabilitation of residence structures.

17.

Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, Local Governments, and Non-Profit
Organizations."

18.

Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.

TITLE

DATE SUBMITTED

Standard Form 424B (Rev. 7-97) Back