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2012 Indian and Native American grant planning
Summary ETA allowed selected Workforce Investment Act Section 166 Indian and Native American grantees to extend or modify 2011 strategic plans through program year 2013 and gave funding instructions and allotments. It attached planning worksheets and tables. ETA now labels the period-specific advisory Canceled.
Document
Federal guidance
Agency
U.S. Department of Labor, Employment and Training Administration (ETA)
Document number
TEGL No. 34-11
Date issued
June 11, 2012
Status
Withdrawn
ETA lists this advisory Canceled as of 2026-10-24; its PDF prints Expiration Date: Continuing and Rescissions: None. It concerns 2012 plans and allotments; no cancellation instrument is identified.
Status last verified October 24, 2026
Is this still the rule?
This document has been withdrawn. Ezel checks what federal law requires today, under current federal labor law, and answers your situation with citations.
About this page: The full text below is the official document from U.S. Department of Labor, Employment and Training Administration (ETA). Ezel adds the plain-English summary and tracks the document's status. The official source linked on this page is authoritative for any reliance.
Accessible letter PDF: https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2012/TEGL_34_11_Acc.pdf
CLASSIFICATION
EMPLOYMENT AND TRAINING ADMINISTRATION WIA/Planning/Section 166
ADVISORY SYSTEM CORRESPONDENCE SYMBOL
U.S. DEPARTMENT OF LABOR OWI/DINAP
Washington, D.C. 20210 DATE
June 11, 2012
ADVISORY: TRAINING AND EMPLOYMENT GUIDANCE LETTER NO. 34-11
TO: ALL SECTION 166 INDIAN AND NATIVE AMERICAN GRANTEES
FROM: JANE OATES /s/
Assistant Secretary
SUBJECT: Extension or Modification of Program Year (PY) 2011 One-Year Strategic
Planning Directions for New Designated Grantees and Funding Allotments
for Selected Grantees of the Workforce Investment Act (WIA) Indian and
Native American Program.
1. Purpose. To notify WIA Section 166 Indian and Native American grantees of the
Employment and Training Administration’s (ETA) (a) decision to allow existing
designated grantees that were granted waivers to extend or modify their current
Comprehensive Services Program (CSP) plan and Supplemental Youth Services Program
(SYSP) plan through Program Year (PY) 2013 (June 30, 2014) and (b) provision of
planning directions for new designated grantees. This Training and Employment Guidance
Letter (TEGL) also gives final funding allotments for designated grantees that were granted
waivers, and directions for newly designated grantees.
2. References.
• Section 166 of WIA located at: http://www.doleta.gov/dinap/cfml/wiapage.cfm;
• Regulations implementing WIA Section 166 Indian and Native American Program
located at: http://www.doleta.gov/dinap/cfml/wiapage.cfm;
• TEGL 22-10, Planning Guidance and Instructions for Submission of a One-Year
Strategic Plan for the Workforce Investment Act (WIA) Section 166 Indian and Native
American Program for Program Year (PY) 2011 located at:
http://wdr.doleta.gov/directives/attach/TEGL/TEGL22-10-ACC.pdf;
• Career Pathways Initiative located at: https://learnwork.workforce3one.org/;
• Notice of Availability of Funds and Solicitation for Grant Applications for Indian and
Native American Employment and Training Programs; Solicitation for Grant
Applications and Announcement of Competition Waivers for Program Years 2012 and
2013, Vol.77, NO.52, page 15811FR located at: http://www.gpo.gov/fdsys/pkg/FR-2012-
03-16/xml/FR-2012-03-16.xml#seqnum15811; and
• Planning forms included in this TEGL located at:
https://ina.workforce3one.org/page/prog_planning
3. Background. WIA Section 166 requires grantees to have an approved two-year strategic
plan in order to operate a WIA Section 166 grant. The current PY 2011 strategic plan
RESCISSIONS EXPIRATION DATE
None Continuing
two-year strategic plan in place beginning July 1, 2012. In lieu of developing a “full” two-
year plan, ETA will authorize current designated grantees the option to extend or modify
their current one-year plan.
A grant extension/modification is only available to those current grantees that have been
designated as a WIA Section 166 grantee in PY 2012, as provided in Attachment E of this
TEGL. Incumbent grantees that are not designated for PY 2012-PY 2013 will not receive a
grant award. Therefore, their grant cannot be extended or modified. Grantees that are not
designated for PY 2012-PY 2013 must discontinue WIA grant services on June 29, 2012.
New designated grantees are required to submit a Two-Year Strategic Plan that implements
the Career Pathway model (TEGL 22-10) before June 29, 2012, and a strategy to accept the
former grantee’s participant caseload to not disrupt services currently being provided. The
Career Pathway model is further discussed in Attachment F of this TEGL. A copy of
TEGL 22-10 can be obtained at:
http://wdr.doleta.gov/directives/corr_doc.cfm?DOCN=3012
4. Implementing a Two-Year Strategic Plan for PY 2012 and 2013.
A. Grantees Who Received a Waiver Avoiding Competition under Solicitation for Grant
Announcement (SGA) PY 11-04
ETA will approve all grant extensions/modifications from WIA Section 166 grantees that
received a waiver of PY 2012 competition and will consider the legislative plan
requirement satisfied by approving an extension/modification of the current plan. Grantees
receiving an extension must continue to provide the same services in the same manner as
they have been provided under their PY 2011 plan.
WIA Section 166 grantees may request ETA approval to modify a plan to add, expand,
delete, or diminish any service allowable under the regulations (20 CFR 668.750(b)).
However, grantees must follow the SGA requirement to serve the entire geographic service
area(s) for which they were designated. A grantee choosing to modify its PY 2011
strategic plan must include a planning narrative (Attachment F) and a revised
Comprehensive Services Form (Attachment C). Grantees must request a modification to
their two-year plan if major changes are planned or circumstances require significant
changes to the scope, purpose, or design of the grant, such as:
i. For grantees who have proposed to serve more than 100 participants annually, an
expectation that the number of participants will be reduced by 25% or more;
ii. For grantees who have proposed to serve 100 or fewer participants annually, an
expectation that the number of participants will be reduced by 25 or more;
iii. A determination that the strategy provided in the current one-year plan is not
meeting the workforce needs of the community;
iv. Shifts in the local labor market and/or employer demands (such as job skills
training) which require a strategy that is significantly different from the current
approved plan;
v. A change in the efficiency level provided in the PY 2011 strategic plan; or
vi. A change in the administrative cost limit that was approved in the PY 2011 plan.
vii. Being newly designated for an area that was open for competition.
In order to receive an extension/modification and to receive PY 2012 funding, all
designated WIA Section 166 grantees must submit the following information:
1. Signed Cover Letter. The cover letter must indicate the grantee’s request to
extend/modify its PY 2011 Strategic Plan. Grantees requesting to modify must also
include a narrative that clearly explains what is being revised in the plan, and provide
justification for the proposed changes. The cover letter must also have an original
signature.
2. Grant Application – Standard Form 424 (SF-424). The SF-424 must clearly identify the
grantee and must be signed by an individual with authority to enter into a grant agreement
(Attachment A). Upon confirmation of an award, the individual signing the SF-424 on behalf
of the grantee shall be considered the authorized representative of the applicant. As stated in
block 21 of the SF-424 form, the signature of the authorized representative on the SF-424
certifies that the organization is in compliance with the Assurances and Certifications form SF-
424B (available at http://apply07.grants.gov/apply/FormLinks?family=15). In addition, the
authorizing signature in block 21 of the SF-424 form constitutes assurance by the applicant of
the following in accordance with 29 CFR 37.20.
As a condition to the award of financial assistance from the Department of Labor
(Department) under Title I of WIA, the grant applicant assures that it will comply fully
with the nondiscrimination and equal opportunity provisions of the following laws:
• Section 188 of WIA prohibits discrimination against all individuals in the United
States on the basis of race, color, religion, sex, national origin, age, disability,
political affiliation or belief, and against beneficiaries on the basis of either
citizenship/status as a lawfully admitted immigrant authorized to work in the United
States or participation in any WIA Title I financially assisted program or activity;
• Title VI of the Civil Rights Act of 1964, as amended, which prohibits
discrimination on the basis of race, color and national origin;
• Section 504 of the Rehabilitation Act of 1973, as amended, which prohibits
discrimination against qualified individuals with disabilities;
• The Age Discrimination Act of 1975, as amended, which prohibits discrimination
on the basis of age; and
• Title IX of the Education Amendments of 1972, as amended, which prohibits
discrimination on the basis of sex in educational programs.
The grant applicant also assures that it will comply with 29 CFR Part 37 and all other
regulations implementing the laws listed above. The grant applicant understands that the
United States has the right to seek judicial enforcement of this assurance.
The following information is about how to fill out particular items on the SF-424:
• Item #8(c)—Organizational Data Universal Numbering System (D-U-N-S®):
All applicants for Federal grant and funding opportunities are required to have a
current D-U-N-S® number, and must supply their D-U-N-S® number on the SF-424.
The D-U-N-S® number is a nine digit identification number that uniquely identifies
business entities. If you do not have a D-U-N-S® number, you can get one for free
through the D&B Web site: http://fedgov.dnb.com/webform/displayHomePage.do.
• Item #11—Catalog of Federal Domestic Assistance Number (CFDA): The
CFDA number for the WIA Section 166 program is 17.265. This number must be
provided in item #11.
• Item #14—Areas Affected by Project: Applicants must provide the geographic
area(s) for which they were designated. Current grantees that received a waiver
must serve the entire geographic service area(s) for which they were designated.
Grantees designated for areas that were open to competition must serve the entire
geographic area(s) for which they were designated. Grantees may include service
areas in an attachment to the SF-424 if additional space is needed.
• Item #17—Proposed Project Start Date and End Date: WIA Section 166 Adult
and Youth programs are funded for a two-year period and are based on a PY period.
The two year plan covers the period from July 1, 2012 through June 30, 2014.
(WIA permits the Secretary to make youth funds available for obligation beginning
on April 1, 2012, so that grantees can begin planning the youth program. See
Section 5: Period of Performance and Section 6: PY 2012 Funding Allocations
below for more information).
• Item #18—Estimated Funding: The WIA Section 166 program is a formula
funded program, which is based on population characteristics, geographic service
area, and annual congressional appropriations. Since WIA Section 166 funding
awards are calculated by the Department/ETA, it is not necessary for applicants to
complete Item #18.
• Item #19—Is Application Subject to Review By State Under Executive Order
12372 Process? The WIA Section 166 program is not subject to Executive Order
12372.
3. Budget Information Form and Narrative Standard Form 424A (SF 424A) and
Attachment B. SF- 424A can be found at:
http://apply07.grants.gov/apply/FormLinks?family=15. Current designated grantees must
use the PY 2012 funding allotments listed in Attachment E and newly designated grantees
will receive allotment information from the Grant Officer. In preparing the Budget
Information Form, the grantee must provide a concise narrative explanation to support the
budget request, explained in detail below.
• The budget narrative must provide a description of costs associated with each line
item on SF-424A;
• The entire Federal grant amount requested (PY 2012 and PY2013) must be included
on the SF-424, and SF-424A and budget narrative, for the Adult and Youth. In the
absence of a PY 2013 appropriation, grantees should use PY 2012 figures to plan
for PY 2013;
• The amount listed on SF-424, SF-424A and budget narrative must be the same.
Please note that the funding amount included on SF-424 will be considered the
official funding amount requested if any inconsistencies are found; and
• Grantees that fail to provide an SF-424A with an approved D-U-N-S® number, SF-
424A, and a budget narrative will not receive funding.
All designated grantees must be registered with the Federal Central Contractor Registry
(CCR). Step-by-step instructions for registering with CCR can be found at
http://www.grants.gov/applicants/org_step2.jsp.
An awardee must maintain an active CCR registration with current information at all times
during which they have an active Federal award or an application under consideration. To
remain registered in the CCR database after the initial registration, the applicant is required
to review and update on an annual basis from the date of initial registration or subsequent
updates its information in the CCR database to ensure it is current, accurate and complete.
For purposes of this paragraph, the applicant is the entity that meets the eligibility criteria
and has the legal authority to apply and to receive the award. Failure to register with the
CCR will result in your grant not being funded.
4. Comprehensive Services Form (if applicable):
WIA regulations at 20 CFR 668.710 require a projection of participant services and
expenditures covering the planning cycle. Attachment C is the form grantees will use to
describe planned services, cost for services, cost per participant, and performance
outcomes. As previously stated, designated grantees seeking to modify their PY 2011 plan
must complete the Comprehensive Services Form (Attachment C). Grantees seeking an
extension of their PY 2011 plan are not required to submit this form. All grantees newly
designated to service areas must also complete this form.
Section VII of Attachment C requires grantees to estimate their performance outcomes for
the three performance measures (Entered Employment Rate, Employment Retention Rate,
and Average Earnings). When completing Section VII, grantees must plan to meet the
“recommended level” of performance for the Entered Employment Rate and the “national
performance levels” for Employment Retention and Average Earnings. The Performance
Standard Worksheet can be found at: https://ina.workforce3one.org/page/prog_planning/.
Note: The link above includes Performance Standards Worksheets for all WIA Section 166
grantees (126 pages). Please be sure the grantee name on Line A matches your organization
when obtaining the recommended level of performance.
• Entered Employment Rate (EER): Each WIA Section 166 grantee has a
“recommended level” of performance for the Entered Employment Rate which can
be found on Line N of the grantee’s Performance Standards Worksheet. The rate on
Line One, Column “A” of Section VII must be equal to or greater than the
recommended level found on Line N of the Performance Standards Worksheet.
• Employment Retention: The “national performance level” for Employment
Retention for all grantees is 73.1 percent. This is the level established for the WIA
Section 166 Program overall, and does not factor in local economic conditions, nor
does it factor in the characteristics of the participants served. Since a level of
performance for Employment Retention has not been established for each grantee,
ETA will not find grantees deficient for not meeting the Employment Retention rate
at the end of PY 2012. However, grantees must strive to achieve a 73.1 percent
Employment Retention rate. Therefore, Line Two, Column “B” of Section VII must
be equal to or greater than 73.1 percent.
Average Earnings: The “national performance level” for Average Earnings for all
grantees is $10,049. This is the level established for the WIA Section 166 Program
overall, and does not factor in the local economic conditions, or the characteristics of
participants served.
Thus, a level of performance for Average Earnings has not been established for
individual grantees. ETA will not find WIA Section 166 grantees deficient for not
meeting the Average Earnings rate at the end of PY 2012. However, grantees must
strive to achieve a $10,049 Average Earnings rate and, therefore, Line Three;
Column “C” of Section VII must be equal to or greater than $10,049.
Adult Performance Measures and Goals
Measure Goal
Entered Employment Rate 80.5 Percent
Employment Retention 73.1 Percent
Average Earnings $10,049
Note: To assist grantees in the completion of the Attachment C form, a type-ready version,
along with instructions and an example of a completed form, can be found at:
https://ina.workforce3one.org/page/prog_planning.
5. SYSP Planning Worksheet (ONLY for newly designated grantees that receive youth
funding or designated grantees seeking a modification to their SYSP)
WIA regulations at 20 CFR 668.420 require grantees to include performance measures for
the SYSP in order to measure program progress. ETA has established two performance
indicators for the WIA Section 166 Youth Program, which are:
Youth Performance Measures and Goals
Measure Goal
Attainment of Two or More Goals 80 Percent
Educational Attainment for Dropouts 50 Percent
A designated grantee requesting a modification to the SYSP must complete the Planning
Worksheet (Attachment D). All newly designated grantees operating the SYSP are also
required to complete this form. Grantees must strive to achieve the recommended level of 80
percent performance for “Attainment of Two or More Goals” and 50 percent performance for
“Educational Attainment for Dropouts.” A usable version of the SYSP planning worksheet
and instructions can be found at: https://ina.workforce3one.org/page/prog_planning.
A grant extension/modification/award letter and Notice of Obligation (NOO) authority from
the Grant Officer will serve as the grantee’s notice of an approved grant
extension/modification. Unilateral grant extensions/modifications award letters will be
issued on or around May 31, 2012 for grantees receiving youth funds, and July 1, 2012 for
grantees receiving adult funding only. Grantees must submit the required information for
ETA approval no later than June 29, 2012.
B. New Designated Grantees:
All new designated grantees must submit a two-year plan before June 30, 2012, to receive
funding. New designated grantees who are acquiring an existing service area must include a
caseload transfer strategy in the two- year plan. Newly designated grantees must also submit
the items listed in Section 4(A) of this TEGL.
WIA Section 166(e) requires that grantees submit to the Secretary a program plan that
describes a two-year strategy for meeting the needs of Indian, Alaska Native, or Native
Hawaiian individuals. In order to receive PY 2012 funding, all newly designated WIA
Section 166 grantees must submit the items in Section 4 (A) and the full two-year plan.
WIA states that such a plan shall –
(i) be consistent with the purpose of Section 166;
(ii) identify the population to be served;
(iii) identify the education and employment needs of the population to be served in the
manner in which the activities to be provided will strengthen the ability of the
individual served to obtain or retain unsubsidized employment;
(iv) describe the activities to be provided and the manner in which such activities are to
be integrated with other appropriate activities (e.g., career pathways);
(v) describe the performance measures to be used to assess the performance of entities
in carrying out the activities (see Sections 4 and 5 above);
In addition to meeting the requirements of WIA Section 166(e) indicated above, ETA
encourages newly designated grantees to incorporate the Career Pathways model into their
two-year plan. Attachment F of this TEGL discusses the Career Pathways model in detail
and grantees are expected to incorporate this approach into the planning narrative. By
answering the questions in Attachment F, grantees will have addressed all the requirements
of the planning narrative. New designated grantees receiving SYSP funds must also describe
the services they intend to provide and the target population they intend to serve in the
planning narrative.
New PY 2012-PY 2013 grantees are also required to submit Grievance Procedures.
According to the WIA regulations at 20 CFR 667.600, grantees must establish and maintain a
procedure for grievances and complaints for participants and other interested parties. To
ensure the requirements of this section are met, newly designated grantees must provide a
copy of their grievance and complaint procedures as an attachment to their two year plan. At
a minimum, the grievance procedures must include: 1) a process for addressing grievances
and complaints from participants and other applicable parties; 2) an opportunity for a fair and
impartial hearing to be completed by the grantee within 60 days of the filing of a grievance;
and 3) an opportunity to file a grievance with the Department’s WIA Section 166 Indian and
Native American Program when a decision is not made within 60 days, or either party is
dissatisfied with the local hearing decision. Discrimination complaints filed under provisions
of WIA Section 188 may be directed or mailed to the Director, Civil Rights Center, U.S.
Department of Labor, Room N-4123, 200 Constitution Avenue, N.W., Washington, D.C.
20210 in accordance with 29 CFR Part 37.
5. Period of Performance. Grantees requesting an extension and/or modification to their PY
2011 strategic plan will receive a unilateral extension/modification to add PY 2012 and PY
2013 funding to their existing grant when such funds become available. New designated
grantees must submit a Comprehensive Service plan for approval. The period of
performance for WIA Section 166 grantees is from July 1, 2012 - June 30, 2014. The SYSP
performance period begins April 1, 2012 for all grantees operating SYSP programs and
covers the period from April 1, 2012 through June 30, 2014.
Grantees should be aware that SYSP funds were not available in their grantee subaccounts on
April 1, however, grantees that received a waiver may use “carryover” funds from previous
PYs (if available) to implement the SYSP. Waived grantees that do not have carryover funds
from previous PYs may use other (nonrestricted) resources to begin operating a SYSP and
reimburse the resource for allowable costs (retroactive to April 1)when funds become
available in grantees subaccounts. The options in this paragraph are not available on any
grantee for areas that were open to competition.
IMPORTANT: WIA Section 166 grantees are advised that issuance of a formal
commitment or obligation of the Department PY 2012 funds will only occur when a Notice
of Obligation (NOO)/award letter has been issued by the Grant Officer. Grantees that
expend funds prior to receiving an official “designation” letter and a NOO/award letter from
the Grant Officer assume the risk of not being reimbursed for funds that have been used for
their WIA Section 166 program.
6. PY 2012 Funding Allocations. The PY 2012 appropriation level for the Section 166 CSP is
$47.5 million and $12.3 million for the SYSP. WIA Section 166 grantees should use the
allotments on Attachment E for planning purpose and newly designated grantees should use
allotment information received from the Grant Officer. As noted above, entities that have
been designated as a Section 166 grantee will receive an official NOO/award letter from the
Grant Officer.
7. Administrative Cost Limit. Division of Indian and Native American Program (DINAP)
Bulletin 99-05 (dated December 10, 1999) provides ETA’s policy on administrative cost
limits for the WIA Section 166 Program. The policy sets a baseline limit of 15 percent (of
the funding year allocation) for administrative costs. ETA may approve a higher
administrative limit, not to exceed 20 percent, if grantees provide acceptable justification for
a higher limit, as outlined in the above bulletin. In addition, grantees requesting a rate higher
than 15 percent for this two-year plan must include a detailed administrative budget and
narrative justification with the two-year plan. The budget should include items such as, but
not limited to, indirect costs, staff salaries, fringe benefits, rental space, utilities, equipment,
supplies, and travel. 20 CFR 667.220 defines what functions and activities constitute
administrative costs subject to the administrative cost limit.
8. Waivers. WIA Section 166(h)(3) permits waivers of any regulatory requirement except for
those areas cited in 20 CFR 668.920; a waiver can be requested at any time. When
submitting a waiver, grantees must follow the WIA regulations at 20 CFR 661.420(c).
Waiver approvals require a separate process and, therefore, should not be included in a plan
modification.
9. Acquisition of Equipment. Grant Officer approval is required prior to the acquisition of
equipment that has a useful life of more than one year and an acquisition cost of $5,000 or
more per unit pursuant to Office of Management and Budget (OMB) Circulars A-102 [29
CFR 97.33] and A-110 [29 CFR 95.2 (n)]. Approval of equipment is a separate process.
Grantees must submit requests for the purchase of equipment separately. These requests will
not be approved under an extension/modification.
10. Assurances and Certifications. Newly designated grantees must submit the assurances and
certifications with their plan (see Attachment G). Newly designated grantees should review
the assurances and certifications to ensure they understand and agree to the responsibilities
and requirements in administering a WIA Section 166 grant.
11. Action Requested. Grantees requesting an extension and/or modification to the PY 2011
strategic plan must submit the items listed in Section 13. Upon approval, the Grant Officer
will issue a unilateral extension/modification to add PY 2012 and PY 2013 funding to the
existing WIA Section 166 grant when such funds become available. Grantees receiving an
extension/modification must spend PY 2012 and PY 2013 funds in accordance with the
strategies and services identified in the PY 2011 approved plan. All documents must be
submitted to the DINAP office by close of business June 29, 2012. Grant
extensions/modifications must be approved by the Grant Officer before PY 2012 funds can
be obligated.
New designated grantees must submit the items listed in Section 13, below. Upon approval
of the two year plan and required documentation, the Grant Officer will issue an NOO to
obligate PY 2012 and PY 2013 funds to the new WIA Section 166 grant when such funds
become available. Newly designated grantees must submit the two-year plan and
documentation by June 30, 2012. The PY 2012 Strategic Plan must be approved by the
Grant Officer before PY 2012 funds can be obligated.
Please submit the required documents to the following address:
U.S. Department of Labor
Division of Indian and Native American Program
200 Constitution Avenue, N.W.
Room S-4209
Washington, D.C. 20210
ATTN: MIS-CSP DESK
12. Inquiries. Please direct questions to your designated Federal Project Officer provided
below.
Andrea Brown (East) (202)693-3736 Duane Hall (Midwest) (972)850-4637
Craig Lewis (Midwest) (202)693-3384 Guy Suetopka (West) (415)625-7988
Dawn Anderson (Midwest) (202)693-3745 Si Seciwa (West) (415)625-7987
13. Attachments. WIA Section 166 grantees requesting an extension must submit the
attachments listed under Section 13 (A) of this TEGL. Designated grantees seeking to
modify their existing grant must include the information listed under Section 13(B). New
designated grantees must include the attachments listed in both 13(A) and 13 (B) of this
section. Items listed in Section C are for informational purposes only, and need not be
submitted.
A. Required Documents For Grantees Requesting an extension and Newly Designated
Grantees
Cover Letter
Grant Application – Standard Form 424 (Attachment A)
Budget Information Form and Narrative Standard Form 424A (Attachment B)
B. Additional Required Documents For Grantees Requesting Modification and For
Newly Designated Grantees:
Comprehensive Services Form (Attachment C)
Supplemental Youth Planning Worksheet, if applicable (Attachment D)
Narrative, if applicable (Attachment F)
Assurance and Certifications (Attachment G)
C. The Following Attachments are for Informational Purposes Only:
Designated Grantees Granted Waivers, PY 2012 Funding Allotments
(Attachment E) are available as type-ready forms at :
https://ina.workforce3one.org/page/prog_planning
Attachment 1: https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2012/TEGL_34_11_Att1.pdf
OMB Number: 4040-0004
Expiration Date: 01/31/2009
Application for Federal Assistance SF-424 Version 02
*1. Type of Submission: *2. Type of Application * If Revision, select appropriate letter(s)
Preapplication New
Application Continuation *Other (Specify)
Changed/Corrected Application Revision
3. Date Received : 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:
*Street 1:
Street 2:
*City:
County:
*State:
Province:
*Country:
*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: Fax Number:
*Email:
OMB Number: 4040-0004
Expiration Date: 01/31/2009
Application for Federal Assistance SF-424 Version 02
*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.):
*15. Descriptive Title of Applicant’s Project:
OMB Number: 4040-0004
Expiration Date: 01/31/2009
Application for Federal Assistance SF-424 Version 02
16. Congressional Districts Of:
*a. Applicant: *b. Program/Project:
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.)
Yes No
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:
Authorized for Local Reproduction Standard Form 424 (Revised 10/2005)
Prescribed by OMB Circular A-102
OMB Number: 4040-0004
Expiration Date: 01/31/2009
Application for Federal Assistance SF-424 Version 02
*Applicant Federal Debt Delinquency Explanation
The following should contain an explanation if the Applicant organization is delinquent of any Federal Debt.
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 Entry: Item: Entry:
1. Type of Submission: (Required) Select one type of submission 10. Name Of Federal Agency: (Required) Enter the name of the
in accordance with agency instructions. federal agency from which assistance is being requested with this
• Pre-application application.
• Application
• Changed/Corrected Application – Check if this submission is to 11. Catalog Of Federal Domestic Assistance Number/Title:
change or correct a previously submitted application. Unless Enter the Catalog of Federal Domestic Assistance number and
requested by the agency, applicants may not use this form to title of the program under which assistance is requested, as found
submit changes after the closing date. in the program announcement, if applicable.
2. Type of Application: (Required) Select one type of application in 12. Funding Opportunity Number/Title: (Required) Enter the
accordance with agency instructions. Funding Opportunity Number and title of the opportunity under
which assistance is requested, as found in the program
• New – An application that is being submitted to an agency for announcement.
the first time.
• Continuation - An extension for an additional funding/budget
period for a project with a projected completion date. This can 13. Competition Identification Number/Title: Enter the competition
include renewals. identification number and title of the competition under which
• Revision - Any change in the federal government’s financial assistance is requested, if applicable.
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
14. Areas Affected By Project: This data element is intended for use
provided.
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
A. Increase Award D. Decrease Duration
Project/Performance Site Location(s) Form. Add attachment to
B. Decrease Award E. Other (specify)
enter additional areas, if needed.
C. Increase Duration
3. Date Received: Leave this field blank. This date will be assigned 15. Descriptive Title of Applicant’s Project: (Required) Enter a
by the Federal agency. 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.
4. Applicant Identifier: Enter the entity identifier assigned buy the
Federal agency, if any, or the applicant’s control number if
applicable.
5a. Federal Entity Identifier: Enter the number assigned to your 16. Congressional Districts Of: 15a. (Required) Enter the
organization by the federal agency, if any. applicant’s congressional district. 15b. Enter all district(s) affected
5b. Federal Award Identifier: For new applications leave blank. For a by the program or project. Enter in the format: 2 characters state
continuation or revision to an existing award, enter the previously abbreviation – 3 characters district number, e.g., CA-005 for
assigned federal award identifier number. If a changed/corrected California 5th district, CA-012 for California 12 district, NC-103 for
application, enter the federal identifier in accordance with agency North Carolina’s 103 district. If all congressional districts in a state
instructions. are affected, enter “all” for the district number, e.g., MD-all for all
6. Date Received by State: Leave this field blank. This date will be congressional districts in Maryland. If nationwide, i.e. all districts
assigned by the state, if applicable. within all states are affected, enter US-all. If the program/project
is outside the US, enter 00-000. This optional data element is
7. State Application Identifier: Leave this field blank. This identifier
intended for use only by programs for which the area(s) affected
will be assigned by the state, if applicable. are likely to be different than place(s) of performance reported on
8. Applicant Information: Enter the following in accordance with the SF-424 Project/Performance Site Location(s) Form. Attach an
agency instructions: additional list of program/project congressional districts, if needed.
a. Legal Name: (Required) Enter the legal name of applicant that 17. Proposed Project Start and End Dates: (Required) Enter the
will undertake the assistance activity. This is the organization that proposed start date and end date of the project.
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 18. Estimated Funding: (Required) Enter the amount requested, or
employer or taxpayer identification number (EIN or TIN) as to be contributed during the first funding/budget period by each
assigned by the Internal Revenue Service. If your organization is contributor. Value of in-kind contributions should be included on
not in the US, enter 44-4444444. 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.
c. Organizational DUNS: (Required) Enter the organization’s 19. Is Application Subject to Review by State Under Executive
DUNS or DUNS+4 number received from Dun and Bradstreet. Order 12372 Process? (Required) Applicants should contact the
Information on obtaining a DUNS number may be obtained by State Single Point of Contact (SPOC) for Federal Executive Order
visiting www.Grants.gov. 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.
d. Address: Enter address: Street 1 (Required); city (Required); 20. Is the Applicant Delinquent on any Federal Debt?
County/Parish, State (Required if country is US), Province, (Required) Select the appropriate box. This question applies to
Country (Required), 9-digit zip/postal code (Required if country the applicant organization, not the person who signs as the
US). 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.
e. Organizational Unit: Enter the name of the primary 21. Authorized Representative: To be signed and dated by the
organizational unit, department or division that will undertake the authorized representative of the applicant organization. Enter the
assistance activity. 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
f. Name and contact information of person to be contacted on
application as the official representative must be on file in the
matters involving this application: Enter the first and last name
applicant’s office. (Certain federal agencies may require that this
(Required); prefix, middle name, suffix, title. Enter organizational
authorization be submitted as part of the application.)
affiliation if affiliated with an organization other than that in 7.a.
Telephone number and email (Required); fax number.
9. 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
Government O. Individual
D. Special District P. For-Profit Organization
Government (Other than Small
E. Regional Organization Business)
F. U.S. Territory or Q. Small Business
Possession R. Hispanic-serving
G. Independent School Institution
District S. Historically Black
H. Public/State Controlled Colleges and
Institution of Higher Universities (HBCUs)
Education T. Tribally Controlled
I. Indian/Native American Colleges and
Tribal Government Universities (TCCUs)
(Federally Recognized) U. Alaska Native and
J. Indian/Native American Native Hawaiian
Tribal Government Serving Institutions
(Other than Federally V. Non-US Entity
Recognized) W. Other (specify)
K. Indian/Native American
Tribally Designated
Organization
L. Public/Indian Housing
Authority
Attachment 2: https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2012/TEGL_34_11_Att2.pdf
OMB Approval No. 0348-0044
BUDGET INFORMATION - Non-Construction Programs
SECTION A - BUDGET SUMMARY
Grant Program Catalog of Federal
Estimated Unobligated Funds New or Revised Budget
Function Domestic Assistance
or Activity Number Federal Non-Federal Federal Non-Federal Total
(a) (b) (c) (d) (e) (f) (g)
$ $ $ $ $
1. 0.00
2. 0.00
3. 0.00
4. 0.00
$ $ $ $ $
5. Totals 0.00 0.00 0.00 0.00 0.00
SECTION B - BUDGET CATEGORIES
GRANT PROGRAM, FUNCTION OR ACTIVITY Total
6. Object Class Categories
(1) (2) (3) (5)
$ $ $ $ $
a. Personnel 0.00
b. Fringe Benefits 0.00
c. Travel 0.00
d. Equipment 0.00
e. Supplies 0.00
f. Contractual 0.00
g. Construction 0.00
h. Other 0.00
i. Total Direct Charges (sum of 6a-6h) 0.00 0.00 0.00 0.00 0.00
j. Indirect Charges 0.00
$ $ $ $ $
k. TOTALS (sum of 6i and 6j) 0.00 0.00 0.00 0.00 0.00
7. Program Income $ $ $ $ $ 0.00
Authorized for Local Reproduction Standard Form 424A (Rev. 7-97)
Previous Edition Usable Prescribed by OMB Circular A-102
SECTION C - NON-FEDERAL RESOURCES
(a) Grant Program (b) Applicant (c) State (d) Other Sources (e) TOTALS
8. $ $ $ $ 0.00
9. 0.00
10. 0.00
11. 0.00
12. TOTAL (sum of lines 8-11) $ 0.00 $ 0.00 $ 0.00 $ 0.00
SECTION D - FORECASTED CASH NEEDS
Total for 1st Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter
13. Federal
$ 0.00 $ $ $ $
14. Non-Federal 0.00
15. TOTAL (sum of lines 13 and 14) $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
(a) Grant Program FUTURE FUNDING PERIODS (Years)
(b) First (c) Second (d) Third (e) Fourth
16. $ $ $ $
17.
18.
19.
20. TOTAL (sum of lines 16-19) $ 0.00 $ 0.00 $ 0.00 $ 0.00
SECTION F - OTHER BUDGET INFORMATION
21. Direct Charges: 22. Indirect Charges:
23. Remarks:
Authorized for Local Reproduction Standard Form 424A (Rev. 7-97) Page 2
INSTRUCTIONS FOR THE SF-424A
Public reporting burden for this collection of information is estimated to average 180 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 (0348-0044), 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.
General Instructions
For continuing grant program applications , submit these forms
This form is designed so that application can be made for funds before the end of each funding period as required by the grantor
from one or more grant programs. In preparing the budget, agency. Enter in Columns (c) and (d) the estimated amounts of
adhere to any existing Federal grantor agency guidelines which funds which will remain unobligated at the end of the grant
prescribe how and whether budgeted amounts should be funding period only if the Federal grantor agency instructions
separately shown for different functions or activities within the provide for this. Otherwise, leave these columns blank. Enter in
program. For some programs, grantor agencies may require columns (e) and (f) the amounts of funds needed for the
budgets to be separately shown by function or activity. For other upcoming period. The amount(s) in Column (g) should be the
programs, grantor agencies may require a breakdown by function sum of amounts in Columns (e) and (f).
or activity. Sections A, B, C, and D should include budget
estimates for the whole project except when applying for For supplemental grants and changes to existing grants, do not
assistance which requires Federal authorization in annual or use Columns (c) and (d). Enter in Column (e) the amount of the
other funding period increments. In the latter case, Sections A, B, increase or decrease of Federal funds and enter in Column (f) the
C, and D should provide the budget for the first budget period amount of the increase or decrease of non-Federal funds. In
(usually a year) and Section E should present the need for Column (g) enter the new total budgeted amount (Federal and
Federal assistance in the subsequent budget periods. All non-Federal) which includes the total previous authorized
applications should contain a breakdown by the object class budgeted amounts plus or minus, as appropriate, the amounts
categories shown in Lines a-k of Section B. shown in Columns (e) and (f). The amount(s) in Column (g)
should not equal the sum of amounts in Columns (e) and (f).
Section A. Budget Summary Lines 1-4 Columns (a) and (b)
Line 5 - Show the totals for all columns used.
For applications pertaining to a single Federal grant program
(Federal Domestic Assistance Catalog number) and not requiring Section B Budget Categories
a functional or activity breakdown, enter on Line 1 under Column
(a) the Catalog program title and the Catalog number in Column In the column headings (1) through (4), enter the titles of the
(b). same programs, functions, and activities shown on Lines 1-4,
Column (a), Section A. When additional sheets are prepared for
For applications pertaining to a single program requiring budget Section A, provide similar column headings on each sheet. For
amounts by multiple functions or activities, enter the name of each program, function or activity, fill in the total requirements for
each activity or function on each line in Column (a), and enter the funds (both Federal and non-Federal) by object class categories.
Catalog number in Column (b). For applications pertaining to
multiple programs where none of the programs require a Line 6a-i - Show the totals of Lines 6a to 6h in each column.
breakdown by function or activity, enter the Catalog program title
on each line in Column (a) and the respective Catalog number on Line 6j - Show the amount of indirect cost.
each line in Column (b).
Line 6k - Enter the total of amounts on Lines 6i and 6j. For all
For applications pertaining to multiple programs where one or applications for new grants and continuation grants the total
more programs require a breakdown by function or activity, amount in column (5), Line 6k, should be the same as the total
prepare a separate sheet for each program requiring the amount shown in Section A, Column (g), Line 5. For
breakdown. Additional sheets should be used when one form supplemental grants and changes to grants, the total amount of
does not provide adequate space for all breakdown of data the increase or decrease as shown in Columns (1)-(4), Line 6k
required. However, when more than one sheet is used, the first should be the same as the sum of the amounts in Section A,
page should provide the summary totals by programs. Columns (e) and (f) on Line 5.
Lines 1-4, Columns (c) through (g) Line 7 - Enter the estimated amount of income, if any, expected
to be generated from this project. Do not add or subtract this
For new applications , leave Column (c) and (d) blank. For each amount from the total project amount, Show under the program
line entry in Columns (a) and (b), enter in Columns (e), (f), and
(g) the appropriate amounts of funds needed to support the
project for the first funding period (usually a year).
SF-424A (Rev. 7-97) Page 3
INSTRUCTIONS FOR THE SF-424A (continued)
narrative statement the nature and source of income. The Line 15 - Enter the totals of amounts on Lines 13 and 14.
estimated amount of program income may be considered by the
Federal grantor agency in determining the total amount of the Section E. Budget Estimates of Federal Funds Needed for
grant. Balance of the Project
Section C. Non-Federal Resources Lines 16-19 - Enter in Column (a) the same grant program titles
shown in Column (a), Section A. A breakdown by function or
Lines 8-11 Enter amounts of non-Federal resources that will be activity is not necessary. For new applications and continuation
used on the grant. If in-kind contributions are included, provide a grant applications, enter in the proper columns amounts of Federal
brief explanation on a separate sheet. funds which will be needed to complete the program or project over
the succeeding funding periods (usually in years). This section
need not be completed for revisions (amendments, changes, or
Column (a) - Enter the program titles identical to supplements) to funds for the current year of existing grants.
Column (a), Section A. A breakdown by function or
activity is not necessary. If more than four lines are needed to list the program titles, submit
additional schedules as necessary.
Column (b) - Enter the contribution to be made by the
applicant. Line 20 - Enter the total for each of the Columns (b)-(e). When
additional schedules are prepared for this Section, annotate
Column (c) - Enter the amount of the State’s cash and accordingly and show the overall totals on this line.
in-kind contribution if the applicant is not a State or
State agency. Applicants which are a State or State Section F. Other Budget Information
agencies should leave this column blank.
Line 21 - Use this space to explain amounts for individual direct
Column (d) - Enter the amount of cash and in-kind
object class cost categories that may appear to be out of the
contributions to be made from all other sources.
ordinary or to explain the details as required by the Federal grantor
agency.
Column (e) - Enter totals of Columns (b), (c), and (d).
Line 22 - Enter the type of indirect rate (provisional, predetermined,
final or fixed) that will be in effect during the funding period, the
Line 12 - Enter the total for each of Columns (b)-(e). The amount estimated amount of the base to which the rate is applied, and the
in Column (e) should be equal to the amount on Line 5, Column total indirect expense.
(f), Section A.
Line 23 - Provide any other explanations or comments deemed
Section D. Forecasted Cash Needs necessary.
Line 13 - Enter the amount of cash needed by quarter from the
grantor agency during the first year.
Line 14 - Enter the amount of cash from all other sources needed
by quarter during the first year.
SF-424A (Rev. 7-97) Page 4
Attachment 3: https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2012/TEGL_34_11_Att3.pdf
ATTACHMENT C
COMPREHENSIVE SERVICES PROGRAM
Grantee: Example of Grantee Attachment C
Section |: Total Funds Available
Section |. Total Funds Available Funding |
1. PY 2012 Funding (See Attachment E) $100,000
2. Estimated carry-over from prior program years $20,000
3. Total Funds Available $120,000
Sections Il, Ill, IV & V: Total Participants, Customers and Exiters
Section Il. Estimated Participants, Funding and Efficiency Participants Funding [==]
1. Number of New Participants Enrolled in the Program for PY 2012 25
2. Participants Carried Over from the Previous program year 5
3. Total Participants, Funding and Efficiency (w/out self service customers’ 30 $120,000
Section Ill. Estimated Self Service "Customers"
4. Number of Customers that Receive Self Services Only for PY 2012
Section IV. Efficiency - Participants and Self Service Customers
5. Total Participants, Funding and Efficiency (with self service customers
P40 | $120,000] $3,000
Section V. Estimated Exiters
6. Number of participants in line II.3 above that will exit in PY 2012
Section VI: Activities and Costs
Isection Vi. Estimated Participants, Funding and Efficiency Participants Costs
1. CRT - Job Skills 12 21,000}
2. CRT - Basic Education 5 2,000}
3. Work Experience 3 19,000}
4. On-the-Job Training 0 ol
5. Supportive Services 20 4,000}
16. Training Assistance 7
7. Administrative Costs - Percentage: 0.2
8
$120,000
. Total Participants and Costs
Section Vil: Common Measures Performance Outcomes
Section VII. j ES b. c.
(Common Measures Numerator Denominator "Denominator Retention Average
Projected Outcomes eaemnesmed Rate Earnings
Employed 1~ qtr. after exit 25
1. Entered Employment Rate Exiters during PY 2012 30
, Emp. 2” and 3° qtr. after exit 19
2. Retention Rate ENTS during DY 2072 30 63.3%
Earnings 2° and 3™ qtr. $342,000
3. Average Earnings Exiters during PY 2012 30 $11,400
Attachment 4: https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2012/TEGL_34_11_Att4.pdf
Supplemental Youth Services (SYS) Planning Worksheet
Attachment D
attains of a high school diploma (line 12.a above) or attains a GED (line 13 above).
1. Enter the estimated number of youth participants to be served for PY 2012 25
2. From the number above, estimate how many participants will exit in PY 2012 20
3. From no. 2 above, enter the estimated number of youth dropouts for PY 2012 4
Youth Participant Goals and/or Attainments Summary
Minimum Performance Requirement - at least 60% of Indian and Native American (INA) Attainment
youth enrolled in the Supplemental Youth Services program for the program year must attain Rate
a minimum of (2) two of the (13) thirteen goals listed below. Enter the estimated number of
exiters from line 2 above that will attain the goals indicated below
4. Completed Work Readiness 20 100.0%
5. Completed Internship or Vocational Exploration Program 18 90.0%
6. Completed Career Assesment 20 100.0%
7. Entered Unsubsidized Employment (Including Military) 2 10.0%
8. Remained in School 5 25.0%
9, Returned to School Full Time 0 0.0%
10. Enrolled in Job Corps 0 0.0%
11. Improved Basic Skills by at Least Two Grade Levels 10 50.0%
11.a Improved Basic Skills by at Least Two Grade Level (Dropouts Only) [ 2 |
12. Attained High School Diploma | 2 | t0.0% |
{2.a Attained High School Diploma (Dropouts Only)
13. Attained GED 2 50.0%
14. Completed Occupational Skills Training 0 0.0%
15. Completed Leadership Skills Training 0 0.0%
16. Entered Other (Non-Supplemental Youth) Training Program 0 0.0%
17. Successful Completion of Summer Employment 15 75.0%
Numerator
SECTION V. Performance Outcomes / Performance Value |Denominator| Met Goal?
18. Attainment of Two or More Goals (At least two goals/attainments from lines 4 - 17 above 4 ine
must be greater than 60%)
19. Educational Attainment for Dropouts (planned Attainment rate must be equal to or 4
greater than 50%.) An educational attainment is achieved when a dropout - who has
exited the prgoram - improves basic skills by at least two grade levels (line 11.a above ), 100% Yes
4
Attachment 5: https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2012/TEGL_34_11_Att5.pdf
Attachment E
Designated Grantees Granted Waivers,
PY 2012 Funding Allotments
Grant Type State Grantee Total
Appropriation Total $47,561,938 $12,365,295
TAT (- 475,619)
Grantee Total $47,086,319 $12,365,295
(CSP) (SYSP)
ADULT YOUTH
AL Poarch Band of Creek Indians 80,113 0
477 AK Aleutian/Pribilof Islands Association 24,276 10,771
477 AK Association of Villiage Council 348,320 147,440
477 AK Bristol Bay Native Association 100,353 43,083
477 AK Central Council of Tlingit and Haida 164,010 61,034
477 AK Chugachmiut 23,653 5,266
477 AK Cook Inlet Tribal Council 375,561 131,163
477 AK Copper River Native Association 15,892 8,377
477 AK Kawerak Incorporated 130,643 53,854
AK Kenaitze Indian Tribe 37,536 20,344
477 AK Kodiak Area Native Association 24,668 8,377
477 AK Maniilaq Association Inc. 97,850 46,673
477 AK Metlakatla Indian Community 15,824 4,787
477 AK Orutsararmuit Native Council 44,824 14,361
477 AK Tanana Chiefs Conference, Inc. 245,945 101,724
AZ American Indian Association of Tucson 293,350 0
AZ Colorado River Indian Tribes 53,712 28,722
AZ Gila River Indian Community 442,776 189,086
AZ Hopi Tribal Council 188,559 105,314
AZ Hualapai Tribe 28,253 17,952
AZ Inter Tribal Council of Arizona, Inc. 69,176 34,227
AZ Native Americans for Community Action 171,465 0
AZ Navajo Nation 5,288,334 2,745,345
AZ Pasqua Yaqui Tribe 87,179 49,067
AZ Phoenix Indian Center, Inc. 1,066,204 0
AZ Quechan Indian Tribe 29,148 15,558
AZ Salt River Pima-Maricopa Indian Council 73,442 46,673
AZ San Carlos Apache Tribe 334,382 198,661
477 AZ Tohono O'Odham Nation 321,557 199,857
AZ White Mountain Apache Tribe 393,888 238,153
AR American Indian Center of Arkansas, Inc. 276,474 0
CA California Indian Manpower Consortium, Inc. 2,890,237 99,569
CA Candelaria American Indian Council 278,276 0
CA Indian Human Resources Center, Inc. 291,676 0
CA Northern CA Indian Development Council, Inc. 259,720 55,290
CA Southern CA Indian Center, Inc. 1,425,057 0
CA Tule River Tribal Council 106,352 7,181
CA United Indian Nations, Inc. 382,767 0
CA Ya-Ka-Ama Indian Education & Development 54,319 0
CO Denver Indian Center 539,187 0
CO Southern Ute Indian Tribe 32,489 9,573
CO Ute Mountain Ute Indian Tribe 74,874 20,344
FL Florida Governor's Council on Indian Affairs 990,726 0
FL Miccosukee Corporation 103,160 5,027
HI Alu Like, Inc. 1,141,903 1,673,057
477 ID Nez Perce Tribe 59,493 13,882
477 ID Shoshone-Bannock Tribes 154,543 51,460
IN American Indian Center of Indiana, Inc. 204,002 0
KS United Tribes of Kansas and S.E. Nebraska 173,055 9,335
LA Inter-Tribal Council of Louisiana, Inc. 419,566 3,590
ME Penobscot Nation 162,586 22,498
MA Mashpee-Wampanoag Indian Tribal Council, Inc. 50,030 0
MA North American Indian Center of Boston, Inc. 181,128 0
477 MI Grand Traverse Band of Ottawa & Chippewa 26,735 0
Indians
MI Inter-Tribal Council of Michigan, Inc. 58,237 26,329
MI MI Indian Employment and Training Services, I 398,148 0
MI North American Indian Association of Detroit 118,742 0
MI Potawatomi Indian Nation 51,714 0
MI Sault Ste. Marie Tribe of Chippewa Indians 142,303 17,473
MI Southeastern Michigan Indians. Inc. 63,528 0
MN American Indian OIC 221,939 0
MN Bois Forte R.B.C. 16,968 8,138
MN Fond Du Lac R.B.C. 165,559 16,275
MN Leech Lake R.B.C. 127,694 47,631
477 MN Mille Lacs Band of Chippewa Indians 45,968 21,302
MN Minneapolis American Indian Center 294,591 0
477 MN Red Lake Tribal Council 185,046 75,396
477 MN White Earth R.B.C. 100,475 49,067
MS Mississippi Band of Choctaw Indians 250,272 60,794
MO American Indian Council 615,286 8,377
477 MT Assiniboine & Sioux Tribes 227,722 123,265
MT B.C. of the Chippewa Cree Tribe 117,702 34,706
477 MT Blackfeet Tribal Business Council 239,729 113,692
477 MT Confederated Salish & Kootenai Tribes 235,617 124,462
MT Crow Indian Tribe 137,196 78,746
477 MT Fort Belknap Indian Community 101,761 45,477
MT Montana United Indian Association 286,033 0
MT Northern Cheyenne Tribe 178,335 88,559
NE Indian Center, Inc. 235,918 0
NE Omaha Tribe of Nebraska 66,078 41,886
477 NE Winnebago Tribe 37,334 19,148
NV Inter-Tribal Council of Nevada 236,027 43,801
NV Las Vegas Indian Center, Inc. 159,298 0
477 NV Reno Sparks Indian Colony 14,168 8,377
477 NV Shoshone-Paiute Tribes 101,790 13,164
NM Alamo Navajo School Board 74,320 44,280
NM Eight Northern Indian Pueblo Council 34,133 12,446
NM Five Sandoval Indian Pueblos, Inc. 127,744 83,533
NM Jicarilla Apache Tribe 51,502 25,132
NM Mescalero Apache Tribe 73,094 55,050
NM National Indian Youth Council 1,334,754 0
477 NM Ohkay Owingeh 22,238 11,967
NM Pueblo of Acoma 113,550 27,525
NM Pueblo of Isleta 33,274 10,531
477 NM Pueblo of Laguna 72,729 33,509
477 NM Pueblo of Taos 33,953 16,754
477 NM Pueblo of Zuni 237,725 116,084
NM Ramah Navajo School Board, Inc. 75,128 27,525
NM Santa Clara Indian Pueblo 27,053 11,967
NM Santo Domingo Tribe 83,533 40,690
NY Native Am. Comm. Services of Erie & Niagara Co 132,795 0
NY Native American Cultural Center, Inc. 173,320 2,873
477 NY Seneca Nation of Indians 198,422 28,722
NY St. Regis Mohawk Tribe 115,983 20,344
NC Cumberland County Association for Indian People 54,213 0
NC Eastern Band of Cherokee Indians-Reservation Only 97,160 51,460
NC Guilford Native American Association 65,342 0
NC Haliwa-Saponi Tribe, Inc. 50,905 0
NC Lumbee Regional Development Association 855,806 0
NC North Carolina Commission of Indian Affairs 247,991 0
477 ND Spirit Lake Sioux Tribe 130,237 67,017
ND Standing Rock Sioux Tribe 188,543 111,298
477 ND Three Affiliated Tribes - Ft. Berthold Reservation 157,476 50,263
ND Turtle Mountain Band of Chippewa Indians 256,715 114,888
ND United Tribes Technical College 200,931 0
OH North America Indian Cultural Centers 440,315 0
OK Absentee Shawnee Tribe of Oklahoma 19,533 11,728
477 OK Cherokee Nation of Oklahoma 1,131,284 604,598
OK Cheyenne-Arapaho Tribes 135,466 93,346
477 OK Chickasaw Nation of Oklahoma 309,669 181,667
477 OK Choctaw Nation of Oklahoma 497,393 260,891
477 OK Citizen Band Potawatomi Indians of Oklahoma 277,717 196,028
OK Comanche Tribe of Oklahoma 132,295 64,625
477 OK Creek Nation of Oklahoma 622,124 318,335
OK Four Tribes Consortium of Oklahoma 83,530 60,794
OK Inter-Tribal Council of N.E. Oklahoma 64,129 24,175
OK Kiowa Tribe of Oklahoma 110,004 80,661
477 OK Osage Tribal Council 83,948 46,673
OK OTOE-Missouria Tribe of Oklahoma 28,336 15,079
477 OK Pawnee Tribe of Oklahoma 26,994 13,164
OK Ponca Tribe of Oklahoma 70,758 50,024
OK Seminole Nation of Oklahoma 86,317 64,625
OK Tonkawa Tribe of Oklahoma 54,007 25,132
OK United Urban Indian Council, Inc. 315,117 178,316
OK Wyandotte Tribe of Oklahoma 94,268 0
477 OR Confed. Tribes of Siletz Indians of Oregon 378,770 958
477 OR Confed. Tribes of the Umatilla Indian Res 23,630 13,164
OR Confederated Tribes of Warm Springs 110,871 37,100
OR Organization of Forgotten Americans 256,807 5,505
PA Council of Three Rivers 810,301 0
RI Rhode Island Indian Council 548,284 0
SC South Carolina Indian Development Council, Inc. 212,785 2,394
477 SD Cheyenne River Sioux Tribe 194,393 126,855
SD Lower Brule Sioux Tribe 48,881 17,952
SD Oglala Sioux Tribe 576,001 372,189
477 SD Rosebud Sioux Tribe 424,075 219,005
477 SD Sisseton-Wahpeton Sioux Tribe 108,174 52,657
SD United Sioux Tribe Development Corp. 491,052 11,967
SD Yankton Sioux Tribe 93,956 47,870
TN Native American Indian Association, Inc. 201,050 0
TX Alabama-Coushatta Indian Tribal Council 763,499 958
TX Dallas Inter-Tribal Center 336,834 0
TX Ysleta del Sur Pueblo 565,303 15,558
UT Indian Training & Education Center 309,645 5,266
UT Ute Indian Tribe 102,971 53,854
VT Abenaki Self-Help Association/ NH Ind. Council. 70,425 0
VA Mattaponi Pamunkey Monacan Consortium 218,757 0
WA American Indian Community Center 351,173 16,275
477 WA Colville Confederated Tribes 159,161 44,280
WA Confederated Tribes & Bands of the Yakama Nation 175,925 97,894
WA Lummi Indian Business Council 97,241 23,935
477 WA Makah Tribal Council 29,794 11,967
WA Puyallup Tribe of Indians 113,818 12,925
WA United Indians for All Tribes Foundation 248,607 0
477 WA Spokane Reservation 34,848 21,542
477 WA The Tulalip Tribes 38,603 19,148
WA Western WA Indian Empl. and Trng Pgm. 549,154 70,130
477 WI Ho-Chunk Nation 152,785 4,308
WI Lac Courte Oreilles Tribal Governing Board 74,190 29,919
WI Lac Du Flambeau Band of Lake Superior Chippewa 36,754 10,771
477 WI Menominee Indian Tribe of Wisconsin 85,786 44,280
WI Oneida Tribe of Indians of WI, Inc. 143,344 14,361
WI Spotted Eagle, Inc. 189,407 0
477 WI Stockbridge-Munsee Community 48,416 3,350
WI Wisconsin Indian Consortium 74,320 23,696
477 WY Eastern Shoshone Tribe 112,658 32,073
WY Northern Arapaho Business Council 191,555 72,044
Attachment 6: https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2012/TEGL_34_11_Att6.pdf
Attachment F
NOTE: A revised CSP narrative is required only if a modification is being
requested or for newly designated grantees.
Two-Year Comprehensive Service Plan (CSP) Narrative
To further the Secretary’s strategic goal of preparing workers for good jobs, and in support
of the Native American Employment and Training Council’s (Council) recommendations -
to enhance educational attainment and careers, newly designated WIA Section 166 grantees
will begin planning for the “Career Pathways” Program, "Trails to Opportunity," in its
Two-Year PY 2012 Strategic Plan. Grantees seeking a modification to their existing PY
2011 career pathway strategies must also submit a revised narrative.
All WIA Section 166 grantees will continuously receive technical assistance and guidance
throughout PY 2012 and PY 2013 on implementing career pathways plans. The
Department will work closely with the grantee community to successfully implement the
career pathways model.
Illiteracy and low education attainment continue to hinder the ability of Indian and Native
Americans to compete in a competitive labor market. By using the career pathway
framework, WIA Section 166 grantees can assist low-income Indian and Native American
adults and youth in addressing long-term education and training needs, providing their
customers with the skills necessary to get good jobs. Intensive training and support
services are needed to enhance worker skills and help Indians and Native Americans to
succeed in a knowledge-based economy.
Preparing Indian and Native American workers for good jobs requires that the WIA Section
166 Program focus on helping Indian and Native Americans overcome a multitude of
barriers to employment, providing additional opportunities for education and work
experiences, and targeting assistance towards skills needed to secure good jobs, especially
in high-growth industries.
The “Career Pathways” Program, "Trails to Opportunity," plan consists of a connected
series of training and education programs, with integrated support services, work
experiences, and learning on the job, that enable adults and youth to combine work and
learning. The career pathways plan provides clear sequences of coursework and credentials
that help individuals of varying skill levels earn credentials valued by employers, enter
more rewarding careers in high-demand and emerging industries and occupations, and
advance to increasingly higher levels of education and employment. A career pathways
program consists of six key elements that usually occur simultaneously that include:
(a) Building Cross-Agency Partnerships: means establishing a diverse group of
representatives from tribal, state, local agencies, and/or members of the business
community to design, create, and implement a shared vision based on the needs of the
community. Recommended partners should include, but are not limited to, tribal
community colleges and education, Temporary Assistance for Needy Families
providers, veteran affairs offices, social services agencies, workforce investment
boards, and/or local One-Stop Career Centers.
(b) Engaging Employers and Gap Analysis: requires conducting a labor market analysis to
identify the employment and training needs in the area. Assessing the gaps is a way for
grantees to identify the best sectors around which to build career pathways. A career
pathways plan should target high-demand and growing employment opportunities on or
near the reservation or approved service area (e.g., hospitality, health care, construction,
art, etc). The market analysis plan should also include an outreach strategy to engage
employers in the target areas.
(c) Clarifying Roles and Responsibilities: identifying, defining, and formalizing the roles
and responsibilities of the career pathways team are critical components of the plan.
The career pathways team guides the process when developing the plan, identifying key
roles and responsibilities of team members, identifying labor market information, and
developing a program design. The career pathways team should produce and use a
written memorandum of understanding to guide this process.
(d) Program Design: provides a clear sequence of training, education, coursework, and
credentials that meet the needs of high-demand industries. The program design should
be created around high-demand industries in the area that support career ladders that
pay family-sustaining wages. In addition, the program design should be supported by
the tribal leadership, the community, and/or the state.
(e) Identifying Funding Needs/Sources: to operate the career pathways program and core
components of the system including program development, professional development,
operational cost, and supportive services. Partners will work together to raise and
leverage funding from tribal, Federal-foundations, state, and local sources.
(f) Align Policies and Programs: identifying and coordinating employment and training
services with other tribal, local, or state agencies are keys to implementing a career
pathway system. In this area, agencies and programs work cooperatively across
organizations to leverage resources and foster systematic change.
Career pathways are an approach to linking education and training services in ways that
will lead to sustainable jobs. The long term goals are to 1) increase the number of
Indian and Native American individuals who earn a high school diploma, GED, or
obtain a recognized credential that enable them to compete for employment in high-
demand and emerging industries and occupations; 2) increase the number of
participants that obtain long term, sustainable employment; 3) establish multiple entry
and exit points for individuals along the education and training continuum; and 4)
create systemic change and enhance partnerships that better connect education, training,
supportive services, and the workforce system.
Links such as http://www.careeronestop.org/ or
http://www.learnwork.workforce3one.org/
may assist grantees with more information in developing career pathways strategies.
Question 1: What are the specific goals of the WIA Section 166 grantee’s program for the
program year(s) involved and what services does the grantee intend to make available? What
method will the grantee use to target its services to specific segments of its services population?
How will the program integrate the Veteran Priority of Service protocol?
{Enter your response to this question here}
Question 2: How will the grantee consult with tribal (or appropriate tribal departments), states,
the governors’ office, One-Stop Career Centers, Workforce Investment Boards, local agencies,
veterans’ offices, and/or members of the business community to design and implement a shared
career pathways plan based on the needs of the community?
{Enter your response to this question here}
Question 3: Which of the potential tribal or other community officials will be responsible for
identifying, defining, and formalizing the career pathways plan?
{Enter your response to this question here}
Question 4: Who are the other providers in the area that are potential partners (e.g., tribal
community colleges and education providers, Temporary Assistance for Needy Families
providers, veteran offices, social services agencies, workforce investment boards or local
One-Stop Career Centers, business representatives, and labor-management organizations) for the
grantees’ career pathway plan?
{Enter your response to this question here}
Question 5: Within the approved service area, what are the prospective employment
opportunities and/or the best sectors around which to build career pathways? Identify and briefly
describe the target high-demand and growing employment opportunities on or near the
reservation or approved service areas (e.g., hospitality, health care, construction, artistry, or other
appropriate entrepreneurial opportunities). What is the grantee’s outreach strategy to engage the
potential employers identified in the approved service areas? That is, how will the grantee work
with local employers (in your approved or designated service area) to place participants into
jobs?
{Enter your response to this question here}
Question 6: How will the grantee identify and coordinate employment and training services with
other tribal, local, One-Stop Career Center, or state agencies to ensure non-duplication of its
employment and training services? What are some of the potential Federal or state resources that
can be leveraged?
{Enter your response to this question here}
Question 7: What are the current educational or career needs in your approved or designated
service areas and how will the grantee prepare its customers, regardless of their skill level, to
obtain a high school diploma, GED, training credential, employment, a postsecondary education,
or enter the military?
{Enter your response to this question here}
Supplemental Youth Services Program (SYSP) Planning Narrative
A SYSP plan narrative is required only for newly designated grantees receiving SYSP
funding or designated grantees seeking a modification to their existing SYSP
Question 1: What is the projected number of youth to be served in SYSP and the target
population to be served (e.g., drop-outs, juvenile offenders, and/or college students)? In
addition, what are the strategies for recruiting and including youth participants in the program’s
career pathway?
{Enter your response to this question here}
Question 2: What services will the grantee make available to youth participants and what are the
types of career training that will be offered to prepare participants to enter a good job?
{Enter your response to this question here}
Question 3: Relevant cultural activities are an important component of WIA Section 166 grantee
communities. How will the program interact with educational providers that prepare Indian and
Native American students to successfully move into postsecondary education while maintaining
or promoting cultural identity?
{Enter your response to this question here}
Question 4: How will the SYSP partner with other educational providers to prepare Indian and
Native American youth to obtain a high school diploma, GED, certificate, or postsecondary
education?
{Enter your response to this question here}
Attachment 7: https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2012/TEGL_34_11_Att7.pdf
Attachment G
WORKFORCE INVESTMENT ACT
INDIAN AND NATIVE AMERICAN PROGRAMS
ASSURANCES AND CERTIFICATIONS
FOR
PROGRAM YEAR 2012
By signing the Agreement on the line below, the Grantee’s signatory official agrees to the
certifications and assurances referenced herein, and as detailed in the attached documents.
(NOTE: Please complete and check document boxes as appropriate.)
(GRANTEE)
(NAME OF SIGNATORY OFFICIAL)
(SIGNATURE) (DATE)
ASSURANCES AND CERTIFICATIONS
The Department of Labor will not award a grant or agreement where the grantee has failed to accept the
ASSURANCES AND CERTIFICATIONS contained in this section. In performing its responsibilities
under the Grant, the Grantee hereby certifies and assures that it will fully comply with the following:
Assurances - Non-Construction Programs (SF-424B)
Debarment and Suspension Certification (20 CFR Part 98)
Certification Regarding Lobbying (29 CFR Part 93)
Drug Free Workplace Certification (29 CFR Part 98)
Nondiscrimination and Equal Opportunity Assurance (29 CFR Part 37)
Certification of Non-Delinquency
By signing the face sheet of this Grant Agreement, the Grantee is accepting the above assurances and
certifications as detailed below:
A. ASSURANCES - NON-CONSTRUCTION PROGRAMS. Some of these assurances may not be
applicable to your project or program. If you have questions, please contact the awarding agency.
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 costs) 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.47284763) 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 CFR 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. 1681-1683, and 1685-1686), which prohibits
discrimination on the basis of handicaps; (c) Section 504 of the Rehabilitation Act of 1973 (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 ee-3), 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. 360l 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 provides 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 with the provisions of the Hatch Act (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.
9. Will comply, as applicable, with the provisions of the Davis-Bacon 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 (40.327-333), regarding labor standards for federally assisted construction
subagreements.
10. 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.
11. 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 flood plains 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
(Clear Air) Implementation Plans under Section 176(c) of the Clear 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. 93-
205).
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 wide 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.
B. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS - PRIMARY COVERED TRANSACTIONS.
The prospective primary participant certifies to the best of its knowledge and belief, that it and its
principals:
1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transactions by any Federal department or agency;
2. Have not within a three-year period preceding this proposal been convicted or had a civil
judgment rendered against them for commission of fraud or a criminal offense in connection
with obtaining, attempting to obtain, or performing a public (Federal, state, or local)
transaction or contract under a public transaction; violation of Federal or state antitrust
statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of
records, making false statements, or receiving stolen property;
3. Are not presently indicted or otherwise criminally or civilly charged by a government entity
(Federal, state, or local) with commission of any of the offenses enumerated in paragraph
(1)(b) of this certification; and
4. Have not within a three-year period preceding this application/proposal had one or more
public transactions (Federal, state, or local) terminated for cause or default.
Where the prospective primary participant is unable to certify to any of the statements in this
certification, such prospective participant shall attach an explanation to this proposal.
C. CERTIFICATION REGARDING LOBBYING - Certification for Contracts, Grants,
Loans, and Cooperative Agreements
By accepting this grant, the signee hereby certifies, to the best of his or her knowledge and believes
that:
1. No Federally one-year 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 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 Federally appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with this Federal contract, grant, loan or cooperative agreement, the
undersigned shall complete and submit Standard Form - LLL, "Disclosure Form to
Report Lobbying," in accordance with its instructions.
3. The signer 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.C. Any person who fails to file the required certification shall be subject
to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
D. CERTIFICATION REGARDING DRUG FREE WORKPLACE
REQUIREMENTS
The grantee certifies that it will provide a drug-free workplace by:
1. Publishing a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession, or use of a controlled substance is prohibited in the grantee’s workplace
and specifying the actions that will be taken against employees for violation of such prohibition;
2. Establishing an ongoing drug-free awareness program to inform employees about:
A. The dangers of drug abuse in the workplace;
B. The grantee’s policy of maintaining a drug-free workplace;
C. Any available drug counseling, rehabilitation, and employee assistance programs; and
D. The penalties that may be imposed upon employees for drug abuse violations occurring in
the workplace.
3. Making it a requirement that each employee to be engaged in the performance of the grant be
given a copy of the statement required by paragraph (1);
4. Notifying the employee in the statement required in paragraph (1) that, as a condition of
employment under the grant, the employee will:
A. Abide by the terms of the statement; and
B. Notify the employer in writing of his or her conviction for a violation of a criminal drug
statute occurring in the workplace no later than five calendar days after such conviction;
5. Notifying the agency in writing, within 10 calendar days after receiving notice under
subparagraph (4)(B) from an employer or otherwise receiving actual notice of such conviction.
Employers of convicted employees must provide notice, including position title, to every grant
officer or other designee on whose grant activity the convicted employee was working, unless the
Federal agency has designated a central point for the receipt of such notices. Notice shall include
the identification number(s) of each affected grant.
6. Taking one of the following actions within 30 calendar days of receiving notice under
subparagraph (4)(B) with respect to any employee who is so convicted:
A. Taking appropriate personnel action against such an employee, up to and including
termination, consistent with the requirements of the Rehabilitation Act of 1973, as
amended, or;
B. Requiring such employee to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by a Federal, State or local health, law
enforcement, or other appropriate agency; and
7. Making a good faith effort to continue to maintain a drug-free workplace through implementation
of paragraphs ((1), (2), (3), (4), (5), and (6)).
The grantee may insert in the space provided below the site(s) for the performance of work done in
connection with this specific grant.
Place of Performance (Street address, city, county, state, and zip code)
Check ( ) if there are additional workplaces on file that are not identified above.
E. NONDISCRIMINATION AND EQUAL OPPORTUNITY ASSURANCE
As a condition of the award of financial assistance from the Department of Labor under Title I or WIA,
the grant applicant assures that it will comply with the nondiscrimination and equal opportunity
provisions of the following laws:
(1) Section 188 of the Workforce Investment Act (WIA) of 1998 prohibits discrimination against all
individuals in the United States on the basis of race, color, religion, sex, national origin, age, disability,
political affiliation, or belief, and against beneficiaries on the basis of either citizenship/status as a
lawfully admitted immigrant authorized to work in the United States or participation in an WIA Title I -
financially assisted program or activity;
(2) Title VI of the Civil Rights of 1964, as amended, which prohibits discrimination on the basis of race,
color, and national origin;
(3) Section 504 of the Rehabilitation Act of 1973, as amended, which prohibits discrimination on the
basis of age; and individuals with disabilities;
(4) The Age Discrimination Act of 1975, as amended, which prohibits discrimination on the basis of age;
and
(5) Title IX of the Education Amendments of 1972, as amended, which prohibits the discrimination on
the basis of sex in educational programs.
The grant applicant also assures that it will comply with 29 CFR Part 37 and all other regulations
implementing the laws listed above. This assurance applies to the grant applicant’s operation of the WIA
Title I - financially assisted program or activity, and to all agreements the grant applicant makes to carry
out the WIA Title I - financially assisted program or activity. The grant applicant understands that the
United States has the right to seek judicial enforcement of this assurance.
FY 2000 Statutory Requirements
(Imposed by Public Law 106-113; November 17, 1999)
Title V – GENERAL PROVISIONS
Section 503(a). No part of any appropriation contained in this Act shall be used, other than for
normal and recognized executive-legislative relationships, for publicity propaganda purposes, for the
preparation, distribution, or use of any kit, pamphlet, booklet, publication, radio, television, or video
presentation designed to support or defeat legislation pending before the Congress or any State
legislature, except in presentation to the Congress or any State legislature itself.
(b) No part of any appropriation contained in this Act shall be used to pay the salary or expenses of
any grant or contract recipient, or agent acting for such recipient, related to any activity designed to
influence legislation or appropriations pending before the Congress or any State legislature.
Section 505. Notwithstanding any other provision of this Act, no funds appropriated under this Act
shall be used to carry out any program of distributing sterile needles or syringes for the hypodermic
injection of any illegal drug.
Section 506(a). Purchase of American-Made Equipment and Products. It is the sense of the Congress
that, to the greatest extent practicable, all equipment and products purchased with funds made available in
this Act should be American-made.
(b) Notice Requirement in providing financial assistance to, or entering into any contract with, any
entity using funds made available in the Act, the head of each Federal agency, to the greatest extent
practicable, shall provide to such entity a notice describing the statement made in subsection (a) by the
Congress.
(c) Prohibition of Contracts with Person Falsely Labeling Products Made in America - if it has been
finally determined by a court or Federal agency that any person intentionally affixed a label bearing a
“Made in America” inscription, or any inscription with the same meaning, to any product sold in or
shipped in the United States that is not made in the United States, the person shall be ineligible to receive
any contract or subcontract made with funds made available in this Act, pursuant to the debarment,
suspension, and ineligibility procedures described in Section 9.400 through 9/409 or Title 48, Code of
Federal Regulations.
Section 507. When issuing statements, press releases, requests for proposals, bid solicitations, and
other documents describing projects or programs funded in whole or in part with Federal money, all
grantees receiving Federal funds included in this Act, including but not limited to State and local
governments and recipients of Federal research grants, shall clearly state: (1) the percentage of the total
costs of the program or project which will be financed with Federal money; (2) the dollar amount of
Federal funds for the project or program; and (3) percentage and dollar amount of the total costs of the
project or program that will be financed by nongovernmental sources.
Section 508(a). None of the funds appropriated under this Act, and none of the funds in any trust
fund to which funds are appropriated under this Act, shall be expended for any abortion.
(b) None of the funds appropriated under this Act, and none of the funds in any trust fund to which
funds are appropriated under this Act, shall be expended for health benefits coverage that includes
coverage of abortion.
(c) The term “health benefits coverage”: means the package of services covered by a managed care
provider or organization pursuant to a contract or other arrangement.
Section 509(a). The limitation established in the preceding section shall not apply to an abortion
(1) if the pregnancy is the result of an act of rape or incest; or
(2) in the case where a woman suffers from a physical disorder, physical injury, or physical illness,
including a life-endangering physical condition caused by or arising from the pregnancy, which would, as
certified by a physician place the woman in danger of death unless an abortion is performed.
(b) Nothing in the preceding section shall be construed as prohibiting the expenditure by a State,
locality, entity, or private person of State , local, or private funds (other than a State’s or locality’s
contribution or Medicaid matching funds).
(c) Nothing in the preceding section shall be construed as restricting the ability of any managed care
provider from offering abortion coverage or the ability of a State or locality to contract separately with
such a provider for such cover with State funds (other than a State’s or locality’s contribution of Medicaid
matching funds).
Section 510(a). None of the funds made available in this Act may be used for–
(1) the creation of a human embryo or embryos are for research purposes; or
(2) research in which a human embryo or embryos destroyed, discarded, or knowingly subjected to
risk or injury or death greater than that allowed for research on fetuses in utero under 45 CFR
46.208(a)(2) and section 498(b) of the Public Health Service Act (42 U.S.C. 289g(b)).
(b) For purposes of this section, the term “human embryo or embryos” includes any organism, not
protected as a human subject under 45 CFR 46 as of the date of the enactment of this Act, that is derived
by fertilization, parthenogenesis, cloning, or any other means from one or more human gametes or human
diploid cells.
Section 511(a). Limitation on Use of Funds for Promotion of Legalization of Controlled Substances.
None of the funds made available in this Act may be used for any activity that promotes the legalization
of any drug or other substance included in Schedule I of the schedules of controlled substances
established by Section 202 of the Controlled Substances Act (21 U.S.C. 812).
(b) Exceptions. The limitation in Subsection (a) shall no apply when there is significant
medical evidence of a therapeutic advantage to the use of such drug or other substance or that federally
sponsored clinical trials are being conducted to determine therapeutic advantage.
Section 512. None of the funds made available in this Act may be obligated or expended to enter into
or renew a contract with an entity if –
(1) such an entity is otherwise a contractor with the United States and is subject to the requirement in
Section 4212(d) of Title 38, United States Code, regarding submission of an annual report to the Secretary
of Labor concerning employment of certain veterans; and
(2) such entity has not submitted a report as required by that section for the most recent year for
which such requirement was applicable to such entity.
Section 514. None of the funds made available in this Act may be used to promulgate or adopt any
final standard under Section 1173(b) of the Social Security Act (42 U.S.C. 1320d-2(b)) providing for, or
providing for the assignment of, a unique health identifier for an individual (except in an individual’s
capacity as an employer or a health care provider), until legislation is enacted specifically approving the
standard.
SPECIAL CONDITIONS
1. This grant, when executed, establishes a legal relationship between the U. S. Department of Labor
(the Department) and the grantee. Payments under this grant shall be made through the Advance
Payment/Payment Management System unless otherwise indicated in accordance with 29 CFR Part
97.21.
2. The grantee hereby agrees that any allowable WIA costs incurred by the awardee pursuant to this grant
prior to the obligation of WIA funds by the Department are incurred at the grantee's own risk. The
Department has no responsibility to reimburse such costs in the absence of an obligation.
3. The grantee agrees to comply with the reporting instructions issued by the Indian and Native American
Program (INAP).
4. Matching Funds:
Will be required for programs under this grant.
X Will not be required for programs under this grant.
5. The Grant Officer's Technical Representative is not authorized to change any of the terms or
conditions of the grant. Such changes, if any, will be accomplished only by the Grant Officer by the
use of a properly executed grant modification.
6. Grantee must receive prior approval from the Department /Employment and Training Administration's
Property Officer for the purchase and/or lease of property and/or equipment having a useful life of
more than one year and an acquisition cost which equals the lesser of (a) the capitalization level
established by the organization for financial statement purposes or (b) $5,000.
Items of equipment with an acquisition cost of less than $5,000 are considered to be supplies and are
allowable as direct costs of Federal awards without specific awarding agency approval. The request
must be directed through your Grant Officer's Technical Representative and must include a detailed
description and cost of the items to be acquired.
7. In compliance with Executive Orders 12876, 12900, 12928, and 13021, the grantee is strongly
encourage to provide sub-granting opportunities to Historically Black Colleges and Universities,
Hispanics serving Institutions, and Tribal Colleges and Universities.
SPECIAL CLAUSE NO. 1 - INDIRECT COST
SPECIAL NOTE: This clause is to be utilized only for those grantees seeking indirect costs. It is to
be utilized for all affected grants and modifications.
In order to avoid major audit problems, disallowed costs and to receive timely reimbursement of indirect
costs, grantees should take those necessary steps to comply with this clause as well as the critical
timeframes for submission of indirect cost proposals.
You are governed by, and must comply with one of the following cost principle categories:
(1) Federal Acquisition Regulation (FAR) Subparts 31 and 42 apply to private-for-profit contractors;
(2) OMB Circular A-87 applies to state and local governments and Federally-recognized Indian Tribes.
States receiving WIA formula-allocated funds can elect to waive A-87 coverage; (3) OMB Circulars A-
21, A-88 and FAR 42.705-3 apply to educational institutions;
(4)OMB Circular A-122 applies to nonprofit institutions excluding those addressed in the preceding as
well as hospitals.
The total amount of grant funds will not be increased to reimburse grantee organizations for costs which
exceed the total award due to indirect cost rates higher than anticipated. In addition, the application of
approved indirect cost rates does not relieve the grantee of any other cost limitations regarding the grant.
INDIRECT COST RATES AND COST ALLOCATION PLANS
Review the following Options and check the applicable statement:
OPTION 1: DOL IS THE ONLY FUNDING SOURCE FOR THIS GRANTEE
DOL is the only funding source for this grantee, therefore, no Indirect Cost Rate
Agreement or Cost Allocation Plan is needed.
OPTION 2: GRANTEES WITH MULTIPLE FUNDING SOURCES
Grantees should have either an approved Indirect Cost Rate Agreement or an approved Cost
Allocation Plan. If a grantee does not have an Indirect Cost Rate Agreement or approved Cost
Allocation Plan, a proposal/plan must be sent to the appropriate cognizant Federal agency for
approval. If the Department of Labor (DOL) is your cognizant agency, proposals for indirect cost
rates and supporting data and documentation should be sent to the DCD Negotiator in the appropriate
DOL Regional Office or if applicable, to the DCD National Office whose address and phone number
listed below. In addition, if you do not know your cognizant Federal agency, please call the phone
number listed below:
Director
Division of Cost Determination
U. S. Department of Labor
OASAM
200 Constitution Avenue, N.W., Room S-1510
Washington, D. C. 20210
Phone Number: (202) 693-4100
An approved Indirect Cost Rate is in place.
An approved Cost Allocation Plan is in place.
An Indirect Cost Proposal has been submitted to its’ cognizant agency. A copy of the letter
transmitting the proposal is attached.
SPECIAL CLAUSE NO. 2 KEY OFFICIALS
A. Department of Labor Representatives. The grantee organizations primary contact with the
Department is the Indian and Native American Program Grant Officer's Technical Representative
(GOTR) (Federal Project Officer). Although the GOTR is the primary contact, under no circumstances
is the GOTR authorized to sign grant documents or approve any alterations to the grant involving a
change in the period, scope, price, or other terms and conditions of the grant or order requiring the Grant
Officer's approval. Grantees will be notified by INAP of the assigned GOTR and of changes in the
assignment as they occur.
B. Grantee Representatives. Please list below the names and telephone numbers of those individuals
(i.e., signatory official(s), WIA Director, organization's comptroller, contract officer, etc). who are
authorized and responsible for the operation and the administration of the grant program. A
modification to your grant is not necessary to record changes of listed individuals, except for signatory
officials. However, the INAP GOTR should be advised in writing of changes as they occur.
NAME AND TITLE: _________________________________________________
PHONE NO.: _____________________________ Signatory? Yes No
NAME AND TITLE: _________________________________________________
PHONE NO.: _____________________________ Signatory? Yes No
NAME AND TITLE: _________________________________________________
PHONE NO.: _____________________________ Signatory? Yes No
NAME AND TITLE: _________________________________________________
PHONE NO.: _____________________________ Signatory? Yes No
NAME AND TITLE: _________________________________________________
PHONE NO.: _____________________________ Signatory? Yes No
NAME AND TITLE: _________________________________________________
PHONE NO.: _____________________________ Signatory? Yes No
NAME AND TITLE: _________________________________________________
PHONE NO.: _____________________________ Signatory? Yes No
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(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: Prime 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and
Subawardee Address of Prime.
Tier if known:
Congressional District, if known: Congressional District, if known:
6. Federal Department/Agency: 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 Entity b. Individuals Performing Services (including address if different
(if individual, last name, first name, MI): from No. 10a) (last name, first name, MI):
(Attach Continuation Sheet(s) SF-LLL-A, if necessary) (Attach Continuation Sheet(s) SF-LLL-A, if necessary)
11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply)
actual planned $ a. retainer
b. one-time fee
12. Form of Payment (check all that apply): c. commission
d. contingent fee
a. cash e. deferred
b. in-kind; specify: f. other, specify:
nature value
14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or
Member(s)
contacted, for Payment Indicated in item 11:
(attach Continuation Sheet(s) SF-LLL-A, if necessary)
15. Continuation Sheet(s) SF-LLL-A attached: YES NO
16. Information requested through this form is authorized by title 31
U.S.C. section 1352. This disclosure of lobbying activities is a Signature __________________________________________
material representation of fact upon which reliance was placed by
the tier above when this transaction was made or entered into. This Print Name: ____________________________________
disclosure is required pursuant to 31 U.S.C. 1352. This information
Title: _______________________________________________
will be reported to the Congress semi-annually and will be available
for public inspection. Any person who fails to file the required Telephone Number: Date:__________
disclosure shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure.
Authorized for Local Reproduction Standard Form - LLL-A
DISCLOSURE OF LOBBYING ACTIVITIES CONTINUATION SHEET
Reporting entity: Page .
Approved by OMB 0348-0046 Authorized for Local Reproduction Standard - LLL-A
CERTIFICATION REGARDING LOBBYING ACTIVITIES
Section 18 of the “Lobbying Disclosure Act of 1995," signed by the President on December 19, 1995,
requires that any organizations described in Section 501(c)(4) of the Internal Revenue Code of 1986
which engages in lobbying activities shall not be eligible for the receipt of Federal funds constituting an
award, grant, loan, or any other form.
As an officer of
Company Name
1. This is to certify that our IRS Status is:
An IRS 501 (c) (3) entity
An IRS 501 (c) (4) entity
Other (specify) entity
2. If your organization is a 501(c)(4) entity, as checked under No. 1 above, select one of the
statements below:
We have or plan to engage in lobbying activities.
We have not or will not engage in lobbying activities.
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