HomeMy WebLinkAboutFederal Fund Grant
Title II Formula .Grants Program
Application for Federal Funds
Original applications should be postmarked no later than February 1 st to:
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Indiana Criminal Justice Institute
ATTN.: Youth Division
One North Capitol Avenue, Suite 1000
Indianapolis, IN 46204-2038 .
(317) 233-3340
*N 0 faxed copies will be accepted
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Indiana Criminal Justice Institute
TITLE II FORMULA GRANTS PROGRAM
(See Appendix A for instructions, program description and guidelines.)
1
o Continuation Project
[g] New Project
Previous Grant Numbers for this Project:'
2 Project Title: . At-Risk Behavior Diversion Program
3 Name of Agency/Organization: City of Jeffersonville
Address: 500 Quartermaster Court
City: Jeffersonville State IN Zipcode: . 47130 - County: Clark
Email: n1a Tel: 812 / 285 / 6400 Fax: 812 / 285 / 6403
4 Financial Officer: Peggy Wilder, City Clerk Treasurer
Address:
City: Jeffersonville State IN Zipcode: 47130 - County: Clark
Email: n1a Tel: 812 / 285 / 6400 Fax: 812 / 285 6403
Federal Employer ID
5 Number: 035- 6001067
(\ 6 Type of Agency/Organization: o State o Comity [g] City o Town o Other .
7 Location of Agency/Organization: U.S. Congressional District: 9 State Judicial District: 9
8
Name of Agency/Organization: Clark County Youth Shelter & FamilyServices, Inc; .'
Address: 118 E. Chestnut, P.O. Box 886
City: Jeffersonville State IN Zipcode: 47131 -
Email: ccadrnin@ccysfs.org Tel: 812 / 284 /. 5229
Fax:
County:
812 /
Clark
284 / 5301
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Project Director: Laura Fleming-Balmer, Executive Director
Address: 118 E. Chestnut St., P.O. Box 886
City: Jeffersonville State ~ Zipcode:
Email: ccadrnin@ccysfs.org Tel: 812 /.284
'47131 -
/ 5229 Fax:
County: Clark
812 /'284 / 5301
10
Other Contact: A. Schneidau
Tel: 812
/ 284 / 5229
Email:
ccys@ccysfs.org
11 Amount of Funding Requested I $
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12a How many volunteers will be used for this project? 1
12b How many juveniles are expected to receive direct servites ftomthis project?
1144
2
A Ptoject Abstract. Provide a short summaryQfthe proposed project to be funded. A good project .
abstract is not a discussion of the problem, but should instead provide reviewers wIth an overview of the
proposal in one or two paragraphs.
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The At-Risk Behavior Diversion Program will address behaviors of youth ages 11 to 18 that typically lead youth to
committ status offenses and/or other offenses and increase the liklihood of future incidences of crime. Our focus
will be on four behaviors specifically: truancy, anger management, shoplifting, and alcohol abuse. Under the
umbrella of At-Risk Behavior Diversion, we plan to offerAngerManagement classes, which will provide youth
skills for addressing conflict in constructive rather than destructive ways; Truancy Diversion classes, which will
address the roots of the truancy problem and altermitives to handle the stressors which cause truancy in many
cases; Shoplifting Prevention, which helps youth identify the feelings, thoughts and actions thatled them to
shoplift; and Alcoholics Anonymous for Teens, a support group for youth coping with alcoholism.
B Problem Identification Statement. Provide a brief problem identification statenientby succinctly
stating the problem in your community that you intend to address through the proposed project.
Community is defined as a neighborhood, city, county, group of counties, or the state as a whole. Data
and information illustrating the problem should be included as part of your statement.
More than half of the clients who are placed with the Clark County Youth Shelter &family ServiCes, Ihc.haveexperienced
a problem with truancy. This signifies that youth believeskippihg school is a reasonable and acceptable manner to
handle problems at home and/or at school and have very little concern or forsight to the consequences of repeated
absences. In addition to this, nearly 100 percent of the clients at CCYS have reported experiencing unacceptable
responses to feelings of anger at one time or another, some of which result in charges, such as battary or other
misdemenor offenses. Shoplifting and alcohol abuse continue to be commonplace occurrances for many of our
youth, who believe their actions are "no big deal" because "everybody's doing it." Our At-Risk Behavior Diversion
Program will address each of these problems with separate weekly classes, focused on support, education and
ultimately diversion.
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Project Description. Describe the project that is being proposed and how itaddressesthe problem you
identified in your Problem Identification Statyment. A good project description will (a) describe an
approach or remedy to the problem (including a indication.ofthe evidence-based model utilized to
develop the project), (b) list the people who will benefit from the project (be as specific as possible,
including both direct and indirect beneficiaries), and (c) indicate the timeline for determining successful
outcomes for this project. If the proposed project is a continuation project, please also provide a brief
summary of the achievements of the project up to this point.
The At-Risk Behavior Diversion Program is an umbrella to address four components of at-riskbehaviors: anger, truancy,
alcohol abuse, and shoplifting. We propose to provide separate weekly meetings to youth ages 11 to 18 that address each of
these four behaviors. The meetings will be attended by residents of oW' shelter facility, referred clients, and voluntary
participants throughout Southern Indiana. These clients vary in ethnicity, sex and economic status. The curriculum for
Anger Management, Shoplifting Prevention and Truency Diversion will be taken from tried and true,. sdentifically proven
programs, which we will purchase. The alcohol abuse program will follow the practices of Alcoholics Anonymous for .
Teens, using literature from that program and a volunteer facilitator, as is practiced in all AA programs. We anticipate
hosting these meetings on an on-going basis, with results measured by pre-tests and post-'tests and feedback rrom the
juvenile probation and court system. This feedback should indicate a decrease in truancy charges as well as fewer
incidences of shoplifting and anger-related crimes. We expect to evaluate our outcomes on an annual basis. Ultimately, we
hope to provide youth and outlet for support and the tools for making better choices. .
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D Funds from this grant program can be used to address specific purpose areas. These purpose areas are
li::;ted below in no particular order. Please review the information and place a checkmark iIi the box next
the purpose area that most appropriately matches the project for which you are requesting funding.
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D Community Assessment Centers. Funding for centers that lead to more integrated and eff.ective ctoss-
system services for juveniles and their families. CACs are designed to positively impact the lives of youth
and divert them from a path of serious, violent, and chronic delinquency. Using a collaborative approach,
CACs serve the community in a timely, cost-efficient, and comprehensive manner. (03)
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Delinquency Prevention. Programs, research, or other initiatives designed to reduce the incidence of
delinquent acts and directed to the general youth population thought to be at-risk of becoming delinquent.
This category includes what is commonly referred to as "primary prevention", but excludes programs
targeted at youth already adjudicated delinquent, and those programs designed specifically to prevent
substance abuse activities that are to be funded under program area 15. (07)
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Substance Abuse Programs. Programs, research, or other initiatives designed to address the use and abuse
of illegal and other prescription and nonprescription drugs and the use and abuse of alcohol. Programs may
include prevention, control, and/or treatment. (15)
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In c~1n (a), list the overall Goal of the proposed project. In column (b), list t)three specific Project Objectives related to that goal. And in column ,)st
the Performance Measures you will be using to report progress under the specific program purpose area chosen under Section D above. Please refer to Appendix A
of this application for definitions and examples of Project Goals, Project Objectives, and Performance Measures (by purpose area).
E
See Appendix A for a description of
the Output & Outcome Performance
Measures & requirements for choosing
specific outputs & outcomes.
List the overall goal of your project. List up to three specific objectives
that support the project goal.
1.
To reduce instances of at-risk
behaviors in youth.
90% of Anger Management course
1. participants can identify alternatives
to acting out in a violent manner.
Output Indicators:
Output: Program area #9:
Number of youth served;
Program area #32:
N umber of youth served.
Output: program area #9:
Utilization rate
Program area #32:
Use of best practice model.
Output: Program area #9: -
Money per youth-served
Program area #32:
Average number of service hours completed.
75% of Truancy Diversion Program
2. participants complete the course _
without an absense.
Outcome Indicators:
Outcome: Program area #9:
Number and'percent of youth arrested.
Program area #32:
Number and percent of youth arrested;
5.
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95% of all AlcohoHcs Anonymous for
3 Teens attendees report having a plan
. to avoid alcohol consumption at the
end of each meeting.
Outcome: Program area #9:
Number and percent of youth completing
program requirements.
Program area #32:
Number and precent of youth completing
program requirements.
Outcome: Program area #9:
Number and percent of youth exhibiting a
change in antisocial behavior.
Program area #32:
N umber and percent of youth exhibiting a
change in substance abuse.
Outcome: Program area #9:
Number and percent of youth/families
satisfied with program.
Program area #32:
N umber and percent of staff satisfied with
program.
Outcome:
Outcome:
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F
Db you have other sources of funding to help support this project:.
o Yes; What proportion of the project will be paid forby other sources (e.g,25%, 75%:
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If yes was checked above, briefly describe the other sources offl,lnding that you have for the project.
G Please provide a sustainability plan detailing how your project will be supported once cn funding is
discontinued. .
Once our programs are established, if our funding is discontinued we plan to work with the local
juvenile justice system to establish fees for clients who participate in our classes.
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H As required by the Juvenile Justice & Delinquency Prevention Act (JJDPA) of 2002, discuss how the
project will assist the State in addressing any overrepresentation of minority youth in the juvenile justice
system. Include a discussion of effprts to specifically address the needs of minority youth and families
in the community. If not applicable, provide justification (e.g. less than 1 % minority population in the
jurisdiction).
The At-Risk Behavior Diversion Program will be designed to meet the needs of every individual
because each case is different. Therefore, mirtorityyouth will receive attention as individualized as are
their cases.
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As required by the JJDP A of 2002, describe how the proposed project, if applicable, would address the
need for gender relevant programming, particularly for female youth, to promote the prevention of and
intervention in juvenile delinquency. If not applicable, please provide an explanation.
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The At-Risk Behavior Diversion Program is not specifically gender relevant. The program is designed
to meet the needs of every individual no matter sex, race, or economic status.
J Place a checkmark next to all of the types of agencies/organizations that you will collaborate or
coordinate with on the proposed project and then provide the name of each agency/organization in the
space provided. It is recommended that you provide letters of support or memorandums of
understanding with the application for those organizations listed below,
Criminal Justice/Government Agencies
o Law Enforcement:
l:8J Court(s): Clark County Superior Court #1
o Prosecution:
l:8J Probation: Clark SuperioJ; Court #1 Probation
o CorrectionslDetention:'
o Other:
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Non-Criminal Justice Government Agencies
l:8J Social Services: Any referring agency
l:8J Mental Health: Any referring agency
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[:g]
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Schools: Any referring school or organization
Public Housing:
Other:
Private Non-Profit Agencies
[:g] Mental Health: Any referring agency
[:g] Y outh/Family Serving Agencies: Any referring agency
D Hospital:
D Faith-Based Organizations:
[:g] Other: Alcoholics Anonymous
Other (e.g., business sector)
D Specify:
D Specify:
K Who will evaluate the effectiveness ofthe project (check all that apply):
[:g]
D
Sub grantee agency personnel
Independent evaluators (e.g., university research staff)
Please specify:
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L How will the effectiveness of the project be evaluated? Provideabrief description of the evaluation plan
for the project below. . .
Pre-tests and post-tests will be taken for Anger Management, Shoplifting Prevention and Truancy
Diversion classes. Results of these tests will indicate the success, and .effectiveness of those program.s. In
addition, the Juvenile Probation Department will be able to track the number of truancy cases and
shoplifting charges to determine the effect of our programs on youth decision making. The Alcoholics
Anonymous for Teens meeting will be evaluated sim.ply by attendance and interest in the program.
Currently, teen AA meetings are rare in our Southern Indiana area. We anticipate that, with word of
mouth and simple promotion, this meeting <.:ould become very well attended.
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Indiana Criminal Justice Institute
TITLE II FORMULA GRANTS BUDGET WORKSHEET
(See attached instructions for the Budget Worksheet.)
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For ICJI Use Only
LEGAL APPLICANT:
City of Jeffersonville
Grant Number:
Date Received:
/
/
lame oSItion It. e 'I Hne Sa arv Talle Benefits Tota. jost
Merlyn Schleicher Bookkeeper 3% $ 4735.64 $ 0.00 $ 142.06
. .
Amy Schneid au Assistant Director/Developffi(mt 2% $ 25771.20 $ 0.00 $ 515.42
Laura Fleming-Balmer Executive Director 1% $ 54870.40 $0.00 $ 548.70
Rich Roselli Residential Director/Counselor 2% $ 35006.40 $0.00 $ 700.13
$ $ $
.
$ $ $
, $ $ $
. . $ $ $
I New Hires & Existing Employees Subtotal .
$ 120383.60 $ 0.00 $ 1906.31
P .. /T'l
% of Gross
. ~ I /\\
:Fringe
N
IC
r, 'Name
Position/Title
0/0 of
Time
Total Hours
V ohmteered
Unknown AA for Teens Meeting Leader 72
.
.
.
Name of COlltractor
Type of
Contractor
Nature of Job or Service
Fee Basis Total Cost
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Unknown facilitator Anger Management group facilitator $30/hr $ 2340.00
Unknown facilitator Shoplifting Prevention group facilitator $30/hr $ 2340.00
Unknown facilitator Truancy Diver~ion group facilitator. $30/hr $ 2340.00
$
~--- $
, !
I $
$
I Contractual Services Subtotal $ 7020.00
TITLE II FORMULA GRANTS BUI>GET WORKSHEET
(See attached instructions for the Budget Worksheet.)
Destination
Item
Ex ense
Office Supplies (paper, copies, pens)
Toilet paper/tissues
Alcoholics Anonymous literature
Meeting refreshments
Truancy Diversion Program (complete)
Anger Management Program (complete)
Shoplifting Prevention Program (complete)
Television/DVD player
Transporbltion Per Diem Lodging Total Cost
$ $. $. $
$ $. $. .$
$ $ $ $.
$ $. $ $.
$ $ $ $.
$0.00 $. 0.00 $ 0.00 $. 0.00
Pur ose
Travel Subtotal
Lease/Rent!
Purchase Quantity
o
Unit Price
Total Cost
$
$
$
$
$
$
$
$
$
$
$0.00
$
$
$
$
$
$
$
$
$
$
$ 0.00
Unit Price Total Cost
$5.00 $ 1040.00
$ $ 200.00
$ $ 500.00
,
$10.00 $ 2080;00
$ $
$ $
$ $
$ 300.00 $ 300.00
$ $
$ $
$ $
TITLE II FORMULA GRANTS BUDGET WORKSHEET
(See attached instructions for the Bildget Worksheet.)
a. PERSONNEL (NEW HIRES & EXISTING EMPLOYEES SUBTOTAL)
$ 1906.31
$ 7020.00
b. CONTRACTUAL SERVICES
c. TRAVEL
$ 0.00
d. EQUIPMENT
$
e. OPERATING EXPENSES
$
f. GRAND TOTAL
$
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Amount of
Funding Requested
Indiana Criminal Justice Institute
INSTRUCTIONS FOR TITLE II FORMULA GRANTS BUDGET WORKSHEET
New Hires & Existing Employees: Newly hired and existing employees paid with grant funds should be listed here.
Column J:
Column 2:
Column 3:
Column 4:
Column 5:
Column 6:
List the name of each person paid with grant funds.
List each person's position/title.
List the percent of time each person will devote to this grant.
List each person's gross salary/wage. .
List the total of fringe benefits to be paid to each person (such as FICA, insurance, unemployment compensation.)
Enter the sum of gross salary/wage and fringe benefits under total cost.
Then provide the gross salary/wage, fringe benefits and total costsubtotals for all employees. Please note that for each individual,
fringe benefits may not exceed 3 J. 34% of the dollar amount listed in the total cost column (column 6).
V olunteers: Individuals who will be volunteering for this project should be listedl1ere.
Column J:
Column 2:
Column 3:
Column 4:
List the name of each volunteer.
List each person's position/title.
List the percent of time each person will devote to this grant.
List the total hours that each person will volunteer.
r", !Job descriptions and resumes of personnel, if available, should be attached for each individual.
Column 1:
Column 2:
Column 3:
Column 4:
Column 5:
List each consultant, association, group or firm that will be contracted with to provide services to the project.
List the type of consultant fromcolumn 1 (individual, association or organization).
Provide a brief description of the job or service each contractor vvill provide.
List whether the consultant will be paid hourly, daily, weekly, monthly or with a flat fee.
Enter the total cost for each contractor, including travel expenses.
Then provide the total cost subtotal for all contractual services. Please note that compensation for contractual services cannot
exceed $450.00 per eight-hour day (excluding travel and per diem), includingfringe benefits. The maximum rate for compensation
for consultants workingfor educational institutions is the consultant's academic salary (project for 12 months) divided by 260.
Each line in this section of the budget should be used to record travelexpenses for one individual, not expenses for several people
traveling to the same destination. Additional lines should be used to separately record travel expenses for other people going on the
same trip. Travel expenses for consultants should be listed under Contractual Services.
Column 1:
Column 2:
Column 3:
Column 4:
Column 5:
Column 6:
List the travel destination.
Indicate the purpose for traveling to each destination (e.g., IYI .K.id$ Count in Indiana Conference). .
Indicate the total cost associated with transportation to each destination. Transportation costs include car mileage
($.28/rnile), bus fare, airfare, parking expenses, etc. .
Indicate the total per diem for daily subsistence (meals, etc.) associated with each trip. The maximum per diem
rates permitted are $26.00Iday for in-state trayel and $32.00/day for travel out of state.
Enter the total cost oflodging when overnight travel is involved. The maximum lodging rate permitted is
$79.00/night plus tax for in-state lodging.
Enter the sum of total transportation, total per diem andtotalJodging costs.
Then provide the transportation, per diem, lodging and total cost subtotals for aU travel expenses.
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INSTRUCTIONS FOR TITLE II FORMULA GRANTS BUDGET WORKSHEET
Column 1:
Column 2:
Column 3:
Column 4:
Column 5:
List all equipment to be purchased with grant funds:
Indicate whether each item will be leased, rented or purchased.
Indicate the quantity of each equipment item that will be acquired.
Indicate the per unit cost of each equipment item.
Multiply item quantity by the unit cost of each item and enter this amount under total cost.
Then provide the quantity, unit price and total cost subtotals for all equipment. Please note that items that can be purchased for less
than $5,000.00 should be included in Operating Expenses rather than this category.
Column 1:
Column 2:
Column 3:
Column 4:
Column 5:
Column 6:
List all expenses to be paid with grant funds. Expenses can include rent (provide square footage and cost per square
foot for rental), telephone service, utilities, reproduction of documents, printing, and other charges.
List square footage (only for rental space).
List cost per square foot (only for rental space).
Indicate the quantity of each item that will be acquired { e.g., 2 word processing software packages, 12 months of
telephone service, etc.). .
Indicate the per unit cost of each item. . ..
Multiply item quantity by the unit cost of each item and enter this amount under total cost.
. . ~ . .
Then provide the quantity, unit price and total cost subtotalsJor all operating expenses. Items that can be purchased for less than
$5,000.00 should be included here (e.g., Software or other electronic office supplies may be included as operating expenses if the
cost ver item is less than $5.000.00'>
Column 1:
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Total Proiect Costs __ Enter each of the subtotal amounts you calculated for budget items A through E (Project
Personnel, Contractual Services, etc.). Add these. amounts together and enter the sum in the last row, Grand Total.
This amount represents the amount of grant funding requested.
Carry this amount forward to item L on page 2 of your grant application.
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Indiana Criminal Justice Institute
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TITLEII FORMULA GRANTS PROGRAM
CERTIFIED ASSURANCESAND SPECIAL PROVISIONS.
(Please include a copy of the certified assurances and special provisions with the application and retain a copy for your records.)
A. Financial and Administrative Management
1. The applicant assures that it will comply with. applicable financial and administrative OMB. Circulars A -87-102
(Common Rule), A-llO, and A-133, and will comply with the provisionsofthe Office. of the Comptroller, Office
of Justice Programs, OC Financial Guide, current edition.
2. The applicant assures that it will maintain generally accepted accounting procedures to provide for accurate and
timely recording and receipt of fund by source, by expenditure by. item made from such funds, and of unexpended
balances. Adequate controls will be established to ensure that expenditures charged to grant activities are for
allowable purposes and documentation is readily available to verify that such charges are accurate.
3. In compliance with Single Audit Act of 1984,P.L. 98-502, the applicant agrees to provide the Indiana Criminal
Justice Institute with copies of its annual audit reports performed by the Indiana State Board of Accounts.
B. Match and Non-Supplanting of State/Local Funds
1. The applicant assures that federal funds made available through this grant will not be used to supplant state or
local funds, but will be used to supplement and increase the amounts of such funds that would, in the absence of
federal funds, be made available.
2. The applicant certifies that matching funds required to pay the non-federal portion of the cost of this sub grant are
in addition to funds that would have otherwise been made available for the purposes of this project and are not
other federal grant funds.
C. Discrimination Prohibited
r> 1. The applicant assures that it will comply with the nondiscrimination requirements of the OllUlibus Crime Control
and Safe Streets Act of 1968, as amended, 42 USC 3789(d); Title VI of the Civil Rights Act of 1964, as amended;
Section 504 of the Rehabilitation Act of 1973, as amended; Subtitle. A, Title II of the Americans with Disabilities
Act ADA (1990); Title IX of Education Amendments of 1972; the Age Discrimination Act of 1975; the
Department of Justice regulations on disability discrimination, 28 CFR Part 25 mid Part 39; and Executive Order
11246, as amended by Executive Order 11375, and their implementing regulations, 41 CFR Part 60.1 et.seq., as
applicable to construction costs.
2. The applicant assures that in the event a federal or state court or administrative agency makes, or had made, a
finding of discrimination after a due process hearing onthe grounds of race, color, religion, na.tional origin, sex, or
disability against it, the applicant will forward a copy of the finding to the Indiana Criminal Justice Institute within
45 days of the finding, or, if the finding occurred prior the grant award, within 45 days of the award date.
D. Federal Laws & Regulations Applicable to Federal Assistance Programs
1. Recipient will comply with Federal laws and regulations applicable to federal assistance programs and with
provisions of 28 CFR applicant to grants and cooperative agreements including Part II, Applicability of Office of
Management and Budget Circulars; Part 18, Administrative Review Procedure; Pa,rt 20, Criminal Justice
Information Systems; Part 22 Confidentiality ofIdentifiable Research and Statistical Information; Part 23 Criminal
Intelligence Systems Operating Policies; Part30, Intergovernmental Review of Departni.ent of Justice Programs
and Activities; Part 42, NondiscriminationEqual Employment Opportunity PoliGies and Procedures; Part 61,
Procedures for Implementing the National Environmental Policy Act; and Part 63, Floodplain Management and
Wetland Protection Procedures; .
E. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Lower Tier Covered
Transactions (Subgrantees receiving $100,000 or more)
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1. As required by Executive Order 12549,28 CFR Pan 67, Section 67.510, the applicant certifies that it and its
principles: .
(a.) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to denial of
Federal benefits by a State or Fede.ral court, or voluntarily excluded from covered transactions by any Federal
department or agency;
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TITLE II FORMULA GRANTS PROGRAM
CERTIFIED ASSURANCES AND SPECIAL PROVISIONS
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(b.) Have not within a three-year period preceding this application been convIcted of or had a civil judgment
rendered against them for commission of fraud or criminal offenses in connection. with obtaining, attempting
to obtain, or performing a public (Federal or State) 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.
(c.) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal,
State, or local) with commission of any of the offenses enumerated in the paragraph (l)(b) of this
certification; and
(d.) Have not within the a three-year period preceding this application had one or more public transactions
(Federal, State, or local) terminated for cause or default; and .
2. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an
explanation to this application. .
F Certification Regarding Lobbying*. As required by Section 1352, Title 31,28 CFR, Part 69, the prospective
sub grantee certifies, by submission of this proposal, that:
1. No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for
influencing or attempting to influenc.ean officer or employer of any agency, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of Congress in connection with waking any Federal grant, the
entering into of any cooperative agreement, and the extension, continuation, or renewal, amendment, or
modification of any Federal grant or cooperative agreement; .
2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influence 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 grant or cooperative
agreement, the undersigned shall complete and submit Standard Form- LLL, "Disclosure of Lobbying Activities,"
in accordance with "its instructions;
3. The undersigned shall require that language of this certification beincluded in documents for all contracts or
r, cooperative agreements under this grant and that all contractees shaUcertify and disclose accordingly.
* The Anti-Lobbying Act, 1SD.S.C. ~ 19i3, recimtlywasamendtld to expanclsignificantly the f.estriction on use
of appropriated funding for lobbying. This expansion also maktls the anti-lobbying restrictions enforceable via
large civil penalties, with civil fines between $10,000 and $100,000 for each individual occurrence of lobbying
activity. These restrictions are in addition to the anti-lobbying and lobbying disclosure restrictions imposed by
31 D.S.C. ~ 1352.
OMB is currently in the process of amending the OMB cost circulars and the common rule (codified at 28
C.F.R. part 69 for DOJ/OJJDP grantees) to reflect these modifications~ However, in the interest of full
disclosure, all applicants must understand that no federally appropriated funding made available under this
grant program may be used, either directly or fndirectly,to support the enactment, repeal, modification, or
adoption of any law, regulation or policy at any level of government, without the expr~ss approval by the
OJJDP through the Office of Justice Programs. Any violation of this prohibition is subject to a minimum
$10,000 fine for each occurrence. This prohibition applies to all activity, even if currently allowed within the
parameters of the existing OMB circulars.. .
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TITLE II FORMULA GRANTS PROGRAM
CERTIFIED ASSURANCES AND SPECIAL PROVISIONS
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G. Drug-Free Workplace (Subgrantees other than individuals)
1. As required by the Drug-Free Workplace Actofl988 anddefiiled at28CFR, Part 67, Sections 67.615 abd 67.620,
the applicant certifies that it will or willcoritinue to provide adrug-free workplace by:
(a.) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing,
possession, or use of controlled substances is prohibited in the grantee's workplace and specifying the actions
that will be taken against employees for violation of such prohibition;
(b.) Establishing an on-going drug-free awareness program to inform employees about the dangers of drug abuse
in the workplace; the grantees policy of maintaining a drug-free workplace; any available drug counseling,
rehabilitation, and employee assistance programs; and the penalties that may be imposed upon employees for
drug abuse violations occurring in the workplace;
(c.) Making it a requirement that each employee to be engaged int4e performance of the grant be given a copy of
the statement required by paragraph (a). . '.' . .
(d.) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under
the grant, the employee will- . .
1. Abide by the terms of the statement; and' .'
2. Notify the employer in writing of his or her conviction for a violation of crihrinal drug statute occurring
in the workplace no later than five (5) calendar days after such conviction. Employers of convicted
employees must provide notice, including position title, to: Department of Justice, Office of Justice
Programs, ATTN: Control Desk, 633 Indiana Avenue,N.W., Washington, D.C. 20531.
3. Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph
(d)(2), with respect to any employee who is so convicted~' .
a. Taking appropriate personnel action against such an employee, up to and including ternrination,
consistent with the Rehabilitation Act of1973, 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;
c. Making a good faith effort to continue to maintain a drug-free workplace through the
implementation of paragraphs (a), (b), (c), and (d)(1)(2)(3).
n
16
Indiana Criminal Justice Institute
(\
TITLE II FORMULA GRANTS PROGRAM
CERTIFICATIONS & ACCEPTANCE
(All signatures must be original signatures)
The APPLICANT, through the following signatories, certifies that the statements in this grant are true and complete to the
best of the APPLICANT'S knowledge and accepts, as to any grant awarded, the obligation to ,comply with anylndiana
Criminal Justice Institute special conditions specified in the Grant Award. "The signatories certify that we have read the
instructions for this application and are fully cognizant of our duties and responsibilities with regards to the implementation
of the project proposed in the application."
. Official for Legal Applicant _ A representative of the Legal Applicant identified in Number 3 on page 2 of the grant
application.
. Director of Implementing Agency - Director or similar representative of the Implementing Agency Identified in
Number 8 on page 2 of the grarit application.
. Project Director - The Project Director identified in Number 9 on page 2 of the grant application.
. Financial Officer _ The Financial Officer (County Auditor, City Controller, City Clerk-Treasurer, Town Treasurer or
other individual) identified in Number 40n page 2 of the grant application.
A. Signature
Official for Legal Applicant
Date
Title
B. Signature
Director of Implementing Agency
Date
Title
C. Signature
Proj ect Director
Date
Title
D. Signature
Financial Officer
Date
n
Title
17