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Home My WebLink AboutRES 192 Draft 01 2010-2012 �J�t7 Osh ;i•COUNTY OF HAWAII -• �' ��+ STATE OF HAWAII ....................... F•M.i► RESOLUTION NO. 192 11 RESOLUTION AUTHORIZING THE OFFICE OF THE MAYOR TO ENTER INTO AN AGREEMENT WITH THE STATE OF HAWAII DEPARTMENT OF HEALTH, PURSUANT TO HRS 46-7, TO IMPLEMENT THE HAWAII TEEN OUTREACH PROGRAM (HITOP) IN HAWAII COUNTY WHEREAS, the State of Hawaii Department of Health, Family Health and Human Services Division received a grant from the U. S. Department of Health and Human Services to implement the evidence-based Teen Outreach Program in Hawaii County; and WHEREAS, the Prosecuting Attorney's office has agreed to implement the project throughout the Island of Hawaii; and WHEREAS, the goal of the Hawaii Teen Outreach Program (HITOP) is to develop the positive potential of teens with the intended results of less risk-taking behaviors such as violence, school failure and teen pregnancy; and WHEREAS, Hawaii Revised Statutes, Section 46-7, requires that County departments obtain the consent of the council to enter into agreements with the Federal or State governments respecting action to be taken pursuant to any of the powers granted by law to furnish, expend, and receive any funds or other assistance in connection with projects being or to be undertaken pursuant to those powers; now, therefore, BE IT RESOLVED BY THE COUNCIL OF THE COUNTY OF HAWAII, in accordance with section 46-7, Hawaii Revised Statutes, that the Mayor of the County of Hawaii is authorized to execute, on behalf of the County, an agreement with the State of Hawaii Department of Health, to enable the County to conduct the Hawaii Teen Outreach program as outlined in the Letter of Intent, and Scope of Services, attached hereto and incorporated herein by reference as Exhibit "A", and related documents. BE IT FINALLY RESOLVED that the County Clerk of the County of Hawai'i shall transmit copies of this resolution to the Office of the Mayor, Office of the Prosecuting Attorney, and the Finance Department. Dated at Hilo , Hawai'i, this 2lstday of December , 2011. INTRODUCED BY: COUNCIL MEMBER, COUNTY OF HAWAII COUNTY COUNCIL County of Hawaii Hilo, Hawaii I hereby certify that the foregoing RESOLUTION was by the vote indicated to the right hereof adopted by the COUNCIL of the County of Hawai`i on December 21, 2011 ATTEST: 'COUNTY CLERK CHAIRPERSON & PRESIDING ROLL CALL VOTE Reference: C- 478 /FC -169 R RESOLUTION NO. 192 11 AYES NOES ABS EX BLAS X FORD X HOFFMANN X IKEDA X ONISHI X PILAGO X SMART X /ALONG X YOSHIMOTO X 8 0 1 0 Reference: C- 478 /FC -169 R RESOLUTION NO. 192 11 Exhibit "A" Nov-17-2011 02:14pm From-HEALTHY START 0087339078 T-860 P.002/002 F-883 P�"oyylo s R •, '4, .•`y' rt- ��f�1TAy FuODr ACE y,.NI•h NEIL CAN RCaOMpt� - , NRE OOvCKN9R Of HAM! I �d.�",�=-_.i:.� CI'oP of nEkY�� STATE OF HAWAII DEPARTMENT OF HEALTH In!it Moan"fef m: Fiki! HEALTH RESOURCES ADMINISTRATION FAMILY HEALTH SERVICES DIVISION MATERNAL AND CHILD HEALTH BRANCH 741-A SUNSET AVENUE HONOLULU,HAWAII 96816 November 17,2011 Ms. Charlene Iboshi Prosecuting Attorney Office of the Prosecuting Attorney Aupuni Center 655 Kilauea Avenue Hilo, Hawaii 96720 Dear Ms. Iboshi: Upon approval from the State Procurement Office on the evidence-based curriculum,it is the intent of the Maternal and Child Health Branch of the State Department of Health, to award the County of Hawaii's Office of the Prosecuting Attorney, a four year contract(or as Federal funds are available)to provide a comprehensive positive youth development program throughout Hawaii County. It is estimated that S200,000 will be made available following the contract execution; followed by a second year of funding of$150,000 and a third and fourth year for$11 5,000 each year ending September 30,2015. A formal contract will be sent as soon as a notice to proceed is received. We look forward to a long and rewarding partnership with you. Sincerely, AstiLis.„, r:: Barbara Y•ama, Maternal Chili . , lth Branch Chief Pro-wityWnip L Lfelerng,14 e‘Githr Er We rtedar NOV-17-2011 02:23PM From: 8087339078 ID:ADMNXRX Pa9e:002 R=96% •`� a '.:\;w Attachment-Si °? X0,5 , s„ ,.. STATE OF HAWAII SCOPE OF SERVICES 0.0 Description of the target population to be served The PROVIDER, the County of Hawaii Office of the Prosecuting Attorney(CHOPA), will establish the Teen Outreach Program(TOP) on the Island of Hawaii. It is a teen pregnancy prevention program directed specifically to the target populations of Native Hawaiians, Filipinos and other high risk populations of youth ages 13 to 17 years of age. 2.0 Time Schedule The PROVIDER shall provide the services required under this Agreement from December 1, 2011 to September 30, 2015, unless this Agreement is sooner terminated. 1.0 Service Activities A. The CONTRACTOR shall perform the following work: 1. Implement a 9-month Teen Outreach Program(TOP)as an in or out-of-school teen pregnancy prevention education programs that target 15 to 19 year old youth. Groups will consist of 25 participants of both genders. 2. Collaborate with community partners to identify participants and to build community support around youth advocacy and program development. 3. Identify at risk participants,through school officials and program partners,who have high risk behaviors such as:poor school performance, economic disadvantage, single or teen parents, family disruption,problem/delinquent behavior(alcohol/drug use,being part of a gang,physical fighting,carrying weapons), sexually active peers,peers with pro-childbearing attitudes and other risk factors for teen pregnancy. 4. Implement TOP in Hawaii County. a. Develop a Community Advisory Team to assist with the program development,provider and participant recruitment, cultural tailoring,and the program implementation of 20 TOP clubs with a minimum of one(1)in each of the eight(8)Hawaii County districts by December 2014; b. Recruit and train a minimum of ten(10)TOP club facilitators who will primarily be responsible for meeting program fidelity requirements,participant retention, data collection and assist with program and process evaluation duties. c. Provide at least two days a week, 180 minutes of programming for participants during the nine(9)month school year. TOP programming includes: 1. Structured classroom activity with training in the Changing Scenes Curriculum focusing on issues around values,relationships with family and peers, life skills and sexuality; 1 AG-011 Rev 07/28/2005 Attachment- S1 S:- STATE OF HAWAII SCOPE OF SERVICES 2. Service learning with community service projects and facilitated reflection that connects meaningful community service with academic learning, personal growth and civic responsibility; 3. A minimum of 3 hours per month of service learning for a total of 27 hours per program year for each participant. 4. Provide one participant and parent/adult interaction activity each month. d. Provide two training/meetings for facilitators per school year. e. Performance Measures 2 AG-011 Rev 07/28/2005 AUG 8 2019 ,s+'/ DEPARTMENT OF HEALTH &HUMAN SERVICES •'°^/ ADMINISTRATION FOR CHILDREN AND FAMIUES ADMINISTRATION ON CHILDREN,YOUTH AND FAMILIES 1250 Maryland Ave.,SW Washington,D.G.20024 July 27,2011 Director of Health State Department of Health Family Health Services Division 1250 Punchbowl Street Honolulu, HI 96813-2416 Re: Notice of Grant Award Personal Responsibility Education Program FY2010 Dear Grantee: The following award is the allocated amount for the fiscal year indicated for the Personal Responsibility Education Program in accordance with Section 513 of the Social Security Act . Award Amount: —..$250,000 Catalog of Federal Common Domestic Assistance Entity Identification Appropriation Number Grant Document Accounting Amount (CFDA)Program Number Number(EIN) Number(GDN) Number(CAN) 93.092 1-996000449-A4 75-X-1512 10011-1IPREP 2010G99UTSU — $250,000 The project period for these funds starts 08/02/2010. These funds must be obligated no later than 09/30/2012 and liquidated no later than 12/31/2012. Any funds that remain unobligated or unliquidated after these dates will be recouped by this agency. By accepting this award, the State agrees to use these funds in accordance with the provisions of this program's Terms and Conditions (copy enclosed) and all applicable Federal laws, regulations and policies governing the use of Federal funds and the submission of periodic financial reports. Any expenditure found to have been made in violation of these requirements is subject to disallowance and recoupment by this agency and the imposition of additional interest charges under 45 CFR 30.13 and 30.14. Specifically, the State agrees to comply with the provisions of Federal regulations (31 CFR 205) that implements the Cash Management Improvement Act by limiting the amount and timing of your requests to draw Federal funds to the minimum amount necessary to meet actual and immediate program needs and requirements. Failure to adhere to these requirements may result in the unobligated portion of your letter-of-credit to be revoked. Grant funds are made available through the HHS Payment Management System (PMS). Questions concerning payments should be directed to: Division of Payment Management, PO Box 6021, Rockville, Maryland 20852 (Internet web site: http://www.dpm.psc.gov), or to the PMS Help Desk at (877) 614-5533. Questions concerning the program should be directed to LeBretia White,Administration on Children,Youth and Families,at (202) 205-9605 or at lebretia.white @acf.hhs.gov; questions concerning financial reporting should be directed to Nathaniel Morris West, Office of Grants Management at (202) 401-1230 or at nathaniel.we t @acf.hhs,gov. Sincere, Josh M. Lonergan Director Division of Mandatory Grants g/g 3. M 1,u rcd tares Department of Hea.� . Human Services '14*****Z L*adi to,.~sr*WO,. #- Si601: l log ... ADMINISTRATION FOR CHILDREN AND FAMILIES ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES FAMILY AND YOUTH SERVICES BUREAU PERSONAL RESPONSIBILITY EDUCATION PROGRAM GRANT Catalog of Federal Domestic Assistance(CFDA)Program No. 93.092 TERMS AND CONDITIONS FISCAL YEAR 2010 October 1,2009-September 30,2010 By acceptance of any this award,the State or Territory agrees to comply with the terms and conditions detailed below. Failure to comply with these terms and conditions may result in the toss of Federal funds and may be considered grounds for the suspension or termination of one or more of these grants. PROGRAM STANDARDS 1. The administration of this program is based on: • the provisions of Section 513 of the Social Security Act • the approved application and plan, including all assurances, approved amendments or revisions • applicable Federal regulations, program policies and instructions ADMINISTRATIVE REQUIREMENTS 2. This program is governed by the following Federal regulations: • 2 CFR Part 225-Cost Principles for State, Local and Indian Tribal Governments • 45 CFR Part 16- Procedures of the Departmental Grant Appeals Board; • 45 CFR Part 30-Claims Collection; • 45 CFR Part 76-Debarment and Suspension from Eligibility for Financial Assistance (Nonprocurement); • 45 CFR Part 80 - Nondiscrimination Under Programs Receiving Federal Assistance through the Department of Health and Human Services, Effectuation of Title VI of the Civil Rights Act of 1964; • 45 CFR Part 81 - Practice and Procedure for Hearings Under Part 80 of this Title; • 45 CFR Part 84 - Nondiscrimination on the Basis of Handicap in Programs and Activities Receiving Federal Financial Assistance; • 45 CFR Part 86- Nondiscrimination on the Basis of Sex in Education Programs and Activities Receiving or Benefiting from Federal Financial Assistance; • 45 CFR Part 87-Equal Treatment for Faith-Based Organizations; • 45 CFR Part 91 -Nondiscrimination on the Basis of Age in HHS Programs or Activities Receiving Federal Financial Assistance; • 45 CFR Part 92 - Uniform Administrative Requirements for Grants and Cooperative Agreements to State, and Local, and Tribal Governments; • 45 CFR Part 93-New Restrictions on Lobbying; Terms and Conditions Personal Responsibility Education Program Grant Fiscal Year 2010 • 45 CFR Part 95, Subpart E—Cost Allocation Plans; 3, This program is governed by Office of Management and Budget Circular A-133, "Audits of States, Local Governments, and Non-Profit Organizations," issued pursuant to the Single Audit Act of 1984 (Public Law 98-502) and the Single Audit Act Amendments of 1996 (Public Law 104-156) 4. In accordance with Public Law 103-333, the "Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act of 1995,"the following provisions are applicable to this award: Section 507: "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." Section 508: "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 States receiving Federal funds, 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." 5. In accordance with Title XII of Public Law 103-227, the "PRO-KIDS Act of 1994," smoking may not be permitted in any portion of any indoor facility owned or regularly used for the provision of health, day care, education, or library services to children under the age of 18, if the services are funded by Federal programs either directly or through State or local governments. Federal programs include grants, cooperative agreements, loans and loan guarantees, and contracts. The law does not apply to children's services provided in private residences, facilities funded solely by Medicare or Medicaid funds, and portions of facilities used for inpatient drug and alcohol treatment. The above language must be included in any subawards that contain provisions for children's services and all subgrantees shall certify compliance accordingly. Failure to comply with the provisions of this law may result in the imposition of a civil monetary penalty of up to $1,000 per day. 6. Direct Federal grants, sub-awards, or contracts under this program shall not be used to support inherently religious activities such as religious instruction,worship, or proselytization. Therefore, organizations must take steps to separate, in time or location, their inherently religious activities from the services funded under this program. (See 45 CFR Part 87.) 7. Federal grant funds provided under this award may not be used by the grantee or any sub- grantee to support lobbying activities to influence proposed or pending Federal or State legislation or appropriations. This prohibition is related to the use of Federal grant funds and is not intended to affect an individual's right or that of any organization, to petition Congress, or any other level of Government, through the use of other resources. (See 45 CFR Part 93.) Page 2 . Terms and Conditions Personal Responsibility Education Program Gran Fiscal Year 2010 8. This award is subject to the requirements of Section 106(g) of the Trafficking Victims Protection Act of20OU (22U8C7104). The fufi text of this requirement is found at http://www.acf.gov/.drants/award_terms.html . SUB-RECIPIENTS UNDER GRANTS 9. The State is required to determine recipient type when sub-granting or contracting using Federal funds. In accordance with the standards set in 0MB Circular A-133,the determination is based on the substance of the relationship with the State, rather than the form of the agreement. The presence of one or more of the following conditions would indicate that the recipient should be considered a sub-grantee and is subject to-the provisions of OMB Circular A-133: a. Determines who is eligible to receive what Federal financial assistance; b. Has its performance measured against whether the objectives of the Federal program are met; c. Has responsibility for programmatic decision making; d. Has responsibility for adherence to applicable Federal program compliance requirements; e. Uses the Federal funds to carry out a program of the organization as compared to providing goods or services for a program of the pass-through entity; The presence of one or more of the following conditions would indicate that the recipient should be considered a vendor and is not subject to the provisions of OMB Circular A-133: a. Provides the goods and services within normal business operations; b. Provides similar goods or services to many different purchasers; c. Operates in a competitive environment; d. Provides goods or services that are ancillary to the operation of the Federal program; e. Is not subject to compliance requirements of the Federal program. 10. No organization may participate in this program in any capacity or be a recipient of Federal funds designated for this program if the organization has been debarred or suspended or otherwise found to be ineligible for participation in Federal assistance programs under Executive Order 12549, "Debarment and Suspension.' (See 45 CFR 92.35.) The State must include a similar term and/or condition for all sub-awards or contracts awarded under this program. Prior to issuing subawards or contracts under these grants, the state must consult the ineligible parties list to ensure that organizations under funding consideration are not ineligible. The list is available on the Web at http:J/www,epls, ov, 11 The State is responsible for monitoring grant, sub-grant/sub-recipient and contract supported activities to assure compliance with Federal requirements and that performance goals are being achieved. Grantee monitoring must cover each program,function and activity. (See 45CFA02.4Oj 12.The State is required to advise sub-grantees/sub-recipients of requirements imposed on them by Federal |awo, regulations, and the provisions of grant agreements or contracts as well as any supplemental requirements imposed by the State. These include grant administrative requirements under 45 CFR Part 92, audit requirements under OMB Circular A-i 33 and cost principles according to recipient type: Page 3 Terms and Conditions Personal Responsibility Education Program Gran Fiscal Year 2010 • Non-Profit Organizations: 2 CFR Part 230 • Educational Institutions: 2 CFR Part 220; • Commercial Vendors or Subcontractors: 48 CFR Part 31. FINANCIAL MANAGEMENT 13.NOTE: The draw down of funds included in this award is temporarily restricted until the State submits an acceptable as required by the terms of the Funding Opportunity Announcement. The failure to submit this plan could result in the rescission of this award. The State is required to submit this plan no Later than Eebruarw1L2011"bv mail or email to the program office, Att'n: Ms. LeBretia White(See "Important Addresses," below). 14. Federal funds awarded under this program must not be used for construction or the purchase of land. 15. Federal funds awarded through these grants must be expended for the purposes for which they were awarded and within the time period allotted, in accordance with the deadlines discussed below. 16. Project Period, Obligation Period, Uouida1ion Period a. The "project periods" and "obligation periods"for this award are synonymous. b. The Federal funds awarded under these grants for the current fiscal year must be obligated by the end of the obligation period (i.e., no later than September 30. 2012, the last day of FY 2012). Any funds not obligated by that date will be recouped by this Department. c. In accordance with Federal regulations at 45 CFR 92.23(b), Federal funds awarded under these grants must be liquidated "not later than 90 days after the end of the (project) period" (ie . no later than December 30`2012, @0 days after the last day of FY 2012). Any funds not liquidated by that date will be recouped by this Department. 17. Financial Reports In accordance with the requirements at 45 CFR 92.41, the State is required to file separate annual expenditure reports for each grant received, indicating the amount of Federal funds that have been obligated, liquidated and remain unobli eted. Standard 0MB Form SF- 269A (ShortFmrm) "Finmncial Status Report" is used for this purpose. a. The State is requested to file these reports electronically through the ACF On-Line Data Collection (OLDC) system. OLDC requires electronic signatures from the appropriate State official. (See Action Transmittal C]A-ACF-AT'O1'O5. issued January 24. 2OO5.) When electronic reports are completed and submitted, no paper submission is required. b. For States that elect to submit paper copies of the required expenditure reports, send one (1) copy with an original signature of each submission of Form SF-269A (Short Form) to the financial office. Send an additional copy of each submission to the program office. (See"Important Addresses," below.) Page 4 Terms and Conditions Personal Responsibility Education Program Grant Fiscal Yea 2010 C. A "fillable" copy of Form SF-269A(Short Form) is available on the 0MB web site at http://vvm*.vvhitahouoe.gov/onnb/onanto/nt269o.odf d. Regardless of the method of submission,the State must adhere to the following submission schedule for financial reports: • An interim financial report, covering the period from the start of the project period through the end of the next fiscal year, must be submitted no later than 90 days following the end of the next Federal fiscal year (Le., no later than December 30,, 2011), = In accordance with Federal regulations at 45 CFR 92.23(b), the final financial report, covering the entire obligation and liquidation periods, must be submitted no later than the last day of the liquidation period (i.e., no later than December 30,2012). PROGRAM MANAGEMENT 18. Performance Reports. A semi-annual narrative program performance report must describe the program activities carried out, including an assessment of the effectiveness of those activities in achieving the purposes of this grant. Reports are due 30 days after the end of the 2 and 4th fiscal quarters (Le., no later than April 30 and October 30), with the final performance report due 90 days following the end of the project period (ia.. nm later than December 30,2012) Submit the report by mail or email to the program office, Att'n: Ms. LeBretia White (See "Important Addresses,' below). GRANT PAYMENTS 19. Payments under these grants will be made by Letter of Credit through the Department of Health and Human Services' Payment Management System Srnartlink. The State must comply with requirements imposed by the PMS on-line system. Please direct any questions (include phone number) concerning grant payments to the payment office. (See "Important Addresses," below). GRANTEE ADDRESS CHANGES 20. Grant award letters will be sent to the address in our records. Please send address changes or corrections to the financial office. (See "lmportant Addresses," below.) Addresses should not include individuals' names and, if possible, should be limited to four or five lines of text. IMPORTANT ADDRESSES o Program Office: Administration for Children and Families Administration on Children,Youth and Families Family and Youth Services Bureau Att'n: Personal Responsibility Education Program 1250 Maryland Ave., SW, Suite 8000 Washington, DC 20024 Page 5 . . Terms and Conditions Personal Responsibility Education Program Grant Fiscal Year 2010 Contact: LeBretia White e-mail: leomma.w*ite@act.hha.gov phone: (202)205'9605 fax: (202)260-9345 o Financial Office: Administration for Chfldren and Families Office of Gra to Management Division of Mandatory Grants Att'n: Personal Responsibility Education Program 370L'Enfant Promenade, 8.VK. 8m Floor East Washington, D.C. 20447 Contact: Nathaniel Morri West e-mail: nm¢honin|.wmotaothho.qo" phone: (202)401'1230 fax: (202)401-5644 o Payment Office: U.S. Department of Health and Human Services Division of Payment Management Payment Management System (PMS) P.O. Box 6021 Rockville, Maryland 20852 Contact: PMS Help Desk phone: (877)614-5533 Internet site: hun:0wvmw.dpm�sc.gnv IMPORTANT NOTE The U.S. Government Accountability Office (GAO) maintains FraudNET,a system for reporting allegations of fraud, waste and abuse under Federal grants and cooperative agreements. Reports are kept confidential; you need not provide your name. Information provided through the Internet web site is secure and all information is safeguarded against unauthorized disclosure. Report the possible misuse of federal funds, through one of the following methods: PhoOe:(800) 424-5454; Fax: (202) 512-3086; E-mail:haudne1Pga0.gov ; Mail: GAO FraudNB 441 G Stree N.W. Washington, D.C. 20548 Please provide as much detailed information as possible in your report. Page 6 . . /�° ^ � � � ; DEPARTMENT OBHEAL�� d� HUMAN SERVICES AUG ~ ~ �01/ . ~~~z� ADMINISTRATION FOR CHILDREN AND FAMILIES ADMINISTRATION ON CHILDREN YOUTH AND FAMILIES 1250 Maryland Ave., SW Washington, D.C. 20024 August 15, 2011 Director of Health State Department of Health Family Health Seriices Division 1250 Punchbowl Steet Honolulu, HI 86813'2418 Re: Notice of Grant Award Personal Responsibility Education Program FY2011 Dear Grantee: The following award is the allocated amount for the fiscal year indicated for the Personal Responsibility Education Program in accordance with Section 513 of the Social Security Act . | --- — Award Amount: $250.000 ( ca�p �p*�� =may Identification appo,mmn,w,mwy Grant um�mmn Common { �`—~^~—~�~~'~ � Number(PIN) Number | '�— ' ' — m �— —�--�-- ---' ' — —4 — —�� so 092 I I'9es0004u»-A4 | 75-X-1312 | 11 1wpREp ' | 2011G99SU1'I/_ S250,000 ! The project period for these funds starts iO/D1/2O1O. These funds must be obligated no later than 09,30,2013 and liquidated no later than 12/31/2013. Any funds that remain unobligated orunUnuidmted after these dates will be recouped by this agency. By accepting this award, the State agrees to use these funds in accordance with the provisions of this program's Terms and Conditions (copy enclosed) and all applicable Federal |aws, regulations and policies governing the use of Federal funds and the submission of periodic financial reports. Any expenditure found to have been made in violation of these requirements is subject to disallowance and recoupment by this agency and the imposition of additional interest charges under 45CFR3D,|3 and 3O.14. Specifically, the State agrees to comply with the provisions of Federal regulations (31 CFA 205) that implements the Cash Management Improvement Ac by limiting the amount and timing of your requests to draw Federal funds to the minimum amount necessary to meet actual and immediate program needs and requirements. Failure to adhere to these requirements may result in the unobligated portion of your letter-of-credit to be revoked. Grant funds are made available through the HHS Payment Management System (PMS). Questions concerning payments should be directed to: Division of Payment Management, PO Box 6021, Rockville, Maryland 20852 (Internet vvobsi\e: hVp://www.dpm.poo.guv)^ or0u\hePMSHe)pOeokoU (877) S14'6S33. Questions concerning the program should be directed to LeBretia White, Administration on Children, Youth and Families, at (202) 205-9605 or at \ebreUa.whina@ad.hhs.guv; questions i financial reporting h [d be directed to Nathaniel Morris West, Office of Grants Management at (2D2) 4U1-123O or at nath | | t 1 x Director Division of Mandatory Grants IMPORTANT: If the State Plan is conditionally approved by FYSB and acceptable updates are not submitted by September 26, 2011, the failure to submit an acceptable plan could result in the rescission of this award. ry7 _ +'` 3, `r � Unted States_Department of- ' HealthI=.--- Iuman Services g Muir re 4 Y L M Y - .1.1.144.Z x' 70 r , r r T vo 8 8 .t ADMINISTRATION FOR CHILDREN AND FAMILIES ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES FAMILY AND YOUTH SERVICES BUREAU PERSONAL RESPONSIBILITY EDUCATION PROGRAM GRANT Catalog of Federal Domestic Assistance(CFDA)Program No. 93.092 TERMS AND CONDITIONS FISCAL YEAR 2011 October 1,2010-September 30,2011 By acceptance of any this award, the State or Territory agrees to comply with the terms and • conditions detailed below. Failure to comply with these terms and conditions may result in the loss of Federal funds and may be considered grounds for the suspension or termination of one or more of these grants. PROGRAM STANDARDS 1. The administration of this program is based on: • the provisions of Section 513 of the Social Security Act • the approved application and plan, including all assurances, approved amendments or revisions • applicable Federal regulations, program policies and instructions ADMINISTRATIVE REQUIREMENTS 2. This program is governed by the following Federal regulations: • 2 CFR Part 225—Cost Principles for State, Local and Indian Tribal Governments • 45 CFR Part 16—Procedures of the Departmental Grant Appeals Board; • 45 CFR Part 30—Claims Collection; • 45 CFR Part 76—Debarment and Suspension from Eligibility for Financial Assistance (Nonprocurement); • 45 CFR Part 80- Nondiscrimination Under Programs Receiving Federal Assistance through the Department of Health and Human Services, Effectuation of Title VI of the Civil Rights Act of 1964; • 45 CFR Part 81 - Practice and Procedure for Hearings Under Part 80 of this Title; • 45 CFR Part 82- Government wide Requirements for Drug-Free Workplace (Financial Assistance); • 45 CFR Part 84- Nondiscrimination on the Basis of Handicap in Programs and Activities Receiving Federal Financial Assistance; • 45 CFR Part 86—Nondiscrimination on the Basis of Sex in Education Programs and Activities Receiving or Benefiting from Federal Financial Assistance; • 45 CFR Part 87—Equal Treatment for Faith-Based Organizations; • 45 CFR Part 91 -Nondiscrimination on the Basis of Age in HHS Programs or Activities Receiving Federal Financial Assistance; Terms and Conditions Personal Responsibility Education Program Grant Fiscal Year 2011 • 45 CFR Part 92 —Uniform Administrative Requirements for Grants and Cooperative Agreements to State, and Local, and Tribal Governments; • 45 CFR Part 93—New Restrictions on Lobbying; • 45 CFR Part 95, Subpart E—Cost Allocation Plans; 3. This program is governed by Office of Management and Budget Circular A-133, "Audits of States, Local Governments, and Non-Profit Organizations," issued pursuant to the Single Audit Act of 1984 (Public Law 98-502) and the Single Audit Act Amendments of 1996 (Public Law 104-156) 4. In accordance with Public Law 103-333, the"Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act of 1995,"the following provisions are applicable to this award: Section 507: "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.' Section 508: "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 States receiving Federal funds, 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." 5. In accordance with Title XII of Public Law 103-227, the "PRO-KIDS Act of 1994," smoking may not be permitted in any portion of any indoor facility owned or regularly used for the provision of health, day care, education, or library services to children under the age of 18, if the services are funded by Federal programs either directly or through State or local governments. Federal programs include grants, cooperative agreements, loans and loan guarantees, and contracts. The law does not apply to children's services provided in private residences, facilities funded solely by Medicare or Medicaid funds, and portions of facilities used for inpatient drug and alcohol treatment. The above language must be included in any subawards that contain provisions for children's services and all subgrantees shall certify compliance accordingly. Failure to comply with the provisions of this law may result in the imposition of a civil monetary penalty of up to $1,000 per day. 6. Direct Federal grants, sub-awards, or contracts under this program shall not be used to support inherently religious activities such as religious instruction, worship, or proselytization. Therefore, organizations must take steps to separate, in time or location, their inherently religious activities from the services funded under this program. (See 45 CFR Part 87.) 7. Federal grant funds provided under this award may not be used by the grantee or any sub- grantee to support lobbying activities to influence proposed or pending Federal or State legislation or appropriations. This prohibition is related to the use of Federal grant funds and is not intended to affect an individual's right or that of any organization, to petition Congress, Page 2 Terms and Conditions Personal Responsibility Education Program Grant Fiscal Year 2011 or any other level of Government, through the use of other resources. (See 45 CFR Part 93.) 8. This award is subject to the requirements of Section 106(g) of the Trafficking Victims Protection Act of 2000 (22 USC 7104). The full text of this requirement is found at http://www.acf.gov/.grants/award terms.html . SUB-RECIPIENTS UNDER GRANTS 9. The State is required to determine recipient type when sub-granting or contracting using Federal funds. In accordance with the standards set in OMB Circular A-133, the determination is based on the substance of the relationship with the State, rather than the form of the agreement. The presence of one or more of the following conditions would indicate that the recipient should be considered a sub-grantee and is subject to the provisions of OMB Circular A-133: a. Determines who is eligible to receive what Federal financial assistance; b. Has its performance measured against whether the objectives of the Federal program are met; c. Has responsibility for programmatic decision making; d. Has responsibility for adherence to applicable Federal program compliance requirements; e. Uses the Federal funds to carry out a program of the organization as compared to providing goods or services for a program of the pass-through entity; The presence of one or more of the following conditions would indicate that the recipient should be considered a vendor and is not subject to the provisions of OMB Circular A-133: a. Provides the goods and services within normal business operations; b. Provides similar goods or services to many different purchasers; c. Operates in a competitive environment; d. Provides goods or services that are ancillary to the operation of the Federal program; e. Is not subject to compliance requirements of the Federal program. 10. No organization may participate in this program in any capacity or be a recipient of Federal funds designated for this program if the organization has been debarred or suspended or otherwise found to be ineligible for participation in Federal assistance programs under Executive Order 12549, "Debarment and Suspension." (See 45 CFR 92.35.) The State must include a similar term and/or condition for all sub-awards or contracts awarded under this program. Prior to issuing subawards or contracts under these grants, the state must consult the ineligible parties list to ensure that organizations under funding consideration are not ineligible. The list is available on the Web at htto://www.eols.00v. 11.The State is responsible for monitoring grant, sub-grant/sub-recipient and contract supported activities to assure compliance with Federal requirements and that performance goals are being achieved. Grantee monitoring must cover each program, function and activity. (See 45 CFR 92.40.) 12.The State is required to advise sub-grantees/sub-recipients of requirements imposed on them by Federal laws, regulations, and the provisions of grant agreements or contracts as well as any supplemental requirements imposed by the State. These include grant Page 3 Terms and Conditions Personal Responsibility Education Program Grant Fiscal Year 2011 administrative requirements under 45 CFR Part 92, audit requirements under OMB Circular A-133 and cost principles according to recipient type: • Non-Profit Organizations: 2 CFR Part 230; • Educational Institutions: 2 CFR Part 220; • Commercial Vendors or Subcontractors: 48 CFR Part 31. FINANCIAL:MANAGEMENT.. 13. Federal funds awarded under this program must not be used for construction or the purchase of land. 14. Federal funds awarded through these grants must be expended for the purposes for which they were awarded and within the time period allotted, in accordance with the deadlines discussed below. 15. Project Period, Obligation Period. Liquidation Period a. The"project periods" and "obligation periods" for this award are synonymous. b. The Federal funds awarded under these grants for the current fiscal year must be obligated by the end of the obligation period (i.e., no later than September 30,2013, the last day of FY 2013). Any funds not obligated by that date will be recouped by this Department. c. In accordance with Federal regulations at 45 CFR 92.23(b), Federal funds awarded under these grants must be liquidated"not later than 90 days after the end of the (project) period" (i.e., no later than December 30, 2013, 90 days after the last day of FY 2013). Any funds not liquidated by that date will be recouped by this Department. 16. Financial Reports In accordance with the requirements at 45 CFR 92.41,the State must submit an original annual financial status report of expenditures, within 120 days after of the end of the each fiscal year. Beginning in FY 2011, all financial status reports for all years' open awards must be made on the SF-425 (copy enclosed with instructions). A separate annual expenditure report is required for each fiscal year until all funds have been liquidated for the reported fiscal year. Complete all applicable information other than lines 10.a. through 10.c.a. a. The State is requested to file these reports electronically through the ACF On-Line Data Collection (OLDC)system. OLDC requires electronic signatures from the appropriate State official. (See Action Transmittal OA-ACF-AT-01-05, issued January 24, 2005.) When electronic reports are completed and submitted, no paper submission is required. b. For States that elect to submit paper copies of the required expenditure reports, send one (1) copy with an original signature of each submission of Form SF-425 to the financial office. Send an additional copy of each submission to the program office. (See"Important Addresses,"below.) c. A"fillable" copy of Form SF-425 is available on the OMB web site at http://www.whitehouse.gov/sites/default/files/omb/assets/grants_forms/SF-425.pdf Page 4 Terms and Conditions Personal Responsibility Education Program Grant Fiscal Year 2011 d. Regardless of the method of submission,the State must adhere to the following submission schedule for financial reports: • An interim financial report, covering the period from the start of the project period through the end of the next fiscal year, must be submitted no later than January 30, 2013. • In accordance with Federal regulations at 45 CFR 92.23(b), the final financial report, covering the entire obligation and liquidation periods, must be submitted no later than January 30, 2014. 17. Subaward and Executive Compensation reporting requirements. HHS now requires this program award to adhere to the Subaward and Executive Compensation reporting requirements of"the Transparency Act" (as defined in 2 CFR Part 170). Under the Transparency Act, all subawards (as defined in 2 CFR Part 170) over $25,000 must be reported, unless exempted. Please see the newly applicable Award Term for Federal Financial Accountability and Transparency Act (FFATA) at the following URL: http://www.acf.hhs.gov/grants/award term ffata.html PROGRAM MANAGEMENT 18. Performance Reports. A semi-annual narrative program performance report must describe the program activities carried out, including an assessment of the effectiveness of those activities in achieving the purposes of this grant. Reports are due 30 days after the end of the 2rtd and 4'"fiscal quarters (i.e., no later than April 30 and October 30), with the final performance report due 90 days following the end of the project period (i.e., no later than December 30, 2013) Submit the report by mail or email to the program office,Att'n:Ms. LeBretia White (See "Important Addresses,"below). GRANT PAYMENTS 19. Payments under these grants will be made by Letter of Credit through the Department of Health and Human Services' Payment Management System (PMS) and Smartlink. The State must comply with requirements imposed by the PMS on-line system. Please direct any questions (include phone number) concerning grant payments to the payment office. (See"Important Addresses," below). GRANTEE ADDRESS CHANGES 20. Grant award letters will be sent to the address in our records. Please send address changes or corrections to the financial office. (See°Important Addresses," below.) Addresses should not include individuals' names and, if possible, should be limited to four or five lines of.text. IMPORTANT ADDRESSES Page 5 Terms and Conditions Personal Responsibility Education Program Grant Fiscal Year 2011 o Program Office: Administration for Children and Families Administration on Children, Youth and Families Family and Youth Services Bureau Attin: Personal Responsibility Education Program 1250 Maryland Ave., SW, Suite 8000 Washington, DC 20024 Contact: LeBretla White e-mail: lebretia.wh iteOacf.hhs.gov phone: (202)205-9605 fax: (202)-205-9535 o Financial Office: Administration for Children and Families Office of Grants Management Division of Mandatory Grants Att'n: Personal Responsibility Education Program 370 L'Enfant Promenade, S.W., 61" Floor East Washington, D.C. 20447 Contact: Nathaniel Morris West e-mail: pathaniel.west( acf.hhs.gov phone: (202)401-1230 fax: (202)401-5644 o Payment Office: U.S. Department of Health and Human Services Division of Payment Management Payment Management System (PMS) P.O. Box 6021 Rockville, Maryland 20852 Contact: PMS Help Desk phone: (877)614-5533 Internet site: http://www.dpm.psc.gov IMPORTANT NOTE The U.S. Government Accountability Office (GAO) maintains FraudNET, a system for reporting allegations of fraud, waste and abuse under Federal grants and cooperative agreements. Reports are kept confidential; you need not provide your name. Information provided through the Internet web site is secure and all information is safeguarded against unauthorized disclosure. Report the possible misuse of federal funds, through one of the following methods: Phone:(800) 424-5454; Fax: (202) 512-3086; E-mail:fraudnet gao.gov ; Mail: GAO FraudNET 441 G Street N.W. Washington, D.C. 20548 Please provide as much detailed information as possible in your report. Page 6 FEDERAL FINANCIAL REPORT (Farrow form instructions) 1. Federal Agency end Organizational Element 2. Federal Grant or Otter Identifying Number Assigned by Federal Agency Page of to Which Report is Submitted (To report multiple grants,use FFR Attachment) 1 _ Pages 3. Recipient Organization(Name and complete address including Zip code) 4a. DUNS Number 4b. EIN 5. Recipient Account Number or Identifying Number 6. Report Type 7. Basis of Accounting (To report multiple grants,use FFR Attachment) p Quarterly O Semi-Annual ❑Annual o Final o Cash o Accrual 8. ProjeetCrant Period 9. Reporting Period End Date From:(Month,Day.Year) 1f ITo. (Month.Day.Year) (Month,Day.Year) 10. Transactions I Cumulative (Use lines a-c for single or multiple grant reporting) Federal Cash(To report multiple grants,also use FFR ABadtment): • a. Cash Receipts b. Cash Disbursements c Cash on Hand pine a minus b) (Use lines d-o for single grant reporting) Federal Expenditures and Unobflgated Balance: d. Total Federal funds authorized e. Federal share of expenditures 1. Federal share of untquidated obligations g. Total Federal share(sum of Ones a and 1) h. Unobligated balance of Federal funds(tine d minus g) Recipient Share: i. Total recipient share required j. Recipient share of expenditures k. Remaining recipient share to be provided(tine i minus j) Program Income: I. Tom/Federal program income earned m. Program income expended in accordance with the deduction alternative n. Program income expended in accordance with the addition alternative o. Unexpended program income fine I minus One m or linen) a. Type b.Rate c.Period From Period To d.Base e. Amount Charged I.Federal Share 11.Indirect Expense g.Totals: 12. Remarks: Attach any expranafions deemed necessary or information required by Federal sponsoring agency in compliance with governing legislation: 13. Certification: By signing this report,I certify to the beat of my knowledge and belief that the report Is true,complete,and accurate,and the expenditures, disbursements and cash receipts are for the purposes and Intent set forth in the award documents.1 am aware that any false,fictitious,or fraudulent Information may subject me to criminal,civil,or administrative penalties.(U.S.Code,Title le,Sectlan 1001) - a. Typed or Printed Name and Tote of Authorzed Certifying Official c. Telephone(Area coda,number and extension) d. Email address b.Signature 01 Authorized Certifying Official e. Dale Report Submitted (Month,Day.Year) 1a lLy?t6a• g .z. 77 7 F,°e x> ;SP sr :, ur �3 rY,it, Sterrdrd Form 425•Revised eR4r1010 Okla Appeayseuriber:0118-0001 Erpkation Data:10416011 Paperwork Barden Statement According to the Paperwork Reduction Act as amended.no persons are required to respond to a collection of information unless it displays o voted 0510 Control Number.The valid OMB control number for the information collection is 03484061. Pukka reporting burden for this oofeeton of Inlomwpon le meowed to average 1.5 hours per response.including term for reviewkg Mna n:tens. searchirg eroatirg data maces.gadmrug and mamtaxu g the data needed,and completing end reviewing the collection ol Wonn000n.Send corentertts regarding the burden esnrnate or any other aspect er inn collection el mtormaeos t.rrkdry suggestons for reducing the leaden•to the;Mice of Management and Dtdget,Paperwork Reduction Project(0318406;).Weantrigton.DC 20503. • Federal Financial Report Instructions Report Submissions 1) Recipients will be instructed by Federal agencies to submit the Federal Financial Report(FFR) to a single location, except when an automated payment management reporting system is utilized. In this case,a second submission location may be required by the agency. 2) If recipients need more space to support their FFRs,or FFR Attachments, they should provide supplemental pages.These additional pages must indicate the following information at the top of each page: Federal grant or other identifying number(if reporting on a single award),recipient organization,Data Universal Numbering System(DUNS)number, Employer Identification Number (EIN), and period covered by the report. Reporting Requirements 1) The submission of interim FFRs will be on a quarterly, semi-annual,or annual basis,as directed by the Federal agency. A final FFR shall be submitted at the completion of the award agreement.The following reporting period end dates shall be used for interim reports: 3/31,6/30,9/30,or 12/31. For final FFRs,the reporting period end date shall be the end date of the project or grant period. 2) Quarterly and semi-annual interim reports shall be submitted no later than 30 days after the end of each reporting period. Annual reports shall be submitted no later than 90 days after the end of each reporting period. Final reports shall be submitted no later than 90 days after the project or grant period end date. Note: For single award reporting: 1)Federal agencies may require both cash management information on lines 10(a)through 10(c) and financial status information lines 10(d)through 10(o). 2) 10(b)and 10(e)may not be the same until the final report. Line Item Instructions for the Federal Financial Report FFR Reporting Item Instructions Number Cover Information Federal Agency and Enter the name of the Federal agency and organizational element Organizational Element to identified in the award document or as instructed by the agency. Which Report is Submitted 2 Federal Grant or Other For a single award,enter the grant number assigned to the award by the Identifying Number Federal agency. For multiple awards, report this information on the FFR Assigned by Federal Attachment. Do not complete this box if reporting on multiple awards. Agency 3 Recipient Organization Enter the name and complete address of the recipient organization including zip code. 4a DUNS Number Enter the recipient organization's Data Universal Numbering System (DUNS)number or Central Contract Registry extended DUNS number. 4b 'EIN Enter the recipient organization's Employer Identification Number(EIN). 5 Recipient Account Number Enter the account number or any other identifying number assigned by the or Identifying Number recipient to the award.This number is for the recipient's use only and is not required by the Federal agency. For multiple awards, report this Revised 6/28/2010 FFR Reporting Item Instructions Number information on the FFR Attachment. Do not complete this box if reporting on multiple awards. 6 'eport Type Mark appropriate box. Do not complete this box if reporting on multiple awards. 7 :asis of Accounting Specify whether a cash or accrual basis was used for recording (Cash/Accrual) transactions related to the award(s) and for preparing this FFR. Accrual basis of accounting refers to the accounting method in which expenses are recorded when incurred. For cash basis accounting,expenses are recorded when they are paid. 8 'roject/Grant Period, Indicate the period established in the award document during which rom: (Month, Day, Year) Federal sponsorship begins and ends. Note: Some agencies award multi-year grants for a project period that is funded in increments or budget periods (typically annual increments). Throughout the project period, agencies often require cumulative reporting for consecutive budget periods. Under these circumstances, enter the beginning and ending dates of the project period not the budget period. ,Do not complete this line if reporting on multiple awards. I'roject/Grant Period,To: See the above instructions for"Project/Grant Period,From: (Month, Day, (Month, Day, Year) Year)." 9 Reporting Period End Enter the ending date of the reporting period. For quarterly,semi-annual, ID ate: (Month, Day, Year) and annual interim reports, use the following reporting period end dates: 3/31,6/30,9/30, or 12/31. For final FFRs,the reporting period end date shall be the end date of the project or grant period. 10 ransactions Enter cumulative amounts from date of the inception of the award through the end date of the eporting period specified in line 9. se Lines l0a through 10c, Lines 10d through 100,or Lines 10a through 10o, as specified by the Federal agency, when reporting on single grants. se Line 12, Remarks, to provide any information deemed necessary to support or explain FFR data. Federal Cash (To report multiple grants,also use FFR Attachment) 10a Cash Receipts Enter the cumulative amount of actual cash received from the Federal agency as of the reporting period end date. 10b Cash Disbursements Enter the cumulative amount of Federal fund disbursements(such as cash or checks) as of the reporting period end date. Disbursements are the sum of actual cash disbursements for direct charges for goods and services, the amount of indirect expenses charged to the award, and the amount of cash advances and payments made to subrecipients and contractors. For multiple grants,report each grant separately on the FFR Attachment. The sum of the cumulative cash disbursements on the FFR Attachment must equal the amount entered on Line 10b,FFR. IOc Cash On Hand (Line I0a Enter the amount of Line l0a minus Line I Ob.This amount represents Minus Line 1Ob immediate cash needs. If more than three business days of cash are on hand, the Federal agency may require an explanation Revised 628/2010 FFR Reporting Item Instructions Number on Line 12, Remarks, explaining why the drawdown was made prematurely or other reasons for the excess cash. Federal Expenditures and Unobligated Balance: Do not complete this section if reporting on multiple awards. 10d Total Federal Funds Enter the total Federal funds authorized as of the reporting period end Authorized date. 10e Federal Share of Enter the amount of Federal fund expenditures. For reports prepared on a Expenditures cash basis,expenditures are the sum of cash disbursements for direct charges for property and services; the amount of indirect expense charged; and the amount of cash advance payments and payments made to subrecipients. For reports prepared on an accrual basis,expenditures are the sum of cash disbursements for direct charges for property and services; the amount of indirect expense incurred; and the net increase or decrease in the amounts owed by the recipient for(1)goods and other property received; (2) services performed by employees,contractors, subrecipients, and other payees;and (3)programs for which no current services or performance are required.Do not include program income expended in accordance with the deduction alternative,rebates, refunds, or other credits. (Program income expended in accordance with the deduction alternative should be reported separately on Line I0o.) 10f Federal Share of Unliquidated obligations on a cash basis are obligations incurred,but not Unliquidated Obligations yet paid. On an accrual basis,they are obligations incurred, but for which an expenditure has not yet been recorded. Enter the Federal portion of unliquidated obligations.Those obligations include direct and indirect expenses incurred but not yet paid or charged to the award, including amounts due to subrecipients and contractors. On the final report, this line should be zero unless the awarding agency has provided other instructions. Do not include any amount in Line 1Of that has been reported in Line IOe. Do not include any amount in Line 1Of for a future commitment of funds (such as a long-term contract)for which an obligation or expense has not been incurred. lOg Total Federal Share(Sum Enter the sum of Lines 10e and 10f. of Lines 10e and 100 IOh Unobligated Balance of Enter the amount of Line 10d minus Line 10g. Federal Funds (Line 10d Minus Line 10g) Recipient Share: Do not complete this section if reporting on multiple awards. 10i Total Recipient Share Enter the total required recipient share for reporting period specified in Required line 9.The required recipient share should include all matching and cost sharing provided by recipients and third-party providers to meet the level required by the Federal agency.This amount should not include cost sharing and match amounts in excess of the amount required by the Federal agency(for example,cost overruns for which the recipient incurs additional expenses and,therefore, contributes a greater level of cost Revised 6/28/2010 FFR Reporting Item Instructions I umber sharing or match than the level required by the Federal agency). 10j Recipient Share of Enter the recipient share of actual cash disbursements or outlays(less any Expenditures rebates,refunds,or other credits)including payments to subrecipients and contractors.This amount may include the value of allowable third party in-kind contributions and recipient share of program income used to finance the non-Federal share of the project or program. Note: On the final report this line should be equal to or greater than the amount of Line 10i. 10k Remaining Recipient Share Enter the amount of Line 10i minus Line 10j. If recipient share in Line to be Provided (Line 10i 10j is greater than the required match amount in Line 101,enter zero. Minus LinelOj) 'rogram Income: Do not complete this section if reporting on multiple awards. 101 otal Federal Program Enter the amount of Federal program income earned. Do not report any ncome Earned program income here that is being allocated as part of the recipient's cost sharing amount included in LinelOj. 10m I'rogram Income Expended Enter the amount of program income that was used to reduce the Federal n Accordance With the share of the total project costs. "eduction Alternative 1On Program Income Expended Enter the amount of program income that was added to funds committed n Accordance With the to the total project costs and expended to further eligible project or ddition Alternative program activities. 10o nexpended Program Enter the amount of Line 101 minus Line 10m or Line 10n. This amount Income (Line 101 Minus equals the program income that has been earned but not expended,as of I ine 10m or Line 10n) the reporting period end date. 11 I ndirect Expense: Complete this information only if required by the awarding agency. Enter umulative amounts from date of the inception of the award through the end date of the reporting .eriod specified in line 9. 1 I a ype of Rate(s) tate whether indirect cost rate(s) is Provisional, Predetermined, Final, or ixed. 1 I b 'ate nter the indirect cost rate(s) in effect during the reporting period. 1 1 c l'eriod From; Period To nter the beginning and ending effective dates for the rate(s). 11 d :ase nter the amount of the base against which the rate(s) was applied. l le mount Charged nter the amount of indirect costs charged during the time period pecified. (Multiply 1 lb. x I Id.) 11 f I ederal Share nter the Federal share of the amount in 1 le. 11 g otals nter the totals for columns 11 d, I le. and 11 f. 'emarks, Certification,and Agency Use Only 12 Remarks Enter any explanations or additional information required by the Federal sponsoring agency including excess cash as stated in line 10c. 13a Typed or Printed Name and Enter the name and title of the authorized certifying official. Title of Authorized Certifying Official 13b Signature of Authorized The authorized certifying official must sign here. Certifying Official 13c Telephone(Area Code, Enter the telephone number(including area code and extension)of the Number and Extension) individual listed in Line 13a. 13d E-mail Address Enter the e-mail address of the individual listed in Line 13a. Revised 6/28/2010 FFR Reporting Item Instructions Number 13e Date Report Submitted Enter the date the FFR is submitted to the Federal agency using the (Month,Day,Year) month,day, year format. 14 Agency Use Only This section is reserved for Federal agency use. • Revised 6/28/2010