KentuckyTitle II – 2013 OJJDP Formal Grant: Disproportionate Minority Contact

2017-2018 Request for Proposals

The deadline to apply is July 15, 2017, 5:00 p.m. For more information, see Submission Instructions on page 23.

Approximately $80,000 will be available through the Office of Juvenile Justice and Delinquency Prevention (OJJDP) of the U.S. Department of Justice.

The funds have been earmarked for public and private non-profit organizations, city or county governments for addressing disproportionate minority contact in Jefferson, Fayette, Christian, and Hardin counties. Funds will be dispersed as a sub grant to local non-profit agencies and/or local units of government for assessments, research and programming that addresses disproportionate minority contact. The population to be served will include males and/or females ages 10-18. State agencies are not eligible to apply. Award recipients will be required to accept all DJJ referrals.

The application can be accessed from June 15- July 15, 2017 via the Department of Juvenile Justice website at www.djj.ky.gov. The deadline to apply is July 15, 2017, 5:00 p.m. For more information, contact Stephanie Reynolds at 502-573-2738 or by email at stephaniel.reynolds@ky.gov.

The funding cycle for the grant will be October 1, 2017 through September 30, 2018.

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APPLICATION REQUIREMENTSAll Applicants must successfully submit an application by PDF to Stephanie Reynolds

(StephanieL.Reynolds@ky.gov) by July 15, 2017 by 5:00pm to be considered. All information is required. Ensure you read, address, and submit all required information.

Missing information may cause the application to not be considered for funding.

Agency Name: Project Name: Agency Address: City/State/Zip+4

Federal Tax ID Number: DUNS Number: (N/A if do not have one)KY Vendor Number: (N/A if do not have one)

Has your agency received DJJ funding in the past? YESNO

If yesDates:

Has your agency received federal funding in the past? YESNO

If yes,What agency or office?Dates: Funding amount:Have you ever received a Corrective Action Plan?

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Contact information: No dual roles should be assigned:

1. Agency Representative/CEO – The agency contact responsible for accepting the conditions of the grant award.

Prefix:Name: Title: Address: City/State/Zip+4PhoneEmail

2. Project Director: The agency contact responsible for the operation pf the project and program activity reporting.

Prefix:Name: Title: Address: City/State/Zip+4PhoneEmail

3. Financial Officer: The agency contact responsible for all financial aspects of the grant’s management, including financial report submission.

Prefix:Name: Title: Address: City/State/Zip+4PhoneEmail

Agency Information Provide a brief description of the agency implementing this grant project. Information should include the mission statement, location of the program. This section should not exceed one (1) page. The recommended font is Times New Roman, 12 point and should be double-spaced.

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Project/Program DescriptionProvide a clear and concise description of how the proposed program will be addressing needs of minority youth and how this intervention’s target population will be directed towards impacting the mitigation of DMC. This should include target populations and referral source as well as facility and staffing information including projected days(s) and time(s) of operation.. If this will be a new program for your agency, include information on start up, staffing and facility. This section should not exceed five (5) pages. The recommended font is Times New Roman, 12 point and should be double-spaced.

Geographic Boundaries: Identify what areas this project will serve including schools and/or zip codes or designated neighborhood in the county to be served.

o Jefferson County: _________________________________________o Fayette County: ___________________________________________o Christian County: __________________________________________o Hardin County: ____________________________________________

Serving Families:o Yes (Please identify how parental, familial or youth guardian’s services and involvement

are integrated and addressed in this project).o No

Program Component Totals:Total Number of Program Components:Total Number of Youths to be Served:Total Number of Families to be Served:Total Number of Programming Hours:

Resources and Collaborations:Clearly and concisely, indicate what resources and collaborations will be established and/or utilized to assist with successful implementation/continuation of this project as well as achieve established goals for the program/project. These may include, but are not limited to, indications of in-kind contributions, collaborations, information sharing efforts, or use of volunteers or referral contacts. (Please include any letters of agreement for in-kind match or collaborations).Also identify additional sources of funding that will compliment this project in the format below. For each source of funding, you must complete amount, grant period for which it is funded, and how funds are generated.

Source of Funding & How Funds will be Utilized

Estimated Value of Donated Service or Good

Period in which donated goods or services will be received

Federal State or Privately Generated (choose one)

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Goals, Objectives, and Performance Measures Goals and Objectives: Provide the goals and objectives for the proposed intervention.Goals should be more general: (i.e. To address minority over-representation at arrest (point of contact).The objective should be based on outcomes off the RRI and local assessment as well as actionable (i.e. intervention/strategies), measurable (i.e. expected outcomes) and obtainable (considering contextual considerations and recommendations from local assessment.)

Goals Objectives Short or Long Term Goal

Anticipated Date of Completion

Performance Measures:. Evaluation of a project will consist of the accumulation of quantitative information (process measures) as well as a qualitative assessment (outcome measures).Award recipients will be required to assist in data collections as required for this grant by the Office of Juvenile Justice and Delinquency Prevention. Measures in bold are required as well as a minimum of two non-mandatory outputs and outcomes are required.

Agency is willing to measure, track, and report on the identified output and outcome indicators in the prescribed format? _ YES_ NO

**Agency Representative/CEO must I N I T I A L

Agency has the technology needed to collect data in the prescribed format? _ YES_ NO

**Agency Representative/CEO must I N I T I A L

OUTPUTS Relevant to Project?Number of Full-Time Employees Funded by Title II Federal Funds ☐Yes ☐No

Number of Programs Implemented MANDATORYNumber and Percentage of Program Staff Trained ☐Yes ☐NoNumber of Hours Program Staff Training Provided. ☐Yes ☐NoNumber of Non-Program Personnel Trained ☐Yes ☐NoNumber of Program/Agency Policies or Procedures Created, Amended, or Rescinded

☐Yes ☐No

Number of Program Materials Developed ☐Yes ☐NoNumber of Program Youth Served MANDATORYNumber of Service Hours Completed ☐Yes ☐NoAverage Length of Stay in Program ☐Yes ☐NoNumber of Planning Activities Conducted ☐Yes ☐NoNumber of Assessment Studies Conducted ☐Yes ☐No

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Number of Data Improvement Projects Implemented ☐Yes ☐NoNumber of Objective Decision-Making Tools Developed ☐Yes ☐NoNumber of Program/Agency Policies or Procedures Created, Amended, or Rescinded.

☐Yes ☐No

OUTCOMES Relevant to Project?Number of State Agencies Reporting Improved Data Collection Systems

MANDATORY

Number of Local Agencies Reporting Improved Data Collection Systems

MANDATORY

Number of Minority Staff Hired ☐Yes ☐NoNumber of Percent of Program Youth Who Offend or Re-Offend MANDATORYNumber and Percent of Program Youth Exhibiting Desired Change in Behavior (At least one area below must be checked.)

A. Substance UseB. School AttendanceC. Family RelationshipsD. Anti-Social Behaviors

MANDATORY

☐Yes ☐No☐Yes ☐No☐Yes ☐No☐Yes ☐No

Number and Percent of Program Youth Completing Requirements MANDATORYNumber and Percent of Program Families Satisfied with Program ☐Yes ☐NoNumber and Percent of Program Staff with Increased Knowledge of Program Area

☐Yes ☐No

Number and Percent of Non-Program Personnel with Increased Knowledge of Program Area.

☐Yes ☐No

Number of Contributing Factors Determined from Assessment MANDATORYNumber of Contact Points Reporting Reduction in Disproportionality at the Local Level

MANDATORY

Number and Percent of Recommendations from Assessment Studies Implemented

MANDATORY

You will be required to report quarterly progress on all Performance Measures that are selected above. The Department of Juvenile Justice may require additional reporting items from this list as its discretion.

Clearly and concisely, describe a comprehensive plan for obtaining required information and data for evaluation of the program (outputs and outcomes). Also indicate the plan for measuring the parity changes in local DMC as a result of this project/program being implemented.

Data Sources: (Check all that are applicable)☐Program Attendance Records☐ School Referral Records☐ School Attendance Records☐ Court Records☐ Incident Reports☐ Case Records

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☐ Other: ______________

Data Collection Method:Who will collect the data?

When will the data be collected?

How will the data be used?

Timeline of ActivitiesPresent an outline of projected activities directed toward the implementation//continuation of this program/project by quarter. The recommended font is Times New Roman, 12 point and should be double-spaced. This section should not exceed 3 pages.

First QuarterOctober:

November:

December:

Second QuarterJanuary:

February:

March:

Third QuarterApril:

May:

June:

Fourth QuarterJuly:

August:

September:

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BudgetGrants will be dispersed via reimbursement on a monthly basis. Program costs may be dispersed as a per diem rate inclusive of personnel costs. Grantees should plan to continue projects beyond grant cycle. Clearly and concisely, describe continued plans for obtaining sustainability and fill in chart information as needed.

What needs continued funding?

What sources will be sought out?

Who will pursue the sources?

What is the projected date sources will be obtained?

(1)

(2)

(3)

(4)

*Applicants must attach a full agency budget.

PersonnelPlease attach a current job description and resume for each position.

Name:Position:Annual Salary:Percent on Project:Total Annual Salary:Number of Months on Project:Project Salary:

Fringe Benefits Rate Per Month TotalFlexible Spending or HealthEmployee RetirementAgency RetirementWorkers CompensationFICAUnemployment InsuranceOther (Total Annual Cost)Total FringeAnnual Grant SalaryFederal ShareTotal Cost

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Contractual ServicesThe rate is not to exceed $81.25 per hour ($650 per day max) unless approved.Name Affiliation Specialty Federal Share Total Cost

Contractual Services Total:

Travel and TrainingRequested travel expenses shall not exceed the established mileage and substance policy as set forth by the Commonwealth of Kentucky, Finance and Administration Cabinet. If agency travel and reimbursement policies are more restrictive than state and/or federal regulations, the most restrictive rate or policy must be used to determine the cost assigned to the budget.

Expense Federal Share Total CostAirfareLodgingMealsMileageRegistration/Tuition FeeMiscellaneousTravel Total

Operating ExpensesExamples of Operating Expenses include supplies, rent, utilities, postage, etc.

Item Federal Share Total Cost

Operating Expenses Total

Budget NarrativeProvide detailed information pertaining to each of the expenditures listed in your budget. Please provide any necessary justification for listed items. This should include a narrative detailing calculation method and necessity of all project costs listed on above budget (Personnel, Contractual Services, Training and Travel, and Operating Expenses).

Budget SummaryFederal Share Total Funding

1. Personnel2. Contractual Services3. Travel/Training4. Operating Expenses

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5. MiscellaneousTotals

Capabilities and CompetenciesThis section should describe the experience and capability of the applicant to implement and manage this project and its associated federal funding, highlighting any previous experience implementing projects of similar design or magnitude. This section should not exceed two (2) pages. The recommended font is Times New Roman, 12 point and should be double-spaced.

Attachments

Required:

o At least two (2) letters of support from a community partner to express support for the program.

o Job Descriptions (relevant to the Personnel section).

o Resumes of pertinent staff involved with the program.

o Full agency budget

o Agency Policy & Procedures manual

o Agency Organizational Chart

o Copy of appropriate insurances/licenses/certifications (program specific)

o Audit (see page 22)

Optional:

Additional letters of support from community partners.

Scoring Criteria:

A panel of subject matter experts will review and score the application based on the following criteria-

35% Project/Program Description (includes Timeline of Activities)

35% Capabilities/Competencies (includes relevant attachments)

20% Budget

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10% Performance Measures

CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHERRESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS

Applicants should refer to the regulations cited below to determine the certification to which they are required to attest.  Applicants should also review the instructions for certification included in the regulations before completing this form.  Signature of this form provides for compliance with certification requirements under 28 CFR Part 69, “New Restrictions on Lobbying” and 28 CFR Part 67, “Government-wide Debarment and Suspension (Non-procurement) and Government-wide Requirements for Drug-Free Workplace (Grants).”  The certifications shall be treated as a material representation of fact upon which reliance will be placed when the Department of Justice determines to award the covered transaction, grant, or cooperative agreement.

**Agency Representative/CEO must I N I T I A L B Y E A C H L I N E O N ALL S E C T I O N S .

1. LOBBYING

As required by Section 1352, Title 31 of the U.S. Code, and implemented at 28 CFR Part 69, for persons entering into a grant or cooperative agreement over $100,000, as defined at 28 CFR Part 69, the applicant certifies that:

___(a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the marking of any Federal grant, the entering into any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal grant or cooperative agreement;

___(b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form – LLL, “Disclosure of Lobbying Activities,” in accordance with its instructions;

___(c) The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including sub-grants, contracts under grants and cooperative agreements, and subcontracts) and that all sub-recipients shall certify and disclose accordingly.

 

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2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS (DIRECT RECIPIENT)

As required by Executive Order 12549, Debarment and Suspension, and implemented at 28 CFR Part 67, for prospective participants in primary covered transactions, as defined at 28 CFR Part 67, Section 67.510—

A. The applicant certifies that it and its principal:

____(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal department or agency,

____(b) Have not within a three-period preceding this application been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contact 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 indicated for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any offenses enumerated in paragraph (1)(b) of this certification; and

____(d) Have not within a three-year period preceding this application had one or more public transactions (Federal, State, or Local) terminated for cause or default; and

B. 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.

3. DRUG-FREE WORKPLACE (GRANTEES OTHER THAN INDIVIDUALS)

As required by the Drug-Free Workplace Act of 1988, and implemented at 28 CFR Part 67, Subpart F, for grantees, as defined at 28 CFR Part 67 Sections 67.615 and 67.620.

A. The applicant certifies that it will or will not continue to provide a drug-free workplace by: ___(a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantee’s workplace and specifying the actions that will be taken against employees for violation of such prohibition;

___(b) Establishing an on-going drug-free awareness program to inform

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employees about:

(1) The dangers of drug abuse in the workplace;

(2) The grantee’s policy of maintaining a drug-free workplace;

(3) Any available drug counseling, rehabilitation, and employee assistance programs; and

(4) 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 in the 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 a criminal drug statute occurring in the workplace no later than five calendar days after such conviction;

___(e) Notifying the agency, in writing, within 10 calendar days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction.  Employers of convicted employees’ must provide notice, including position title, to: Department of Justice, Office of Justice Programs, ATTN: Control Desk 81o 7th Street, N.W., Washington, D.C.  20531.  Notice shall include the identification number(s) of each affected grant;

___(f) 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:

(1) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or

(2) 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;

___(g) Making a good faith effort to continue to maintain a drug-free workplace

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through implementation of paragraphs (a), (b), (c), (d), (e), and (f).

B.  The grantee may insert in the space provided below the site(s) for the performance of work done in connection with the specific grant:

   

Place of Performance: ___________

___ Check Here if there are workplaces on filed that are not identified.

 Section 67, 630 of the regulations provides that a grantee that is a State may elect to make one certification in each Federal fiscal year.  A copy of which should be included with each application for Department of Justice funding.  States and State agencies may elect to use OJP Form 4061/7.

 ____Check here if the state has elected to complete the OJP Form 4061/7.  

DRUG-FREE WORKPLACE (GRANTEES WHO ARE INDIVIDUALS)

As required by the Drug-Free Workplace Act of 1988, and implemented at 28 CFR Part 67, Subpart F, for grantees, as defined at 28 CFR Part 67; Sections 67.615 and 67.620: (initial by each statement to document acceptance)

___A. As a condition of the grant, I certify that I will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the grant; and

___B. If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any grant activity, I will report the conviction, in writing, within 10 calendar days of the conviction, to: Department of Justice Office of Justice.

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Special Conditions for Grant Programs*Initial each line

The applicant assures that the agency possesses legal authority to apply for the grant; that resolution, motion, or similar action has been duly adopted or passes as an official act of the applicants governing body, authorizing the filing of the application including all understandings and assurances contained therein, and directing the authorizing person identified as the official representative of the applicant to act in connection with the application and to provide such additional information as may be required.

DISCRIMINATION PROHIBITED.  The sub-grantee agrees to assure that no person shall be excluded from participation in, denied the benefits of, subjected to discrimination under, or denied employment in connection with, any activity receiving funds from the Office of Justice Programs, Office on Violence Against Women, or the Office of Community Oriented Policing Services on the basis of race, color, religion, national origin, sex, handicap, or age.  The sub-grantee shall also assure the designation of an employee who will have lead responsibility for insuring sub-grantees compliance with civil rights regulations.  In accordance with federal civil rights laws, applicant assures it shall not retaliate against individual for taking action or participating in action to secure rights protected by these laws.

___The applicant assures that it will comply, and all its sub-grantees and contractors will comply, with the nondiscrimination requirements of the Omnibus Crime Control and Safe Streets Act of 1968 (Public Law 90-351, 42 U.S.C. § 3789d(c)) or Victims of Crime Act (42 U.S.C. § 10604), as appropriate; Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d); Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794); subtitle A, Title II of the Americans with Disabilities Act of 1990 (42 U.S.C. § 12132); Title IX of the Education Amendments of 1972 (20 U.S.C. § 1681); the Age Discrimination Act of 1975 (42 U.S.C. § 6102); and Department of Justice regulations at 28 C.F.R. pt. 42, subpts. C, D, E, and G, 28 C.F.R. pt. 35, and 28 C.F.R. pt. 54.

___The applicant assures that in the event a federal or state court or federal or state administrative agency makes a finding of discrimination after a due process hearing on the grounds of race, color, religion, national origin or sex against a recipient of funds, the recipient will forward a copy of the finding to the Office for Civil Rights (OCR) of the Office of Justice Programs.

___The applicant assures that it is in compliance with Title VI of the Civil Rights Act by providing services that are accessible to persons with limited English proficiency (LEP).  Recipients will prepare and maintain a written policy on language assistance for LEP persons.

___The applicant agrees to establish safeguards to prohibit employees from using their positions for a purpose that is or gives the appearance of being motivated by a desire for private gain for themselves or others, particularly those with whom they have family, business or other ties.

___The applicant will give the grantor agency or the Comptroller General, through any authorized representative, the access to and the right to examine all records, books, papers, or

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documents related to the grant.

___The applicant understands that whoever embezzles, willfully misapplies, steals or obtains by fraud any funds, assets or property which are the subject of a sub-grant or contract or other form of assistance, whether received directly or indirectly from the Kentucky Department of Juvenile Justice, may be fined not more than $10,000.00 or imprisoned for not more than five (5) years, or both.  Whoever knowingly falsifies, conceals or covers up by trick, scheme or device, any material fact in any application for assistance or in any record required to be maintained, will be subject to prosecution under the provisions of Section 1001 of Title 18, United States Code.  Any law enforcement program or project underwritten in whole or in part by any sub-grantee, or contract or other form of assistance, whether received directly or indirectly from the Kentucky Department of Juvenile Justice, will be subject to the provisions of Section 371 of Title 18, United States Code.

___The applicant agrees to implement this project within 60 days following the grant award effective date or be subject to automatic cancellation of the grant.  Evidence of project implementations must be reported to this office within the first 60 days.

___If the project is not operational within 90 days after acceptance of the award, a further statement explaining the implementation delay will be submitted by the sub-grantee to the Kentucky Department of Juvenile Justice.  Upon receipt of the 90-day letter the Department of Juvenile Justice may cancel the project and redistribute the funds to other program areas.  The Department of Juvenile Justice, where warranted by extenuating circumstances, may request approval from the Office of Justice Programs (OJP) Central Office to extend the implementation date of the project past the 90-day period.

___The applicant understands that all interest or other income earned by the sub-grantee with respect to sub-grant funds or as a result of conduct of the project (sale of publications, registration fees, service charges on fees, asset forfeitures, etc.) must be accounted for.  Interest on sub-grant funds must not accrue to the sub-grantee as the sub-grantee is not authorized to have an excess of a one-month supply of federal and state monies in their possession at the end of any calendar month.

___The applicant understands that federal grant funds made available under the auspices of OJP will not be used to supplant state or local funds, but will be used to initiate, enhance and/or expand the program according to individual program requirements.

___The applicant must state the source(s) of matching funds to be provided in the grant.  The applicant certifies as a part of this application that the matching contributions for this grant are from non-federal sources and may not involve federal funding or be used for another federally assisted program.___The applicant understands that grant funds may not be obligated prior to the effective date of the grant or subsequent to the termination date of the grant period.  Obligations outstanding as of the termination date shall be liquidated within 90 days after the termination of the grant period.

__The applicant understands that if financial reports are submitted past the submission deadline, a penalty of 5% per week of the monthly request, will be assessed to the total amount requested for monthly reimbursement.

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___The applicant agrees that no contract or agreement may be entered into by the sub-grantee for execution of project activities or provision of services to a sub-grant project (other than the purchase of supplies or standard commercial or maintenance services) which is not incorporated in the approved application.  Any such arrangements will provide that the sub-grantee will retain ultimate control and responsibility for the project and that the contractor will be bound by these conditions as well as the sub-grantee.

___The applicant agrees that fund accounting, auditing, monitoring, and evaluation procedures, as may be necessary to keep records as the Kentucky Department of Juvenile Justice,  shall prescribe, will be provided to assure fiscal control, proper management, and efficient distribution of funds received under the Office of Justice Programs.

___The applicant agrees that it will maintain data and information and submit reports in a designated format, in a timely manner and containing information as the Department of Juvenile Justice or the Office of Justice Programs may require.  Such data must be maintained at the applicants office, regardless of whether the administration of that office has changed.

___The applicant agrees that audit requirements as specified in the Office of Justice Programs Financial Guide (most current edition) or the OMB Circular A-133, will be followed until the OMB establishes new audit guidelines.

___The applicant assures that it will comply, and all its sub-grantees and contractors will comply, with the applicable provision of Title I of the Omnibus Crime Control and Safe Streets Act of 1968, as amended; the provisions of the Office of Justice Programs Financial and Administrative Guide for Grants, M7100.1D; and all other applicable federal laws, orders, circulars, or regulations.

___The applicant assures that it will not release the individual names of clients served by the program.  The applicant further assures that all information collected on clients will remain confidential.  If the applicant is subject to the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), it will adhere to all HIPAA requirements.  Any research studies the applicant conducts will conform to the confidentiality of 28 CFR Part 22.

___The applicant understands that a sub-grant may be terminated or fund payments discontinued by Department of Juvenile Justice where it finds a substantial failure to comply with the provisions under which the application was made or regulations promulgated, including these sub-grant conditions or application obligations, but only after notice and hearing and pursuant to all procedures set forth in Sections 510 and 511 of Public Law 90-351, as amended.

___ The applicant understands that if funds are used in a manner inconsistent with the award, the award can be terminated.

___The applicant understands that if the requested project is funded, continuation is not guaranteed.  

___Recipient must adhere to all due dates for program reports. If program reports are not submitted by due dates, payment reimbursement will not be dispersed.

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___ The applicant understands that if programmatic reports are late, or there is a lack of communication with the grant administrator, future funding can be affected.

___Recipients are required to report progress on output and outcome indicators.

___The applicant certifies that neither it nor its principles are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency. (Form# 4061/6 (3-91) can be accessed at www.ojp.usdoj.gov/Forms/cert.pdf )

___The applicant certifies that when issuing statements, press releases, requests for proposals, bid solicitations, and other documents describing projects or programs funded in whole or in part with federal money, all grantees receiving federal funds, including but not limited to state and local governments, shall clearly state: (1) the percentage of the total cost of the program or project which will be financed federal money, and (2) the dollar amount of federal funds for the project or program.

___The applicant certifies that it will make a good faith effort to provide and maintain a drug free workplace by prohibiting the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance in the work place.

___The applicant certifies that to the best of his or her knowledge no federal funds will be used for purposes of lobbying.  If funds have been used for lobbying, a Disclosure of Lobbying Activities form will be submitted. (Form# 4061/6 (3-91) can be accessed at www.ojp.usdoj.gov/forms/disclose.pdf )

___ If awarded funding, the applicant understands that in order to be reimbursed, the applicant must become a vendor of the state. Instructions will be provided upon award notification.

___Applicant understands that federal grant funds, if awarded, may not be used to support inherently religious activities, such as religious worship, instruction, or proselytization.  Recipients may use federal grant funds awarded as a result of this application only to support approved, non-religious program activities.  Therefore, organizations that receive direct governmental funds should take steps to separate, in time or location, any inherently religious activities from the government-funded services that they offer.  Such organizations should also carefully account for their use of all government money.  See USDOJ's Equal Treatment Regulations, 28 C.F.R. Pt. 38.

___The applicant agrees that should the Department of Juvenile Justice determine that it needs to take legal action against the applicant for actions arising out of the grant, the applicant will waive jurisdiction and have the case heard in either state or federal court in Franklin, Kentucky.  ___I have read and understand all Sub-Grantee Conditions and assure that the project(s) proposed in this application meet all the requirements of the Office of Justice Programs, that all the information presented is correct, that there has been appropriate coordination with affected agencies, and that the applicant will comply with the provisions of the Act and all other federal laws.  By appropriate language incorporated in each grant, sub-grantee or other document under

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which funds are to be disbursed, and undersigned assures that the applicable conditions above apply to all recipients of funds from the Office of Justice Programs.  

REQUIRED ATTACHMENTS

AUDIT REQUIREMENTS

STATE AND LOCAL GOVERNMENT AUDIT REQUIREMENTS

OMB Circular A-133 “Audits of States, Local Governments, and Non-Profit Institutions,” (06/24/1997) (includes revisions published in Federal Register 6/27/2003.)  For more information please Click Here.

Audit Threshold:

- Non-federal entities that expend $750,000 or more in federal funds (from all sources including pass through sub-awards) in the organization fiscal year (12-month turnaround reporting period) shall have a single organization wide audit conducted in accordance with the provisions of OMB Circular A-133.

- Non-federal entities that expend less than $750,000 a year in federal awards are exempt from federal audit requirements for that year.  However, a financial audit may be required for any project expending greater than $100,000.  Records must be available for review by appropriate officials including the federal agency, Kentucky Justice and Public Safety Cabinet, Department of Juvenile Justice and General Accounting Office (GAO).

Due Dates for Audit Reports:

A copy of the most current audit report and any management letter(s) available are required with the submission of the grant application.  Future audits are due no later than nine (9) months after the close of each fiscal year during the term of the award.

Audit Costs:The Department of Juvenile Justice will not reimburse any audit costs.

(It is recommended that this information be provided by the Chief Financial Officer)

1) Did the applicant agency expend $750,000.00 or more in federal funds in the organization’s last fiscal year?

___ Yes___ No

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2) Were there any reportable conditions noted?

___ Yes___ No

3) Were there any material weaknesses noted?

___ Yes___ No

 Please choose one of the following options:

___I have attached the Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards Audit.

___I will our mail Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Award's Audit.

___Agency is not required to submit the Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards Audit.  Our Agency's annual financial audit has been attached.

___Our Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Award's Audit is available electronically at:

  NOTE:  Please list sub-award(s) on the Schedule of Expenditures of Federal Awards (SEFA), as "Pass-Through Kentucky Department of Juvenile Justice".

LIMITED ENGLISH PROFICIENCY

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The federal government, and those receiving assistance from the federal government, must take reasonable steps to ensure that Limited English Proficient (LEP) persons have meaningful access to the programs, services and information those entities provide.  This will require agencies to develop creative solutions to address the needs of this ever-growing population of individuals whose primary language is not English.  Agencies must establish and implement policies and procedures for language assistance services that provide LEP persons with meaningful access, without additional charge.

Persons who do not speak English as their primary language and who have a limited ability to read, speak, write or understand English can be LEP.  These individuals are entitled to language assistance with respect to a particular type of service, benefit or encounter.  All programs and operations of entities that receive assistance from the federal government must comply with providing services to LEP individuals.  These services include providing oral language services and providing translation of written materials.  

Applicants are required to have a LEP plan.  Please attach a copy of your agency's LEP plan.

EQUAL EMPLOYMENT

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Each implementing agency receiving Office of Justice Programs assistance within the criminal justice system which has 50 or more employees and which has received grants or sub-grants of $25,000.00 or more pursuant to and since the enactment of the Safe Streets Act of 1968, as amended, and which has a service population with a minority representation of three (3) percent or more, is required to formulate, implement and maintain an equal employment opportunity program.

A certificate of compliance stating an EEOP is in existence in accordance with the regulations is required prior to the authorization of Office of Justice Programs funding.  The filing of such a certificate when no EEOP exists may legally constitute a false, fictitious or fraudulent statement with the intent to defraud the United States.  In filing an EEOP certificate under those circumstances, the signatory may be subject to a fine of not more than $10,000.00 or a prison term of not more than five (5) years.  16 United States Code 1001.  Those who joined in this endeavor may legally be part of a conspiracy to defraud the United States and could be subject to the same penalty.  18 United States Code 371.

Please note, agencies are exempt from completing an Equal Employment Opportunity Plan if they:  have less than 50 employees, are a non-profit organization; are a medical institution; or are receiving an award less than $25,000.   See 28 C.F.R §§ 42.301-.308 for further information.

In addition, you must choose one of the following options:*

___ Implementing Agency IS required to submit an Equal Employment Opportunity Plan to Office for Civil Rights, US Department of Justice and has done so as required.

____ Implementing Agency is NOT required to submit an Equal Employment Opportunity Plan to Office for Civil Rights, US Department of Justice. You must submit certification stating you are NOT required to submit an EEO Plan.

Applicants may obtain a copy of the certification form below: click here to go to the website.

You must review the link below to view the PowerPoint presentation provided by Office of Civil Rights, US Department of Justice.

Equal Employment Opportunity PowerPoint Presentation

___I have viewed and understand the attached Equal Employment Opportunity presentation.

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Submission Instructions:Send the completed application, including all attachments - in PDF format - to StephanieL.Reynolds@ky.gov with the subject line: Application: Disproportionate Minority Contact

Please note that due to state email firewalls, and restrictions on email attachment size, it will be confirmed when the application is received. If no confirmation is received within 3 days of submission, please send an email to StephanieL.Reynolds@ky.gov to ensure that the application was received.

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