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FORM INFORMATION
Form Name / Title HHS Checklist
Form Number HHS-5161-1
Version Number 2.1
Version Date
Description HHS Checklist form included in the HHS Standard Discretionary Application package HHS-5161-1
OMB Control Number 0990-0317
OMB Expiration Date 8/31/2010
Form Family X SF424
(select all that apply) X SF424 R&R
SF424 Individual
SF424 Mandatory
SF424 Short Organizational
FORM TITLE: HHS Checklist
[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17]
Min # of Max # of Field
Field Short Field Minimum Maximum Agency Field Global Library Field Type List of Chars or Chars or Implementatio
Field # Label Label Required? Occurrences Occurrences Name Field Type Field Name Source Business Rules Data Type Values Min Value Max Value n Help Tip
0-0 View Burden Statement View Burden n/a n/a n/a n/a Agency- n/a n/a Clicking displays: n/a n/a n/a n/a Button View Burden Statement
Statement specific Public Burden Statement:
Public reporting burden of this
collection of information is
estimated to average 4 - 50
hours per response, including
the time for reviewing
instructions, searching
existing data sources,
gathering and maintaining the
data needed, and completing
and reviewing the collection of
information. An agency may
not conduct or sponsor, and a
person is not required to
respond to a collection of
information unless it displays
a currently valid OMB control
number. Send comments
regarding this burden
estimate or any other aspect of
this collection of information,
including suggestions for
reducing this burden to HHS
Reports Clearance Officer,
200 Independence Ave., SW,
Humphrey Bldg., Room 531H,
Washington, DC, 20201,
ATTN: PRA (0990-0317). Do
not send the completed form to
this address.
0-1 HHS-5161-1 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
0-2 OMB Approval No. 0990-0317 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
Expiration Date: 8/31/2010
0-3 CHECKLIST n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
0-4 NOTE TO APPLICANT: n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
0-5 This form must be completed and submitted with the original of your n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
application. Be sure to complete each page of this form. Check the
appropriate boxes and provide the information requested. This form
should be attached as the last pages of the signed original of the
application.
1-0 Type of Application Type of Application No 0 1 AppType Radio Group n/a AppType n/a LIST n/a n/a n/a Radio Group n/a
1-1 New New No 0 1 n/a Radio Group n/a AppType Only 1 checkbox selection n/a New n/a n/a Radio Select if this application is a new
allowed submission which is not related to an
existing grant.
1-2 Noncompeting Continuation Noncompeting No 0 1 n/a Radio Group n/a AppType Only 1 checkbox selection n/a Noncompeting Continuation n/a n/a Radio Select if this application is a
Continuation allowed noncompeting continuation submission
related to an existing grant.
1-3 Competing Continuation Competing No 0 1 n/a Radio Group n/a AppType Only 1 checkbox selection n/a Competing Continuation n/a n/a Radio Select if this application is a competing
Continuation allowed continuation submission related to an
existing grant whose project period is
ending.
1-4 Supplemental Supplemental No 0 1 n/a Radio Group n/a AppType Only 1 checkbox selection n/a Supplemental n/a n/a Radio Select if this application is a
allowed supplemental request related to an
existing grant.
A0-1 PART A: The following checklist is provided to assure that n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
proper signatures, assurances, and certifications have been
submitted.
A0-2 Included n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
A0-3 NOT Applicable n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
A1-0 1. Proper Signature and Date on the SF 424 (FACE PAGE) Signature and Date No 0 1 Check424Sig Agency globLib:YesNoDataType n/a n/a n/a n/a n/a n/a Check Applicants must certify that proper
................... Specific signature and date are entered on the
SF 424 (Face Page).
A2-0 2. If your organization currently has on file with HHS the following n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label Before a grant or cooperative
assurances, please identify which have been filed by indicating the agreement award can be made, a
date of such filing on the line provided. (All four have been domestic applicant organization must
consolidated into a single form, HHS 690) certify that it has filed with the DHHS
Office for Civil Rights an Assurance of
Compliance ( HHS 690).
A2-1a Civil Rights Assurance (45 CFR 80) ........................................... Civil Rights No 0 1 CheckCivilRightAssuranc Agency- globLib:YesNoDataType n/a n/a n/a n/a n/a n/a Check Applicants must certify Assurance of
e specific Compliance with Title VI of the Civil
Rights Act of 1964 (P.L. 88-352, as
amended) which prohibits
discrimination on the basis of race,
color, or national origin was filed.
A2-1b n/a Civil Rights Date No 0 1 CivilRightAssuranceSign Agency- n/a n/a Visible only when previous DATE n/a n/a n/a Field Enter the date the assurance of
Date specific field is checked. compliance with Title VI of the Civil
Rights Act of 1964 (P.L. 88-352, as
amended) was filed.
A2-2a Assurance Concerning the Handicapped (45 CFR 84) ................. Handicapped No 0 1 CheckHandicappedAssur Agency- globLib:YesNoDataType n/a n/a n/a n/a n/a n/a Check Applicants must certify Assurance of
ance specific Compliance with Section 504 of the
Rehabilitation Act of 1973 (P.L. 93-112
as amended), which prohibits
discrimination on the basis of
handicaps, was filed. (45 CFR 84)
A2-2b n/a Handicapped Date No 0 1 HandicappedAssuranceSi Agency- n/a n/a Visible only when previous DATE n/a n/a n/a Field Enter the date the Assurance of
gnDate specific field is checked. Compliance with Section 504 of the
Rehabilitation Act of 1973 (P.L. 93-112
as amended) was filed.
A2-3a Assurance Concerning Sex Discrimination (45 CFR 86) .............. Sex Discrimination No 0 1 CheckSexAssurance Agency- globLib:YesNoDataType n/a n/a n/a n/a n/a n/a Check Applicants must certify Assurance of
specific Compliance with Title IX of the
Education Amendments of 1972 (P.L. 92-
318, as amended) which prohibits
discrimination on the basis of sex, was
filed. (45 CFR 86)
A2-3b n/a Sex Discrimination No 0 1 SexAssuranceSignDate Agency- n/a n/a Visible only when previous DATE n/a n/a n/a Field Enter the date the Assurance of
Date specific field is checked. Compliance with Title IX of the
Education Amendments of 1972 (P.L. 92-
318, as amended) was filed.
A2-4a Assurance Concerning Age Discrimination (45 CFR 90 & 45 CFR Age Discrimination No 0 1 CheckAgeAssurance Agency- globLib:YesNoDataType n/a n/a n/a n/a n/a n/a Check Applicants must certify Assurance of
91) ........................................... specific Compliance with the Age
Discrimination Act of 1975 (P.L. 94-
135), which prohibits discrimination on
the basis of age, was filed. (45 CFR 90
and 45 CFR 91)
A2-4b n/a Age Discrimination No 0 1 AgeAssuranceSignDate Agency- n/a n/a Visible only when previous DATE n/a n/a n/a Field Enter the date the Assurance of
Date specific field is checked. Compliance with the Age
Discrimination Act of 1975 (P.L. 94-
135) was filed.
A3-0 3. Human Subjects Certification, when applicable (45 CFR 46) Human Subjects No 0 1 CheckHumanSubjectCerti Radio Group n/a CheckHumanSubjectCertification n/a LIST n/a n/a n/a Radio Group Based on the information provided in the
..................................... fication RFA, if it has been determined that
projects funded under the RFA are
subject to the requirements of 45 CFR
part 46, Protection of Human Subjects,
applicants are required to indicate
whether the Human Subjects
Certification is included.
A3-a n/a Included No 0 1 n/a Radio Group n/a CheckHumanSubjectCertification n/a n/a Yes n/a n/a Radio Based on the information provided in the
RFA, if it has been determined that
projects funded under the RFA are
subject to the requirements of 45 CFR
part 46, Protection of Human Subjects,
applicants are required to indicate
whether the Human Subjects
Certification is included.
A3-b n/a N/A No 0 1 n/a Radio Group n/a CheckHumanSubjectCertification n/a n/a Not Applicable n/a n/a Radio Based on the information provided in the
RFA, if it has been determined that
projects funded under the RFA are
subject to the requirements of 45 CFR
part 46, Protection of Human Subjects,
applicants are required to indicate
whether the Human Subjects
Certification is included.
B0-1 PART B: This part is provided to assure that pertinent n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
information has been addressed and included in the
application.
B0-2 YES n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
B0-3 NOT Applicable n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
B1-0 1. Has a Public Health System Impact Statement for the proposed Impact Statement No 0 1 CheckPHSImpactStateme Radio Group n/a CheckPHSImpactStatement n/a LIST n/a n/a n/a Radio Group The Public Health System Impact
program/project been completed and distributed as required? nt Statement (PHSIS) is applicable to
............................................................... some programs and must be completed
and distributed. See specific
instructions in the RFA, if applicable.
The PHSIS is intended to inform State
and local health officials of health
services grant applications submitted by
organizations within their jurisdictions.
B1-a n/a Yes No 0 1 n/a Radio Group n/a CheckPHSImpactStatement n/a n/a Yes n/a n/a Radio The Public Health System Impact
Statement (PHSIS) is applicable to
some programs and must be completed
and distributed. See specific
instructions in the RFA, if applicable.
The PHSIS is intended to inform State
and local health officials of health
services grant applications submitted by
organizations within their jurisdictions.
B1-b n/a N/A No 0 1 n/a Radio Group n/a CheckPHSImpactStatement n/a n/a Not Applicable n/a n/a Radio The Public Health System Impact
Statement (PHSIS) is applicable to
some programs and must be completed
and distributed. See specific
instructions in the RFA, if applicable.
The PHSIS is intended to inform State
and local health officials of health
services grant applications submitted by
organizations within their jurisdictions.
B2-0 2. Has the appropriate box been checked on the SF-424 (FACE Intergovernmental No 0 1 CheckIntergrovernmental Agency- globLib:YesNoDataType n/a n/a n/a n/a n/a n/a Check On the face page of the SF-424,
PAGE) regarding intergovernmental review under E.O. 12372 ? (45 Review Checked Review specific applicants must certify whether the
CFR Part 100) ............... request is covered under Executive
Order 12372 and where appropriate, if
the State has been given an opportunity
to comment. The date given to State
must be indicated.
B3-0 3. Has the entire proposed project period been identified on the SF- Project Period No 0 1 CheckProjectPeriod424 Agency- globLib:YesNoDataType n/a n/a n/a n/a n/a n/a Check Applicants must assure that the
424 (FACE PAGE)?.................. Identified specific proposed project period has been
identified on the SF-424 (FACE PAGE).
B4-0 4. Have biographical sketch(es) with job description(s) been Biographical Sketch No 0 1 CheckBiographicalSketch Radio Group n/a CheckBiographicalSketch n/a LIST n/a n/a n/a Radio Group Applicants must assure that
provided, when required?.............. Attached biographical sketches with job
description(s) have been provided. See
specific instructions in the RFA.
B4-a n/a Yes No 0 1 n/a Radio Group n/a CheckBiographicalSketch n/a n/a Yes n/a n/a Radio Applicants must assure that
biographical sketches with job
description(s) have been provided. See
specific instructions in the RFA.
B4-b n/a N/A No 0 1 n/a Radio Group n/a CheckBiographicalSketch n/a n/a Not Applicable n/a n/a Radio Applicants must assure that
biographical sketches with job
description(s) have been provided. See
specific instructions in the RFA.
B5-0 5. Has the "Budget Information" page, SF-424A (Non-Construction Budget Information No 0 1 CheckSF424AC Agency- globLib:YesNoDataType n/a n/a n/a n/a n/a n/a Check Applicants must assure that the Budget
Programs) or SF-424C (Construction Programs), been completed Completed specific Information page, SF-424A of SF424C
and included? ............................ has been completed and included.
B6-0 6. Has the 12 month narrative budget justification been provided? 12 Month Detailed No 0 1 Check12MonthBudgetJus Radio Group n/a Check12MonthBudgetJustify n/a LIST n/a n/a n/a Radio Group Applicants must assure that the
...................................................... Budget tify narrative budget justification for the first
12 months has been provided.
B6-a n/a Yes No 0 1 n/a Radio Group n/a Check12MonthBudgetJustify n/a n/a Yes n/a n/a Radio Applicants must assure that the
narrative budget justification for the first
12 months has been provided.
B6-b n/a N/A No 0 1 n/a Radio Group n/a Check12MonthBudgetJustify n/a n/a Not Applicable n/a n/a Radio Applicants must assure that the
narrative budget justification for the first
12 months has been provided.
B7-0 7. Has the budget for the entire proposed project period with Project Period No 0 1 HasDetailProjectBudget Radio Group n/a HasDetailProjectBudget n/a LIST n/a n/a n/a Radio Group Applicants must assure that the budget
sufficient detail been provided? ................... Budget for the entire proposed project period,
with sufficient detailed justifications, has
been provided.
B7-a n/a Yes No 0 1 n/a Radio Group n/a HasDetailProjectBudget n/a n/a Yes n/a n/a Radio Applicants must assure that the budget
for the entire proposed project period,
with sufficient detailed justifications, has
been provided.
B7-b n/a N/A No 0 1 n/a Radio Group n/a HasDetailProjectBudget n/a n/a Not Applicable n/a n/a Radio Applicants must assure that the budget
for the entire proposed project period,
with sufficient detailed justifications, has
been provided.
B8-0 8. For a Supplemental application, does the narrative budget Supplemental No 0 1 SuppOnlyAdditionalFunds Radio Group n/a SuppOnlyAdditionalFunds n/a LIST n/a n/a n/a Radio Group If this is an application for supplemental
justification address only the additional funds requested? Application Budget funds, applicants must assure that the
detailed budget and programmatic
justifications are provided only for the
additional funds requested.
B8-a n/a Yes No 0 1 n/a Radio Group n/a SuppOnlyAdditionalFunds n/a n/a Yes n/a n/a Radio If this is an application for supplemental
funds, applicants must assure that the
detailed budget and programmatic
justifications are provided only for the
additional funds requested.
B8-b n/a N/A No 0 1 n/a Radio Group n/a SuppOnlyAdditionalFunds n/a n/a Not Applicable n/a n/a Radio If this is an application for supplemental
funds, applicants must assure that the
detailed budget and programmatic
justifications are provided only for the
additional funds requested.
B9-0 9. For Competing Continuation and Supplemental applications, has Progress Report No 0 1 CheckProgressReport Radio Group n/a CheckProgressReport n/a LIST n/a n/a n/a Radio Group If this is a Competing Continuation or
a progress report been included? Supplemental application, applicants
must assure that a progress report has
been provided.
B9-a n/a Yes No 0 1 n/a Radio Group n/a CheckProgressReport n/a n/a Yes n/a n/a Radio If this is a Competing Continuation or
Supplemental application, applicants
must assure that a progress report has
been provided.
B9-b n/a N/A No 0 1 n/a Radio Group n/a CheckProgressReport n/a n/a Not Applicable n/a n/a Radio If this is a Competing Continuation or
Supplemental application, applicants
must assure that a progress report has
been provided.
C0-1 PART C: In the spaces provided below, please provide the n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
requested information.
C1-0 Business Official to be notified if an award is to be made n/a n/a n/a n/a n/a Global globLib:HumanNameDataType n/a n/a n/a n/a n/a n/a Label Provide the name of the Business
Official to be notified if an award is to be
made. The Official Notice of Grant
Award will be mailed to the Business
Official named in Part C.
C1-1 Prefix: Business Official No 0 1 Prefix Global globLib:PrefixName n/a n/a LIST Mr.&&Mrs.&&Miss&&Ms.&&Dr. 0 10 Combobox Enter the prefix (e.g., Mr., Mrs., Rev.)
Prefix &&Rev.&&Prof. for the name of the Business Official.
C1-2 First Name: Business Official Yes 1 1 FirstName Global globLib:FirstName n/a n/a AN n/a 1 35 Field Enter Business Official First Name
First Name (Given Name)
C1-3 Middle Name: Business Official No 0 1 MiddleName Global globLib:MiddleName n/a n/a AN n/a 0 25 Field Enter Business Official Middle Name
Middle Name
C1-4 Last Name: Business Official Yes 1 1 LastName Global globLib:LastName n/a n/a AN n/a 1 60 Field Enter Business Official Last Name
Last Name (Surname)
C1-5 Suffix: Business Official No 0 1 Suffix Global globLib:SuffixName n/a n/a LIST Jr.&&Sr.&&M.D.&&Ph.D 0 10 Combobox Enter the suffix (e.g., Jr. Sr., PhD), if
Suffix appropriate for the Business Official.
C1-6 Title: Business Official Yes 1 1 BOTitle Global globLib:HumanTitleDataType n/a n/a AN n/a 1 45 Field Enter Business Official Title
Title
C1-7 Organization: Business Official Yes 1 1 BOOrganizationName Global globLib:OrganizationNameDataType n/a n/a AN n/a 1 60 Field Enter Business Official Organization
Organization Name
C1-8 Street1: Business Official Yes 1 1 BOStreet1 Global globLib:Street1 n/a n/a AN n/a 1 55 Field Enter the first line of Street Address for
Street1 the Business Official
C1-9 Street2: Business Official No 0 1 BOStreet2 Global globLib:Street2 n/a n/a AN n/a 0 55 Field Enter the second line of Street Address
Street2 for the Business Official
C1-10 City: Business Official Yes 1 1 BOCity Global globLib:City n/a n/a AN n/a 1 35 Field Enter Business Official City
City
C1-11 State: Business Official Yes 1 1 BOState Global globLib:State n/a n/a LIST 50 US States, US possessions, 1 55 Popup Enter Business Official State
State territories, military codes
C1-12 ZIP / Postal Code: Business Official Yes 1 1 BOZipPostalCode Agency n/a Must be 5 numeric digits. AN n/a 5 5 Field Enter Business Official 5-digit ZIP /
ZIP / Postal Code specific Postal code.
C1-12a ZIP / Postal Code4: Business Official No 0 1 BOZipPostalCodeplus4 Agency n/a If entered, must be 4 numeric AN n/a 0 4 Field Enter Business Official 4-digit ZIP /
ZIP / Postal Code specific digits. Postal code extension.
plus 4
C1-13 E-mail Address: Business Official Yes 1 1 BOEmail Global globLib:EmailDataType n/a E-mail validation AN n/a 1 60 Field Enter Business Official's E-mail
Email Address
C1-14 Telephone Number: Business Official Yes 1 1 BOPhone Global globLib:TelephoneNumberDataType n/a n/a AN n/a 1 25 Field Enter Business Official Phone Number
Telephone Number with Area Code
C1-15 Fax Number: Business Official No 0 1 BOFax Global globLib:TelephoneNumberDataType n/a n/a AN n/a 0 25 Field Enter Business Official Fax Number
Fax Number with Area Code
C2-0 Program Director/Project Director/Principal Investigator n/a n/a n/a n/a n/a Global globLib:HumanNameDataType n/a n/a n/a n/a n/a n/a Label Program Director/Project
designated to direct the proposed project or program Director/Principal Investigaor
designated to direct the proposed
project or program. The individual
designated to direct the project must be
the same as the individaul identified in
Item 5 on the face page of the
applications.
C2-1 Prefix: PDPI Prefix No 0 1 Prefix Global globLib:PrefixName n/a n/a LIST Mr.&&Mrs.&&Miss&&Ms.&&Dr. 0 10 Combobox Enter the prefix (e.g., Mr., Mrs., Rev.)
&&Rev.&&Prof. for the name of the Program Director.
C2-2 First Name: PDPI First Name Yes 1 1 FirstName Global globLib:FirstName n/a n/a AN n/a 1 35 Field Enter Program Director First Name
(Given Name)
C2-3 Middle Name: PDPI Middle Name No 0 1 MiddleName Global globLib:MiddleName n/a n/a AN n/a 0 25 Field Enter Program Director Middle Name
C2-4 Last Name: PDPI Last Name Yes 1 1 LastName Global globLib:LastName n/a n/a AN n/a 1 60 Field Enter Program Director Last Name
(Surname)
C2-5 Suffix: PDPI Suffix No 0 1 Suffix Global globLib:SuffixName n/a n/a LIST Jr.&&Sr.&&M.D.&&Ph.D 0 10 Combobox Enter the suffix (e.g., Jr. Sr., PhD), if
appropriate for the Program Director.
C2-6 Title: PDPI Title Yes 1 1 PDTitle Global globLib:HumanTitleDataType n/a n/a AN n/a 1 45 Field Enter Program Director Title
C2-7 Organization: PDPI Organization Yes 1 1 PDOrganizationName Global globLib:OrganizationNameDataType n/a n/a AN n/a 1 60 Field Enter Program Director Organization
Name
C2-8 Street1: PDPI Street1 Yes 1 1 PDStreet1 Global globLib:Street1 n/a n/a AN n/a 1 55 Field Enter the first line of Street Address for
the Program Director
C2-9 Street2: PDPI Street2 No 0 1 PDStreet2 Global globLib:Street2 n/a n/a AN n/a 0 55 Field Enter the second line of Street Address
for the Program Director
C2-10 City: PDPI City Yes 1 1 PDCity Global globLib:City n/a n/a AN n/a 1 35 Field Enter Program Director City
C2-11 State: PDPI State Yes 1 1 PDState Global globLib:State n/a n/a LIST 50 US States, US possessions, 1 55 Popup Enter Program Director State
territories, military codes
C2-12 ZIP / Postal Code: PDPI ZIP / Postal Yes 1 1 PDZipPostalCode Agency n/a Must be 5 numeric digits. AN n/a 5 5 Field Enter Program Director 5-digit ZIP /
Code specific Postal code.
C2-12a ZIP / Postal Code4: PDPI ZIP / Postal No 0 1 PDZipPostalCodeplus4 Agency n/a If entered, must be 4 numeric AN n/a 0 4 Field Enter Program Director 4-digit ZIP /
Code plus 4 specific digits. Postal code extension.
C2-13 E-mail Address: PDPI Email Yes 1 1 PDEmail Global globLib:EmailDataType n/a E-mail validation AN n/a 1 60 Field Enter Program Director's E-mail
Address
C2-14 Telephone Number: PDPI Telephone Yes 1 1 PDPhone Global globLib:TelephoneNumberDataType n/a n/a AN n/a 1 25 Field Enter Program Director Phone Number
Number with Area Code
C2-15 Fax Number: PDPI Fax Number No 0 1 PDFax Global globLib:TelephoneNumberDataType n/a n/a AN n/a 0 25 Field Enter Program Director Fax Number
with Area Code
2-0 HHS Checklist (08-2007) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
D0-1 HHS-5161-1 (08/2007) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
D0-2 PART D: A private, nonprofit organization must include n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label A private, nonprofit organization must
evidence of its nonprofit status with the application. Any of include evidence of its nonprofit status
the following is acceptable evidence. Check the appropriate with the application. Any of the following
box or complete the "Previously Filed" section, whichever is is acceptable evidence. Check the
appropriate box or complete the
applicable.
"Previously Filed" section, whichever is
applicable.
D1-a (a) A reference to the organization's listing in the Internal Revenue Reference to IRS No 0 1 CheckReferenceIRSList Agency- globLib:YesNoDataType n/a If checked, disable D2-0, D2- n/a n/a n/a n/a Check Check, if applicable; and provide
Service's (IRS) most recent list of tax-exempt organizations 501(c)(3) specific 1, D2-2. document
described in section 501(c)(3) of the IRS Code.
D1-b (b) A copy of a currently valid Internal Revenue Service Tax Tax exempt No 0 1 CheckIRSCertification Agency- globLib:YesNoDataType n/a If checked, disable D2-0, D2- n/a n/a n/a n/a Check Check, if applicable; and provide
exemption certificate. certificate specific 1, D2-2. document
D1-c (c) A statement from a State taxing body, State Attorney General, or Nonprofit Status No 0 1 CheckStateTaxCertificatio Agency- globLib:YesNoDataType n/a If checked, disable D2-0, D2- n/a n/a n/a n/a Check Check, if applicable; and provide
other appropriate State official certifying that the applicant from State n specific 1, D2-2. document
organization has a nonprofit status and that none of the net earnings
accrue to any private shareholders or individuals.
D1-d (d) A certified copy of the organization's certificate of incorporation Certificate of No 0 1 CheckIncorporationCertifi Agency- globLib:YesNoDataType n/a If checked, disable D2-0, D2- n/a n/a n/a n/a Check Check, if applicable; and provide
or similar document if it clearly establishes the nonprofit status of the Incorporation cation specific 1, D2-2. document
organization.
D1-e (e) Any of the above proof for a State or national parent organization, Local Nonprofit No 0 1 CheckParentOrganzation Agency- globLib:YesNoDataType n/a If checked, disable D2-0, D2- n/a n/a n/a n/a Check Check, if applicable; and provide
and a statement signed by the parent organization that the applicant Affiliate Certification specific 1, D2-2. document
organization is a local nonprofit affiliate.
D2-0 If an applicant has evidence of current nonprofit status on file with an n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
agency of HHS, it will not be necessary to file similar papers again,
but the place and date of filing must be indicated.
D2-1 Previously Filed with: (Agency) Previously Filed No 0 1 AgencyName Global globLib:AgencyNameDataType n/a Disabled if AN n/a 0 60 Field If an applicant has evidence of current
With CheckReferenceIRSList, nonprofit status on file with an agency of
CheckIRSCertification, HHS, it will not be necessary to file
CheckStateTaxCertification, similar papers again. Enter the name of
CheckIncorporationCertificati previous agency of filing.
on, or
CheckParentOrganzationCert
ification are checked
D2-2 on (Date) Date Previously No 0 1 PreviouslyFiledDate Agency- n/a n/a Disabled if DATE n/a n/a n/a Field Enter the previous filing date
Filed specific CheckReferenceIRSList,
CheckIRSCertification,
CheckStateTaxCertification,
CheckIncorporationCertificati
on, or
CheckParentOrganzationCert
ification are checked
3-0 INVENTIONS n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
3-1 If this is an application for continued support, include: (1) the report n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
of inventions conceived or reduced to practice required by the terms
and conditions of the grant; or (2) a list of inventions already
reported, or (3) a negative certification.
4-0 EXECUTIVE ORDER 12372 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
4-1 Effective September 30, 1983, Executive Order 12372 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
(Intergovernmental Review of Federal Programs) directed OMB to
abolish OMB Circular A-95 and establish a new process for
consulting with State and local elected officials on proposed Federal
financial assistance. The Department of Health and Human Services
implemented the Executive Order through regulations at 45 CFR
Part 100 (Inter-governmental Review of Department of Health and
Human Services Programs and Activities). The objectives of the
Executive Order are to (1) increase State flexibility to design a
consultation process and select the programs it wishes to review,
(2) increase the ability of State and local elected officials to influence
Federal decisions and (3) compel Federal officials to be responsive
to State concerns, or explain the reasons.
4-2 The regulations at 45 CFR Part 100 were published in the Federal n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
Register on June 24, 1983, along with a notice identifying the
Department’s programs that are subject to the provisions of
Executive Order 12372. Information regarding HHS programs
subject to Executive Order 12372 is also available from the
appropriate awarding office.
4-3 States participating in this program establish State Single Points of n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
Contact (SPOCs) to coordinate and manage the review and
comment on proposed Federal financial assistance. Applicants
should contact the Governor’s office for information regarding the
SPOC, programs selected for review, and the consultation (review)
process designed by their State.
4-4 Applicants are to certify on the face page of the SF-424 (attached) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
whether the request is for a program covered under Executive Order
12372 and, where appropriate, whether the State has been given an
opportunity to comment.
5-0 BY SIGNING THE FACE PAGE OF THIS APPLICATION, THE n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
APPLICANT ORGANIZATION CERTIFIES THAT THE
STATEMENTS IN THIS APPLICATION ARE TRUE,
COMPLETE, AND ACCURATE TO THE BEST OF THE
SIGNER’S KNOW LEDGE, AND THE ORGANIZATION
ACCEPTS THE OBLIGATION TO COMPLY W ITH U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES’ TERMS
AND CONDITIONS IF AN AW ARD IS MADE AS A RESULT OF
THE APPLICATION. THE SIGNER IS ALSO AW ARE THAT ANY
FALSE, FICTITIOUS, OR FRAUDULENT STATEMENTS OR
CLAIMS MAY SUBJECT THE SIGNER TO CRIMINAL, CIVIL,
OR ADMINISTRATIVE PENALTIES.
5-1 THE FOLLOW ING ASSURANCES/CERTIFICATIONS ARE n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
MADE AND VERIFIED BY THE SIGNATURE OF THE
OFFICIAL SIGNING FOR THE APPLICANT ORGANIZATION
ON THE FACE PAGE OF THE APPLICATION:
5-2 Civil Rights – Title VI of the Civil Rights Act of 1964 (P.L. 88- n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
352), as amended, and all the requirements imposed by or pursuant
to the
HHS regulation (45 CFR part 80).
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5-3 Handicapped Individuals – Section 504 of the Rehabilitation Act n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
of 1973 (P.L. 93-112), as amended, and all requirements imposed by
or
pursuant to the HHS regulation (45 CFR part 84).
5-4 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
Sex Discrimination – Title IX of the Educational Amendments of
1972 (P.L. 92-318), as amended, and all requirements imposed by or
pursuant to the HHS regulation (45 CFR part 86).
5-5 Age Discrimination – The Age Discrimination Act of 1975 (P.L. 94- n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
135), as amended, and all requirements imposed by or pursuant to
the
HHS regulation (45 CFR part 91).
5-6 Debarment and Suspension – Title 2 CFR part 376. n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
5-7 Certification Regarding Drug-Free W orkplace Requirements n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
– Title 45 CFR part 82.
5-8 Certification Regarding Lobbying – Title 32, United States n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
Code, Section 1352 and all requirements imposed by or pursuant to
the HHS
regulation (45 CFR part 93).
5-9 Environmental Tobacco Smoke – Public Law 103-227. n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
5-10 Program Fraud Civil Remedies Act (PFCRA) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
6-0 HHS Checklist (08-2007) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label n/a
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USING THE DATA ANALYSIS TEMPLATE TOOLKIT
It is recommended that you print this sheet. To do so, click File, Print on the menu at the top the screen.
1.
Click on the DAT Instructions tab at the bottom of the screen. It is recommended that you print these instructions to use as a reference during the
2. process of creating your Data Analysis Template (DAT). To do so, click File, Print on the menu at the top the screen.
Click on the Form Info tab at the bottom of the screen. Fill in the requested information about the form. Refer to the instructions printed in 1. for
3. guidance.
Click on the Global Index tab at the bottom of the screen. The Global Index serves two purposes:
4.
o It gives you the ability to view the Grants.gov Global Library of standard fields and their attributes
o It gives you the ability to utilize pre-formatted templates to be used as rows in your form's Data Analysis Template (DAT).
Now is the time to begin preparing the Data AnalysisTemplate (DAT).
Determine the first (next) data element on the form. A data element is a data entry field, form title, section header or label.
5.
IS IT A FORM TITLE, SECTION HEADER, OR LABEL?
YES. Copy the Label row template into your DAT.
Look for Label in the Global Index section III. General Data Element Formats. Click on Label. The template row for a label will be
highlighted. Select Edit, Copy from the menu at the top of the screen. Click on the FORM DAT tab at the bottom of the screen. Click
on the appropriate row number to paste the template into. From the menu, select Edit, Paste. Use the DAT instructions as guidance
for filling in all columns in red.
NO. Then it must be a data entry field.
Grants.gov has created a required standard for representing names and addresses on forms. Elements related to names and
addresses are grouped together in data element groups. If a data element group is selected, all fields within that group must be
included.
IS THE ELEMENT PART OF A NAME OR ADDRESS?
YES. To use the Human Name Group or Address Group, click on the appropriate link in section II of the Global Index. Select
Edit, Copy from the menu at the top of the screen. Click on the FORM DAT tab at the bottom of the screen. Click on the row
number into which template will be pasted. From the menu, select Edit, Paste. Use the DAT instructions as guidance for filling
in all columns in red.
NO. IS THE ELEMENT A GLOBAL DATA ELEMENT?
A global data element is a data element that is commonly used on forms across agencies. Grants.gov has standardized the
attributes for global data elements. Some global data elements may be pre-populated from the application cover sheets, some
may be post-populated after submission to Grants.gov, and some may be forward-populated from the application cover sheets.
The Global Index in section I provides a list of global data elements.
YES. Copy the element's template into your DAT.
Click on the name of the element. The template row for a label will be highlighted. Select Edit, Copy from the menu at the
top of the screen. Click on the FORM DAT tab at the bottom of the screen. Click on the row number into which the
template will be pasted. From the menu, select Edit, Paste. Use the DAT instructions as guidance for filling in all columns
in red.
NO. THEN THE ELEMENT MUST BE AGENCY-SPECIFIC.
Determine the General Field Format in section III of the Global Index that best reflects the data element. Click on the
name of the format or one of the options beneath it. The template row(s) will be highlighted. Select Edit, Copy from the
menu at the top of the screen. Click on the FORM DAT tab at the bottom of the screen. Click on the row number into
which the template will be pasted. From the menu, select Edit, Paste. Use the DAT instructions as guidance for filling in
all columns in red. For information about pre-populating, post-populating, and forward-populating, refer to the DAT
instructions.
Repeat all of the steps in 5. until all elements on the form are represented on the DAT. The data elements on the DAT should be in the same order
they appear on the form. For answers to questions about the process of preparing a Data Analysis Template, contact the PMO Program Advisor.
FORM INFORMATION
ROW ROW NAME ROW DEFINITION
[A] Form Name / Title The name of the form to be displayed on the Grants.gov system
[B] Form Number The number associated with the form within the agency.
[C] Version Number The version number of the form within the agency.
[D] Version Date The version date of the form.
[E] Description A short description of the form.
[F] OMB Control Number The control number issued by the Office of Management and Budget (OMB) when a form is cleared.
[G] OMB Expiration Date The expiration date issued by the Office of Management and Budget (OMB.)
[H] Form Family The families this form should be include with.
FORM ELEMENTS
COLUMN COLUMN NAME COLUMN DEFINITION
[1] Field # A unique, sequential number for (a) each field on the form for which data will be entered or selected and (b) form title, section headers or labels. Use the block number on the form mock up, if
any, otherwise start the count with 1. Format is <block#>-<field#> (e.g. Block 15, field 1 would be represented as 15-1.)
[2] Field Label The name of the field as presented on the form. This label will be used at the beginning of the Help Tip and Accessibility Text. If the label has more than 25 characters, then provide an
abbreviated version in the Short Field Label [3] column. This column is also used when Field Implementation [16] is label and you are specifying the form title, section headers, or labels. You
may change any Global Library template label in red to the label as specified on the form.
[3] Short Field Label Enter condensed version for use at the beginning of Help Tip and Accessibility Text. Please limit to 40 characters or less and do not abbreviate words.
[4] Required? - Enter "Yes" if the field must be completed before the application can be submitted.
- If the field is optional, conditional, or "Required if" then enter "No" in this column.
- If the field is calculated (see BUSINESS RULES [11]) and all fields involved in the calculation are optional, enter “No” in this column.
- If the field is calculated (see BUSINESS RULES [11]) and one or more of the fields involved in the calculation are mandatory, enter “Yes” in this column.
- If the field is to be forward-populated (see FIELD TYPE [8]), then the value for this column should be the same as the value of the source field (e.g. if the source field is optional, the destination
field is optional, if the source field is mandatory, the destination field is mandatory).
[5] Minimum Occurrences - The minimum number of entries that can be made for the same field.
- Enter 0 if the field is optional.
- Enter 1 or more if the field must be completed before the application can be submitted.
[6] Maximum Occurrences - The maximum number of entries that can be made for the same field.
- Must be 1 or more.
[7] Agency Field Name Short name that describes the field. This name will be used as an input to the XML schema. For Global Data Elements, a suggested name is pre-filled in red, though it may be changed.
Grants.gov may modify names as needed to meet guidelines and standards. Note: Each Agency Field Name must be unique on a DAT.
[8] Field Type Select one from the following 5 options:
Pre-populated - Field will be populated with data from the application package. See Global Index Section II for a list of qualifying fields.
Post-populated - Field will be populated in a form after submission to Grants.gov. See the Global Index Section III for a list of qualifying fields.
Forward-populated - Field will be populated with data from the application cover page (e.g., SF424, SF424 (R&R)) or
- Field will be populated with data entered earlier in the form.
Global - Field is a global data element that is not forward-populated or a global data element group.
Agency Specific - Field is unique to your agency. Enter values in ALL columns in this DAT as indicated by the instructions.
Radio Group - Agency-specific field that displays a limited set of alternatives. Applicant has the option of selecting one value.
[9] Global Library Field Name - Pre-formatted for your convenience. No action required.
[10] Field Type Source If Pre-populated - Pre-formatted for your convenience. No action required.
If Post-Populated - Pre-formatted for your convenience. No action required.
If Foward-Populated - If "Foward-populated" was selected in the Field Type [8] column, enter the source's form name (as found on the PureEdge version of the form) and field #. Should
be in the format <form name>-<block #>-<field #> (e.g. SF424-6-1.)
If Global - If "Global" was selected in Field Type [8] column, enter n/a.
If Agency Specific - Pre-formatted for your convenience. No action required.
If Radio Group - If "Radio Group" was selected in the Field Type [8] column, then enter the name radio group. The radio group name may be the same as the Field Label.
[11] Business Rules Simple rules about the field, such as:
- Is a specific format required (e.g., 4 digit year and 5 digit code like "2004-abcdf")? Remember to indicate this format in the element's help tip.
- Is a calculation required for this field (e.g., Total = 15-1 + 15-2 + 15-3 + 15-4)
- Is this field conditionally required (e.g., Required if 3-1 is Yes)
- NOTE: Grants.gov does not enforce business rules across forms.
- Enter n/a if there are no business rules for the field.
[12] Data Type - Pre-formatted for your convenience. No action required.
FORM ELEMENTS
COLUMN COLUMN NAME COLUMN DEFINITION
[13] List of Values - If theData Type [12] is LIST, provide a list of values that you want to be given to the user.
- The format of each list item should be <id>: <description>. Use && to separate each value (e.g. MD: Maryland&& VA: Virginia)
- For Minimum # of Characters [14] and Maximum # of Characters [15], enter the character count for the shortest and longest values in the list
- If the field is required, it must have a default value. Mark the default value with an asterisk before the value, if any (e.g. *MD: Maryland.) If the user does not change
the selection, the field will automatically be filled with the default value.
- Enter n/a if a list of values does not apply.
- NOTE: No list of values is needed for Radio Groups. This list of values is the Field Labels for the Radio Group's radio options.
[14] Minimum # of Characters or - If the Data Type [12] is AN, enter the minimum number of characters that may be entered into a field (minimum field length.) If the field is optional, enter 0.
Minimum Value - If the Data Type [12] is INTEGER, $, or DECIMAL(2), enter the minimum value for the field including decimals where applicable
(e.g. enter "5000" if the value cannot be less than 5000.)
- If the Data Type [12] is LIST, FILE, MULTIFILE or DATE, enter "n/a" in this column.
- A hyphen is not counted as a character if it is included on the form for presentation purposes. It is counted if it is to be stored with the data.
[15] Maximum # of Characters or - If the Data Type [12] is AN, enter the maximum number of characters that may be entered into a field (maximum field length.)
Maximum Value - If the Data Type [12] is INTEGER, $, or DECIMAL(2), enter the maximum value for the field including decimals where applicable
(e.g. enter "10,000" if the value cannot be more than 10,000.)
- If the Data Type [12] is LIST, FILE, MULTIFILE, or DATE, enter "n/a" in this column.
- A hyphen is not counted as a character if it is included on the form for presentation purposes. It is counted if it is to be stored with the data.
[16] Field Implementation - Pre-formatted for your convenience.
[17] Help Tip Text that will be displayed when the applicant clicks on the help icon. Please compose the wording carefully, as this text will be used for the Accessibility text as well as the Help Tip. Use the
following guidelines for creating help tips:
- If the field is required, then the help tip should end with the statement "This field is required." Add "This field is required" to the end of global help tips if they are required.
- If the field has a certain format, then the tip should contain text describing the required format.
- If a Radio Group is required, then the help tip on the Radio Group Header should state "One selection is required."
Grants.gov Global Index
Click on an element name, data element group name, or general element format to view its DAT row template.
Follow the instructions to copy and paste template rows into the Form DAT.
I. GLOBAL DATA ELEMENTS III. GENERAL DATA ELEMENT FORMATS
Agency Name Employer/Taxpayer Identification Number (EIN/TIN) Alphanumeric
Applicant ID Fax Button
CFDA Number Federal Award Identifier Date
CFDA Title Federal Entity Identifier Degree Earned
Congressional District: Applicant Organization Name (Legal Name) Dollar Amount
Congressional District: Program/Project Phone Number Dollar Amount Total
Country Project Name File Attachment - Single
Department Name Project Title Optional Required
Division Name Social Security Number File Attachment - Multiple
DUNS Number Title Optional Required
Email Type of Applicant Numeric
DATA ELEMENTS THAT CAN BE PRE-POPULATED FROM THE APPLICATION PACKAGE with 2 decimals without decimals
Agency Name Competition Identification Number Label
CFDA Number Competition Identification Title List - Drop Down (one selection from a drop-down list of values)
CFDA Title Funding Opportunity Number List - Checkbox (Check for yes. May select multiple options)
Funding Opportunity Title List - Radio Group (one selection from a group of options)
DATA ELEMENTS THAT ARE POST-POPULATED AFTER SUBMISSION TO GRANTS.GOV Optional Required
AOR Signature Percent
Date Received with 2 decimals without decimals
Date Signed Year
II. GLOBAL DATA ELEMENT GROUPS Yes/No Radio Group
Address Group Street1, Street2, City, County, Province, State, Zip Code, Country Optional Required
Human Name Group Prefix, First Name, Middle Name, Last Name, Suffix Yes/No/Other Radio Group
Optional Required
Yes/No/Not Applicable
Optional Required
DATA ANALYSIS ROW TEMPLATES
INSTRUCTIONS: Listed below are Data Analysis row templates for data elements and formats defined in the Global Library. To
copy into your DAT, select Edit, Copy from the menu at the top of the screen. Click on the FORM DAT tab at the bottom of the
screen. Click on the row number you want to paste the template into. From the menu, select Edit, Paste. Use the instructions on
the DAT INSTRUCTIONS tab as guidance for filling in all columns in red.
[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17]
Min # of Max # of
Field Short Field Minimum Maximum Agency Field Global Library Field Type List of Chars or Chars or Field
Field # Label Label Required? Occurrences Occurrences Name Field Type Field Name Source Business Rules Data Type Values Min Value Max Value Implementation Help Tip
GLOBAL DATA ELEMENTS
Fill In Agency Name: Agency Name Fill In Fill In Fill In AgencyName Global or globLib:AgencyNameDataType If Field Type [8] = Forward-populated n/a AN n/a Fill In 60 Field Enter the name of the Federal Agency.
Unique # Forward-populated then Fill In source, else n/a
Fill In Applicant ID: Applicant ID Fill In Fill In Fill In ApplicantID Global or globLib:ApplicantIDDataType If Field Type [8] = Forward-populated n/a AN n/a Fill In 30 Field Enter the applicant's control number (if
Unique # Forward-populated then Fill In source, else n/a applicable)
Fill In CFDA Number: CFDA Number Fill In Fill In Fill In CFDANumber Global globLib:CFDANumberDataType If Field Type [8] = Forward-populated n/a AN n/a Fill In 15 Field Enter the Catalog of Federal Domestic
Unique # then Fill In source, else n/a Assistance number. The first two digits
identify the Federal department or
agency that administers the program,
and the last three numbers are assigned
in numerical sequence.
Fill In CFDA/Program Title: CFDA/Program Title Fill In Fill In Fill In CFDAProgramTitle Global globLib:CFDATitleDataType If Field Type [8] = Forward-populated n/a AN n/a Fill In 120 Field Enter the Catalog of Federal Domestic
Unique # then Fill In source, else n/a Assistance program title.
Fill In Congressional District: Applicant District Fill In Fill In Fill In CongressionalDistrictAppli Global or globLib:CongressionalDistrictDataType If Field Type [8] = Forward-populated n/a AN n/a Fill In 6 Field Enter the Congressional District in the
Unique # Applicant: cant Forward-populated then Fill In source, else n/a format: 2 character State Abbreviation -
3 character District Number. Examples:
CA-005 for California's 5th district, CA-
012 for California's 12th district.
If outside the US, enter 00-000.
Fill In Congressional District: Program District Fill In Fill In Fill In CongressionalDistrictProgr Global or globLib:CongressionalDistrictDataType If Field Type [8] = Forward-populated n/a AN n/a Fill In 6 Field Enter the Congressional District in the
Unique # Program/Project: amProject Forward-populated then Fill In source, else n/a format: 2 character State Abbreviation -
3 character District Number. Examples:
CA-005 for California's 5th district, CA-
012 for California's 12th district.
If all districts in a state are affected,
enter "all" for the district number.
Example: MD-all for all congressional
districts in Maryland.
If nationwide (all districts in all states),
enter US-all.
If the program/project is outside the US,
enter 00-000.
Fill In Country: Country Fill In Fill In Fill In Country Global or globLib:CountryDataType If Field Type [8] = Forward-populated n/a LIST ISO 3166 Country Code List Fill In 49 Popup Select the Country from the provided list.
Unique # Forward-populated then Fill In source, else n/a This field is required.
Fill In Department Name: Department Name Fill In Fill In Fill In DepartmentName Global or globLib:DepartmentNameDataType If Field Type [8] = Forward-populated n/a AN n/a Fill In 30 Field Enter the name of primary
Unique # Forward-populated then Fill In source, else n/a organizational department, service,
Fill In Division Name: Division Name Fill In Fill In Fill In DivisionName Global or globLib:DivisionNameDataType If Field Type [8] = Forward-populated n/a AN n/a Fill In 30 Field laboratory, or equivalent level within the
Enter the name of primary
Unique # Forward-populated then Fill In source, else n/a organizational division, office, or major
Fill In DUNS Number: DUNS Number Fill In Fill In Fill In DUNSNumber Global or globLib:DUNSIDDataType If Field Type [8] = Forward-populated If entered length is 9, then AN n/a 9 13 Field subdivision which will undertake the of
Enter the DUNS or DUNS+4 number
Unique # Forward-populated then Fill In source, else n/a append '0000' the applicant organization.
Fill In Email: Email Fill In Fill In Fill In Email Global or globLib:EmailDataType If Field Type [8] = Forward-populated E-mail validation AN n/a Fill In 60 Field Enter a valid Email Address.
Unique # Forward-populated then Fill In source, else n/a
Fill In Employer/Taxpayer EIN/TIN Fill In Fill In Fill In EmployerTaxpayerIdentific Global or globLib:EmployerIDDataType If Field Type [8] = Forward-populated n/a AN n/a 9 30 Field Enter either TIN or EIN as assigned by
Unique # Identification Number ationNumber Forward-populated then Fill In source, else n/a the Internal Revenue Service. If your
(EIN/TIN): organization is not in the US, enter 44-
4444444
Fill In Fax: Fax Fill In Fill In Fill In Fax Global or globLib:TelephoneNumberDataType If Field Type [8] = Forward-populated n/a AN n/a Fill In 25 Field Enter the Fax Number.
Unique # Forward-populated then Fill In source, else n/a
Fill In Federal Award Identifier: Federal Award Fill In Fill In Fill In FederalAwardIdentifier Global or globLib:ProjectAwardNumberDataType If Field Type [8] = Forward-populated n/a AN n/a Fill In 25 Field Enter the award number previously
Unique # Identifier Forward-populated then Fill In source, else n/a assigned by the Federal agency, if any.
Fill In Federal Entity Identifier: Federal Entity Fill In Fill In Fill In FederalEntityIdentifier Global or globLib:FederalIDDataType If Field Type [8] = Forward-populated n/a AN n/a Fill In 30 Field Enter the number assigned to your
Unique # Identifier Forward-populated then Fill In source, else n/a organization by the Federal agency.
Fill In Organization Name (Legal Organization Name Fill In Fill In Fill In OrganizationName Global or globLib:OrganizationNameDataType If Field Type [8] = Forward-populated n/a AN n/a Fill In 60 Field Enter the legal name of the applicant
Unique # Name): Forward-populated then Fill In source, else n/a that will undertake the assistance
activity.
Fill In Telephone Number: Telephone Number Fill In Fill In Fill In PhoneNumber Global or globLib:TelephoneNumberDataType If Field Type [8] = Forward-populated n/a AN n/a Fill In 25 Field Enter the daytime Telephone Number.
Unique # Forward-populated then Fill In source, else n/a This field is required.
Fill In Project Name: Project Name Fill In Fill In Fill In ProjectName Global or globLib:ProjectNameDataType If Field Type [8] = Forward-populated n/a AN n/a Fill In 60 Field Enter the name of the project.
Unique # Forward-populated then Fill In source, else n/a
Fill In Project Title: Project Title Fill In Fill In Fill In ProjectTitle Global or globLib:ProjectTitleDataType If Field Type [8] = Forward-populated n/a AN n/a Fill In 200 Field Enter a brief, descriptive title of the
Unique # Forward-populated then Fill In source, else n/a project.
22
[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17]
Min # of Max # of
Field Short Field Minimum Maximum Agency Field Global Library Field Type List of Chars or Chars or Field
Field # Label Label Required? Occurrences Occurrences Name Field Type Field Name Source Business Rules Data Type Values Min Value Max Value Implementation Help Tip
Fill In Social Security Number : Social Security Fill In Fill In Fill In SocialSecurityNumber Global or globLib:SocialSecurityNumberDataType If Field Type [8] = Forward-populated SSN format validation AN n/a 11 11 Field Enter a 9-digit Social Security Number.
Unique # Number Forward-populated then Fill In source, else n/a Disclosure of SSN is voluntary. Please
see the application package instructions
for the agency’s authority and routine
uses of the data.
Fill In Title: Title Fill In Fill In Fill In Title Global or globLib:HumanTitleDataType If Field Type [8] = Forward-populated n/a AN n/a Fill In 45 Field Enter the position title.
Unique # Forward-populated then Fill In source, else n/a
Fill In Type of Applicant: Type of Applicant Fill In Fill In Fill In TypeofApplicant Global or globLib:ApplicantTypeCodeDataType If Field Type [8] = Forward-populated n/a LIST A. State Government&& Fill In 82 Popup Select the appropriate applicant type
Unique # Forward-populated then Fill In source, else n/a B. County Government&& code.
C. City or Township Government&&
D. Special District Government&&
E. Regional Organization&&
F. U.S. Territory or Possession&&
G. Independent School District&&
H. Public/State Controlled Institution of
Higher Education&&
I. Indian/Native American Tribal
Government (Federally
Recognized)&&
J. Indian/Native American Tribal&&
Government (Other than Federally
Recognized)&&
K. Indian/Native American Tribally
Designated Organization&&
L. Public/Indian Housing Authority&&
M. Nonprofit with 501C3 IRS Status
(Other
than Institution of Higher
Education)&&
N. Nonprofit without 501C3 IRS Status
(Other than Institution of Higher
Education)&&
O. Private Institution of Higher
Education&&
P. Individual&&
Q. For-Profit Organization (Other than
Small Business)&&
R. Small Business&&
S. Hispanic-serving Institution&&
T. Historically Black Colleges and
Universities (HBCUs)&&
U. Tribally Controlled Colleges and
Universities (TCCUs)&&
DATA ELEMENTS THAT MAY BE PRE-POPULATED FROM THE APPLICATION PACKAGE
Fill In Agency Name: Agency Name Yes 1 1 AgencyName Pre-populated globLib:AgencyNameDataType SubmissionDef.AgencyName n/a AN n/a 1 60 Field Pre-populated from the Application
Unique # cover sheet.
Fill In CFDA Number: CFDA Number No 0 1 CFDANumber Pre-populated globLib:CFDANumberDataType SubmissionDef.CFDANumber n/a AN n/a 0 15 Field Pre-populated from the Application
Unique # cover sheet.
Fill In CFDA/Program Title: CFDA/Program Title No 0 1 CFDAProgramTitle Pre-populated globLib:CFDATitleDataType SubmissionDef.CFDATitle n/a AN n/a 0 120 Field Pre-populated from the Application
Unique # cover sheet.
Fill In Competition Identification Competition Number Yes 1 1 CompetitionIdentificationN Pre-populated globLib:CompetitionIDDataType SubmissionDef.field_CompetitionID n/a AN n/a 1 40 Field Pre-populated from the Application
Unique # Number: umber cover sheet.
Fill In Competition Identification Competition Title Yes 1 1 CompetitionIdentificationTi Pre-populated globLib:CompetitionIDTitleDataType SubmissionDef.field_CompetitionIDTitle n/a AN n/a 1 255 Field Pre-populated from the Application
Unique # Title: tle cover sheet.
Fill In Funding Opportunity Number: Opportuntity Number Yes 1 1 FundingOpportunityNumbe Pre-populated globLib:OpportunityIDDataType SubmissionDef.OpportunityID n/a AN n/a 1 40 Field Pre-populated from the Application
Unique # r cover sheet.
Fill In Funding Opportunity Title: Opportunity Title Yes 1 1 FundingOpportunityTitle Pre-populated globLib:OpportunityTitleDataType SubmissionDef.OpportunityIDTitle n/a AN n/a 1 255 Field Pre-populated from the Application
Unique # cover sheet.
DATA ELEMENTS THAT ARE POPULATED AFTER SUBMISSION TO GRANTS.GOV (POST-POPULATED)
Fill In AOR Signature: AOR Signature Yes 1 1 AORSignature Post-Populated globLib:SignatureDataType n/a n/a AN n/a 1 144 Label Completed by Grants.gov upon
Unique # submission.
Fill In Date Received: Date Received Yes 1 1 DateReceived Post-Populated globLib:DateReceivedDataType n/a n/a DATE n/a n/a n/a Label Completed by Grants.gov upon
Unique # submission.
Fill In Date Signed: Date Signed Yes 1 1 DateSigned Post-Populated globLib:DateSignedDataType n/a n/a DATE n/a n/a n/a Label Completed by Grants.gov upon
Unique # submission.
DATA ELEMENT GROUPS
Address Group
Fill In Address Group Label n/a Fill In Fill In Fill In Fill In Global globLib:AddressDataType n/a n/a n/a n/a n/a n/a Label Fill In or n/a
Unique #
Fill In Street1: Street1 Yes 1 1 Street1 Global or globLib:Street1 If Field Type [8] = Forward-populated n/a AN n/a 1 55 Field Enter the first line of the Street Address.
Unique # Forward-populated then Fill In source, else n/a This field is required.
Fill In Street2: Street2 No 0 1 Street2 Global or globLib:Street2 If Field Type [8] = Forward-populated n/a AN n/a 0 55 Field Enter the second line of the Street
Unique # Forward-populated then Fill In source, else n/a Address.
23
[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17]
Min # of Max # of
Field Short Field Minimum Maximum Agency Field Global Library Field Type List of Chars or Chars or Field
Field # Label Label Required? Occurrences Occurrences Name Field Type Field Name Source Business Rules Data Type Values Min Value Max Value Implementation Help Tip
Fill In City: City Yes 1 1 City Global or globLib:City If Field Type [8] = Forward-populated n/a AN n/a 1 35 Field Enter the City. This field is required.
Unique # Forward-populated then Fill In source, else n/a
Fill In County: County No 0 1 County Global or globLib:County If Field Type [8] = Forward-populated n/a AN n/a 0 30 Field Enter the County.
Unique # Forward-populated then Fill In source, else n/a
Fill In State: State No 0 1 State Global or globLib:State If Field Type [8] = Forward-populated Conditionally required if LIST 50 US States, US possessions, territories, 0 55 Popup Select the state, US possession or
Unique # Forward-populated then Fill In source, else n/a Country is US then active. If military codes military code from the provided list. This
Country is not US, then field is required if Country is the United
inactive States.
Fill In Province: Province No 0 1 Province Global or globLib:Province If Field Type [8] = Forward-populated If Country is US then inactive. AN n/a 0 30 Field Enter the Province.
Unique # Forward-populated then Fill In source, else n/a If Country is not US, then
active
Fill In Country: Country Yes 1 1 Country Global or globLib:Country If Field Type [8] = Forward-populated n/a LIST ISO 3166 Country Code List 1 49 Popup Select the Country from the provided list.
Unique # Forward-populated then Fill In source, else n/a This field is required.
Fill In Zip / Postal Code: Zip / Postal Code No 0 1 ZipCode Global or globLib:ZipPostalCode If Field Type [8] = Forward-populated Conditionally required if AN n/a 0 30 Field Enter the Postal Code (e.g., ZIP code).
Unique # Forward-populated then Fill In source, else n/a Country is US then required. If This field is required if Country is the
Country is not US, then United States.
optional.
Human Name Group
Fill In Human Name Group Label n/a Fill In Fill In Fill In Fill In Global globLib:HumanNameDataType n/a n/a n/a n/a n/a n/a Label Fill In or n/a
Unique #
Fill In Prefix: Prefix No 0 1 Prefix Global or globLib:PrefixName If Field Type [8] = Forward-populated n/a LIST Mr.&&Mrs.&&Miss&&Ms.&&Dr.&&Rev.&& 0 10 Combobox Select the Prefix from the provided list or
Unique # Forward-populated then Fill In source, else n/a Prof. enter a new Prefix not provided on the
list.
Fill In First Name: First Name Yes 1 1 FirstName Global or globLib:FirstName If Field Type [8] = Forward-populated n/a AN n/a 1 35 Field Enter the First Name. This field is
Unique # Forward-populated then Fill In source, else n/a required.
Fill In Middle Name: Middle Name No 0 1 MiddleName Global or globLib:MiddleName If Field Type [8] = Forward-populated n/a AN n/a 0 25 Field Enter the Middle Name.
Unique # Forward-populated then Fill In source, else n/a
Fill In Last Name: Last Name Yes 1 1 LastName Global or globLib:LastName If Field Type [8] = Forward-populated n/a AN n/a 1 60 Field Enter the Last Name. This field is
Unique # Forward-populated then Fill In source, else n/a required.
Fill In Suffix: Suffix No 0 1 Suffix Global or globLib:SuffixName If Field Type [8] = Forward-populated n/a LIST Jr.&&Sr.&&M.D.&&Ph.D 0 10 Combobox Select the Suffix from the provided list or
Unique # Forward-populated then Fill In source, else n/a enter a new Suffix not provided on the
list.
GENERAL DATA ELEMENT FORMATS
Fill In ALPHANUMERIC field Fill In Fill In Fill In Fill In Fill In Agency-specific n/a n/a Fill In AN n/a Fill In Fill In Field Fill In
Unique # template
Fill In Field Label
Fill In BUTTON template Fill In n/a n/a n/a n/a Agency-specific n/a n/a Fill In n/a n/a n/a n/a Button Fill In
Unique # Fill In Button Label
Fill In DATE field template Fill In Fill In Fill In Fill In Fill In Agency-specific n/a n/a Fill In DATE n/a n/a n/a Field Enter the date in the format
Unique # Fill In Field Label MM/DD/YYYY.
Fill In DEGREE EARNED template Fill In Fill In Fill In Fill In Fill In Global globLib:EducationDegreeDataType n/a Fill In AN n/a Fill In 50 Field Enter the highest degree earned.
Unique # Fill In Field Label
Fill In DOLLAR AMOUNT template Fill In Fill In Fill In Fill In Fill In Agency-specific globLib:BudgetAmountDataType n/a $ n/a 0.00 999999999999.99 Field Enter the dollar amount.
Unique # Fill In Field Label Fill In
Fill In DOLLAR AMOUNT TOTAL Fill In Fill In Fill In Fill In Fill In Agency-specific globLib:BudgetTotalAmountDataType n/a $ n/a 0.00 9999999999999.99 Field Enter the total dollar amount.
Unique # template Fill In
Fill In Field Label
Fill In FILE ATTACHMENT template Fill In No 0 1 Fill In Global globLib:SingleAttachmentDataType n/a Fill In FILE n/a n/a n/a Single_File Attach a file using the appropriate
Unique # Fill In Field Label buttons.
Fill In FILE ATTACHMENT template Fill In Yes 1 1 Fill In Global globLib:SingleAttachmentDataType n/a Fill In FILE n/a n/a n/a Single_File Attach a file using the appropriate
Unique # Fill In Field Label buttons. This attachment is required.
Fill In MULTIPLE FILE Fill In No 0 1 Fill In Global globLib:MultipleAttachmentDataType n/a Fill In MULTIFILE n/a n/a n/a Multi_file Attach file(s) using the appropriate
Unique # ATTACHMENT buttons.
Fill In Field Label
Fill In MULTIPLE FILE Fill In Yes 1 1 Fill In Global globLib:MultipleAttachmentDataType n/a Fill In MULTIFILE n/a n/a n/a Multi_file Attach file(s) using the appropriate
Unique # ATTACHMENT buttons. Attachments are required.
Fill In Field Label
Fill In NUMERIC WITHOUT Fill In Fill In Fill In Fill In Fill In Agency-specific n/a n/a Fill In INTEGER n/a Fill In Fill In Field Fill In
Unique # DECIMALS
field template
Fill In Field Label
Fill In NUMERIC WITH DECIMALS Fill In Fill In Fill In Fill In Fill In Agency-specific n/a n/a Fill In DECIMAL(2) n/a Fill In Fill In Field Fill In
Unique # field template
Fill In Field Label
Fill In LABEL template n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Label Fill In or n/a
Unique # Fill In Label from form
Fill In LIST field template Fill In Fill In Fill In Fill In Fill In Agency Specific n/a n/a Fill In LIST Fill In Fill In Fill In Popup Fill In
Unique # Fill In Field Label
Fill In CHECKBOX template Fill In Fill In Fill In Fill In Fill In Agency-specific globLib:YesNoDataType n/a Fill In n/a n/a n/a n/a Check Check to select.
Unique # Fill In Option 1 Field Label
Fill In CHECKBOX template Fill In Fill In Fill In Fill In Fill In Agency-specific globLib:YesNoDataType n/a Fill In n/a n/a n/a n/a Check Check to select.
Unique # Fill In Option 2 Field Label
RADIO GROUP OPTIONAL
24
[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17]
Min # of Max # of
Field Short Field Minimum Maximum Agency Field Global Library Field Type List of Chars or Chars or Field
Field # Label Label Required? Occurrences Occurrences Name Field Type Field Name Source Business Rules Data Type Values Min Value Max Value Implementation Help Tip
Fill In RADIO GROUP HEADER n/a No 0 1 Fill In Radio Group n/a Fill in Radio Group Name Fill In LIST n/a n/a n/a Radio Group Fill in or n/a
Unique # Fill In Radio Group Label (may be same as Field Label)
Fill In Fill in Radio Group Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a n/a n/a n/a Radio Click to select option.
Unique # Option 1 Label
Fill In Fill in Radio Group Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a n/a n/a n/a Radio Click to select option.
Unique # Option 2 Label
RADIO GROUP REQUIRED
Fill In RADIO GROUP HEADER n/a Yes 1 1 Fill In Radio Group n/a Fill in Radio Group Name Fill In LIST n/a n/a n/a Radio Group One selection is required.
Unique # Fill In Radio Group Label (may be same as Field Label)
Fill In Fill in Radio Group Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a n/a n/a n/a Radio Click to select option.
Unique # Option 1 Label
Fill In Fill in Radio Group Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a n/a n/a n/a Radio Click to select option.
Unique # Option 2 Label
Fill In PERCENT WITH DECIMALS Fill In Fill In Fill In Fill In Fill In Agency-specific globLib:PercentDecimalDataType n/a DECIMAL(2) n/a 0.00 100.00 Field Enter in the percentage with decimals.
Unique # Fill In Field Label Fill In
Fill In PERCENT WITHOUT Fill In Fill In Fill In Fill In Fill In Agency-specific globLib:PercentIntegerDataType n/a INTEGER n/a 0 100 Field Enter in the percentage as a whole
Unique # DECIMALS Fill In number.
Fill In Field Label
Fill In YEAR field template Fill In Fill In Fill In Fill In Fill In Agency-specific n/a n/a Fill In YEAR n/a 4 4 Field Fill In
Unique # Fill In Field Label
YES/NO OPTIONAL
Fill In YES/NO RADIO GROUP n/a No 0 1 Fill In Radio Group globLib:YesNoDataType Fill in Radio Group Name n/a LIST n/a n/a n/a Radio Group Fill in or n/a
Unique # HEADER (may be same as Field Label)
Fill In Field Label
Fill In Yes Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a Yes n/a n/a Radio Click to select option.
Unique #
Fill In No Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a No n/a n/a Radio Click to select option.
Unique #
YES/NO REQUIRED
Fill In YES/NO RADIO GROUP n/a Yes 1 1 Fill In Radio Group globLib:YesNoDataType Fill in Radio Group Name n/a LIST n/a n/a n/a Radio Group A selection is required.
Unique # HEADER (may be same as Field Label)
Fill In Field Label
Fill In Yes Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a Yes n/a n/a Radio Click to select option.
Unique #
Fill In No Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a No n/a n/a Radio Click to select option.
Unique #
YES/NO/OTHER OPTIONAL
Fill In YES/NO/OTHER RADIO n/a No 0 1 Fill In Radio Group globLib:YesNoOtherDataType Fill in Radio Group Name n/a LIST n/a n/a n/a Radio Group Fill in or n/a
Unique # GROUPHEADER (may be same as Field Label)
Fill In Field Label
Fill In Yes Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a Yes n/a n/a Radio Click to select option.
Unique #
Fill In No Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a No n/a n/a Radio Click to select option.
Unique #
Fill In Other Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a Other n/a n/a Radio Click to select option.
Unique #
YES/NO/OTHER REQUIRED
Fill In YES/NO/OTHER RADIO n/a Yes 1 1 Fill In Radio Group globLib:YesNoOtherDataType Fill in Radio Group Name n/a LIST n/a n/a n/a Radio Group A selection is required.
Unique # GROUP HEADER (may be same as Field Label)
Fill In Field Label
Fill In Yes Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a Yes n/a n/a Radio Click to select option.
Unique #
Fill In No Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a No n/a n/a Radio Click to select option.
Unique #
Fill In Other Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a Other n/a n/a Radio Click to select option.
Unique #
YES/NO/NOT APPLICABLE OPTIONAL
Fill In YES/NO/NA RADIO GROUP n/a No 0 1 Fill In Radio Group globLib:YesNoNotApplicableDataType Fill in Radio Group Name n/a LIST n/a n/a n/a Radio Group Fill in or n/a
Unique # HEADER (may be same as Field Label)
Fill In Field Label
Fill In Yes Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a Yes n/a n/a Radio Click to select option.
Unique #
Fill In No Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a No n/a n/a Radio Click to select option.
Unique #
Fill In Not Applicable Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a Not Applicable n/a n/a Radio Click to select option.
Unique #
YES/NO/NOT APPLICABLE REQUIRED
Fill In YES/NO/NA RADIO GROUP n/a Yes 1 1 Fill In Radio Group globLib:YesNoNotApplicableDataType Fill in Radio Group Name n/a LIST n/a n/a n/a Radio Group A selection is required.
Unique # HEADER (may be same as Field Label)
Fill In Field Label
Fill In Yes Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a Yes n/a n/a Radio Click to select option.
Unique #
Fill In No Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a No n/a n/a Radio Click to select option.
Unique #
25
[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17]
Min # of Max # of
Field Short Field Minimum Maximum Agency Field Global Library Field Type List of Chars or Chars or Field
Field # Label Label Required? Occurrences Occurrences Name Field Type Field Name Source Business Rules Data Type Values Min Value Max Value Implementation Help Tip
Fill In Not Applicable Fill In No 0 1 n/a Radio Group n/a Fill in Radio Group Name Fill In n/a Not Applicable n/a n/a Radio Click to select option.
Unique #
26
