HomeMy WebLinkAboutResolution - 5864 - Grant Proposal - DOJ & NIJ - Best Scan Possible - 05_28_1998Resolution No. 5864
Item No. 16
May 28, 1998
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
LUBBOCK:
THAT the Mayor of the City of Lubbock be and is hereby authorized and
directed to execute for and on behalf of the city of Lubbock a Law Enforcement
and Corrections Family Support grant proposal, attached herewith, which proposal
shall be spread upon the minutes of the Council and as spread upon the minutes of
this Council shall constitute and be a part of this Resolution as if fully copied
herein in detail.
Passed by the City Council this ? g rh day of mq3z ,
1998.
ATTEST:
kaj Darnell, City Secretary
APPROVED AS TO CONTENT
Ken A. Walker, Chief of Police
APPROVED AS TO FORM:
ui, Assistant City Attorney
disk 3/axesotution doc
APPLICATION FOR 2.DATE SUBMITTE
FEDERAL ASSISTANCE May 15
1. rO QFy t Stu(SStBM: J. DATE RECEIVED
Appllca ,i0 ' i Preappl)cat)on
❑ nstruclion ❑ Construction
4. DATE RECEIVED
Non -Construction ' ❑ Non -Construction
S. APPLICANT INFORMATION
Legal Name:
City of Lubbock
Address (give city, county state, erdZip code):
1015 9th Street
P.O. Box 2000
Lubbock, Lubbock County, Texas 79457
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
7' 5— 6 1 0 10 10 15 19 TO
S. TYPE OF APPLICATION:
❑( New ❑ Continuation ❑ Revision
If Revision, enter appropriate letter(s) in bax(es): ❑ ❑
A. Increase Award B. Decrease Award C. Increase Duration
D. Decrease Duration Other (specify):
10. CATALOG OF FEDERAL DOMESTIC
ASSISTANCE NUMBER: •
N/A
12. AREAS AFFECTED BY PROJECT (cities, counties. sates, etc.). -
Lubbock, Lubbock County, Texas
D
1998
BY STATE
BY FEDERAL AGENCY
Organizational Unit:
OMB
Applicant Identifier
State Application Identifier
Federal Identifier
at .m -,
No, 0348
Name and telephone number of the person to be contacted on matters involving
this application (give area code)
Ken A. Walker
(806) 775-2750
7. TYPE OF APPLICANT: (enter approprate letter in box) U
A. State
H. Independent School Dist.
B. County
I. State Controlled Institution of Higher Learning
C. Municipal
J. Private University
D. Township
K. Indian Tribe
E. Interstate
L. Individual
F. Intermunicipat
M. Profit Organization
G. Special Disinct
N. Other (Specify):
S. NAME OF FEDERAL AGENCY:
Department of Justice and National Institute
�Jc��.nrr�wc 111LC Vr ArrLl�.nryl prI�VJGI.':
Law Enforcement & Corrections Family Support
solicitation for research, evaluation,
development & demonstration projects. U.S.
Department of Justice, National Institute of
Justice.
13. PROPOSED PROJECT:
14 CONGRESSIONAL DISTRICTS OF:
Start Date
''
.W-_Eriding Date -
a. Applicant i b. Project
District 13 - Thornberry District 13 - Thornberry
10'01198
0130/00
District 19 - Combest District 19 - Combest
IS. ESTIMATED FUNDING:
to IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS'
a. YES. THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE
a. Federal
I S 99,378 co
STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON:
DATE N/A
b. A�plicant
I S 101,530 co
c. State
S _0_ .00
f
!
b NO r PROGRAM IS NOT COV'cRcD BY E.0 12372
OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEYI
d Local
( see B - a
S co
plican
e Omer
S co
1. Program Income
S .00
17. IS THE APPLICANT OEUNO UENT ON ANY FEDERAL DEBT?
IDYesIt "Yes' attach an explanation. �( No
9 TOTAL I
3 2DD, 908 •Co
13 TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION%PREAP%UCATION ARE TRUE A`;O CORRECT THE DOCUMENT HAS BEEN DULY
AUTHORIZ_=D BY THE GOVERNING 900Y OF THE APPLICANT AND THE APPLICANT WILL CCMPLY WITH THE ATTACHED ASSURANCES IF THE ASStSTANCE is AWAa7E_
Al Tgpe Nam Of rr r -ed Representative I C 7i,!e C. Tale, -none rur=er
PndA�_ a� °er (SEE ATTACHED LETTER) ��ief Qf _Police 191 i806-775-2750
d. Signature of Authorzed Representative
e. Date Signed
i May 15, 1998
Not Usaole Chief of Police
P•escnoad ov Oti'E C r:.Jla' A• �-Z
Instructions for Completion of the Application for Federal Assistance (SF 424)
The Application for Federal Assistance is a standard form used by most Federal agencies. This form contains 18 different item,
which are to be completed before submission. All applications should include a completed and signed SF 424.
Item
Instructions
1
Type of Submission: If this proposal is not for construction or building purposes. check "Non -Construction",
2
Date Submitted: Indicate the date you sent the application to O1P. The "Application Identifier" is the number
assigned by your jurisdiction. if any. If your jurisdiction does not assil n an identifier number, leave this space blank.
3
Date Received by State: Leave blank. This block is completed by the State single point of contact. if applicable.
4
Date Received by Federal Agency: This item will be completed by O1P.
5
Applicant Information: The "Legal Name" is the unit of government of the parent organization. For example,
the primary or parent organization of a law enforcement agency is the name of the city or township. Thus the city or
township should be entered into the Legal Name box and the name of the law enforcement agency would be entered into
the Organizational Unit box. Designate one person as the contact. and include their telephone number.
6
Employer Identification Number: Each employer receives an employer identification number from the Internal
Revenue Smice. Generally, this number can he easily obtained from your agency's accountant or comptroller.
7
Type of Applicant: Enter the appropriate letter in this space. If the applicant is representing a consortium of
agencies, specify by checking Block N and entering "consortium".
8
Type of Application: Check either new" or "continuation". Check new if this will be your first award for this
purpose described in the application, even if the applicant has received prior awards for other purposes. Check
"continuation", if the project will continue activities of a project, that was begun under a prior award.
9
Name of Federal Agency: Type in the name of the awarding agency, such as "Bureau of Justice Assistance".
10
Catalog of Federal Domestic Assistance Number: This would be contained in the program announcement.
An example would be 16.
I1
Descriptive Title of Applicants Project: Type in tile: (1) title of the program as it appears in the solicitation
or announcement: (2) name of the cngr.it. nt Federal agency, ex. U. S. Department of Edu:ation: and (1) applicant's
fiscal year. i.e. twelve month audit period. ex: 10/l/95 . 9/30/96.
I2
Areas Affected by Pn)ject: Identify the Leographic arcat s) of the project. Indicate "Statewide" or ",\ation�l". if
applicable.
13
Proposed Project Dates: Fill in the proposed begin and end dates of the project.
14
Congressional Districts: Fill in the Congressional Districts in %yhieh the project will he located as
well as the C<m__ressional Distrito s 1 th_ pr,>jeet will serve. Incii.:ate "Statewide" or ":National". it appli:a;+lc.
13
Estimated Funding: In lint: "a: • enter the F:dcral funds requested. n01 10 exceed the OJllar amOUnt ailocat_.:
the program announcement. Indicate am other resources that %vili available to the project and the source of rhos_
on lines "b-f:' as appropriate.
16
State Executive Order 12372: Sorne states require you to submit your application to a Sta:e "Sim_le Poin: of
Contact" i SPOC) to coordinate applications for Federal funds. If your State requires a copy of your are h,:ation. init-Cate
the date submitted. If a copy is not required. indicate the reason. (Refer to the "Administrative Requirennents" se ran '
of the program announcement. for more inforntation.t The SPOC i> not responsihl_ for your a^nlicat::r•
17
Delinquent Federal Debt: T,i., u_stior. appli_s to the applrcan; o;
q C1al�ail(tn. Cat__.n_S C: d_r; 1^eiL'.::
delinquent audit allowances. loans. and taxes.
18
Authorized Representative: T%p: th_ name of the person legali% au:Mori; ed to enter a_rcernent, on ;_ =�� of
your agent%. This signature on th_ ori� ina! appii,:ation must b_ signed in blu_ ink and"or sta-t; e t as "��riciaal ' t nei;
id_ntify th_ ori;inal.
C.V Z.3 "41,94
ASSURANCES
The Applicant hereby assures and certifies compliance with all Federal statutes, regulations, policies, guidelines and requiremer,
including OMB Circulars No. A-21, A-110, A-122, A-128, A-87; E.O. 12372 and Uniform Administrative Requirements for Grants a
Cooperative Agreements-28 CFR, Part 66, Common Rule, that govern the application, acceptance and use of Federal funds for Ill
federally -assisted project. Also the Applicant assures and certifies that:
1. It possesses legal authority to apply for the grant; that a 10
resolution, motion or similar action has been duly adopted or
passed as an official act of the applicant's governing body,
authorizing the filing of the application, including all under-
standings and assurances contained therein, and directing
and authorizing the person identified as the official represen-
tative of the applicant to act in connection with the application
and to provide such additional information as may be re-
quired.
2. It will comply with requirements of the provisions of the
Uniform Relocation Assistance and Real Property Acquisi-
tions Act of 1970 P.L. 91-646) which provides for fair and
equitable treatment of persons displaced as a result of Fed-
eral and federally -assisted programs. 1 1.
3. It will comply with provisions of Federal law which limit certain
political activities of employees of a State or loc31 unit of
government whose principal employment is in connection
with an activity financed in whole or in part by Federal grants.
(5 USC 1501 , et seq.)
4. It will comply with the minimum wage and maximum hours
provisions of the Federal Fair Labor Standards Act if appli-
cable.
5. It will establish safeguards to prohibit employees from using
their positions for a purpose that is or give the appearance of
being motivated by a desire for private gain for tnamselve; or
others, particularly those with whom they have larmly, busi.
ness, or other ties.
6. It will give the sponsoring agency or the Comptroller General,
through any authorized representative, access to and the right
to examine all records, books, papers, or documents related to
the grant.
7. It will comply with all requirements impos-id by the Federal
Sponsoring agency concerning special requirement; of law,
program requirements, and other administrative req-.irements.
B. It will insure that the facilities under its own_rshir, lease or
supervision which shall be utilized in the accomplisr,m-3nt of
the project are not listed in the Environmenta: pro!ection
Agency's (EPA -list of Violating Facilities and that it will notify
the Federal grantor agency of the receipt of any c.- nunica•
lion tram the Director of the EPA Office of r _•d;r3 • ."tivities
indicating Ina: a facilgy to be used in th•3 prol:Y. is under
consideration for listing by the EPA.
9. It will comply with the flood insurance purchase r.currements
o' Section 102ta) of the Flood Disaster Prose::!:r .A:; of
197' =uch: L3•.v 93 87 Slat. 975. ro'• _ "i-emb-:r
3 t 1976. Section. 10-7(al r-:quires. on anc af:zr March 2.
1975. the purchase of flood insurance in commu^i;,-is where
such insurance is available as a condition for the receipt of
any Federal financial assistance for constructior cr acquisi-
tion purposes for use in any area that had been i-_eri:ifiad by
the Secretary of the Department of Housing and Url;_r, Dever•
opment as an area having special flood ha:aras. T phrase
"Federal financial assistance' includes any fare- of Ivan,
grant. guaranty, insurance payment, rebate. suo5f discs-
ter assistance loan or grant, or any other form, of gir?ct or
indirec! Federal assistance.
nature
It will assist the Federal grantor agency in its compliance w
Section 106 of the National Historic Preservation Act of 19
as amended (16 USC 470), Executive Order 11593• and t,
Archeological and Historical Preservation Act of 1966 (
USC 569a-1 et seq.) by (a) consulting with the State Histo,
Preservation Officer on the conduct of investigations,
necessary, to identify properties listed in or eligible for incl
sion in the National Register of Historic Places that a
subject to adverse effects (see 36 CFR Part 800.8) by It
activity, and notifying the Federal grantor agency of It
existence of any such properties, and by (b) complying wi
all requirements established by the Federal grantor agency
avoid or mitigate adverse effects upon such properties.
It will comply, and assure the compliance of all its subgrantee
and contractors, with the applicable provisions of Title I of tr
Omnibus Crime Control and Safe Streets Act of i9sa, e
amended, the Juvenile Justice ar.d Delinquency Preventic
Act, or the Victims of Crime Act, as appropriate: the prov
sions of the current edition of the Office of Justice Program
Financial and Administrative Guide for Grants, fv17100.1. an
all other applicable Federal laws, orders, circulars, or reguli
tions.
12. It will comply with the provisions of 23 CFR applicable to grant
and cooperative agreements including Part 18, Administrativ
Review Procedure, Part 20, Criminal Justice Information Sy:
toms: Part 22, Conlidentiality of Idant'fiable Research an
Statistical Information; Part 23, Criminal Intelligence System
Operating Policies; Part 30, Intargovernmental Review of De
partment of Justice Programs and Activities; Part 42, Nondis
crimination/Equat Employment Opportunity Policies and Prc
cedures: Part 61, Procedures for Implementing the Natione
Environmental Policy Act; Part 63. Floodplain Managemen
and Welland Protection Procedures; and Federal laws or regu
lations applicable to Federal Assistance Programs.
13. It will comply, and all its contractors will comply, with th!
nondiscrimination requirements of the Omnibus Crime Con
trot and Safe Streets Act of 1968. as amended. 42 USC
3789(d), or Victims of Crime Act (.is apprormate). Ti;;_ VI o
the Civil Rights Act of 196.1, as am•2nc!d: S•:ctign 504 of tna
Rehabilitation Act of 1973, as arn•jr,yed: Sultitle A, Tine II o
the Americans With Disabilities Act (AC)A) (1990): TiN3 IX o
the Education Amendments of 1972, the A e Disc.imina;ior
Act et 1975: Deeartmen; of Justice Pi;n•Disc:imination Recu
lahcn; 28 C Pl•. •i2. sonar7 D = anc G enc
0eo3rtm4n: c' Juj: ; r-i:u:3nans on disaziiiry csc
Uor.. 28 CF=, P3rt 35 any Part 39
14 In tn_ even; a Federal or State eCL or Fea?rat ='-
adniristr3tiv3 auznc•. 'na,ez 3 `inJ;. ^! _. •nin•:; 3t
CU? 'JCeS. n•lanr- ,:n t'Ij •.oc. .::5 rl:.. _giC = .^n.
naticn3! orioir sex. c, ::tsabi!i;v a :' ^;; a
the rec!pient will for%vary a cocv et re ! n,:i^ me C .::. _ f3,'
Civil Rights. Office a! Justice Programs.
15. It will provide an Equal Emplgymen: Oopor;unit! Proc'ar7 if
wyuir?dtoma:n;amon�.vrherethe acclici; is'or:.- -_0=10
am, more.
16. It will corriply with the provisions _ th8 oas:3' �a'ner
Rdsources Apt {P,L. 97.3.21 dated O ob?. 1 9??' 1 - S
353t sect hhicn prgnibit_ tn: eccanc • r"o5t ne~
Fece'31 tune_ witnl:7 t:': 0•' Ca3;
sou.':3S Svs, _. ..
05/15/98
Dat_
U.S. DEPARTMENT OF JUSTICE
OFFICE OF JUSTICE PROGRAMS
OFFICE OF THE COMPTROLLER
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND
OTHER RESPONSIBILITY MATTERS; AND DRUG -FREE WORKPLACE REQUIREMENT
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 (Nonpro-curement) 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.
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 S100,000, 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 in-
fluencing 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 con-
nection with the making of any Federal grant, the entering into
of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal grant or
cooperative agreement:
(b) It any funds other than Federal appropriated funds have
been paid or will be paid to any person for influencing or at.
tempting to influence an officer or employee of any agency, a
blember 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 cer.
tification be included in the award documents for all subawards
at all tiers (including subgrants,.con tracts under grants and
cooperative agreements, and subcontracts) and that all sub -
recipients small certify and disclose accordingly.
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 prospec-
tive participants in primary covered transactions. as defined at
23 CFR Par; 67, Section 67.510—
A. The applicant certifies the; it and its principals:
(a) Are not presently debarred. suspended, proposed for dab3r-
ment. declared ineligible. sentenced to denial of Federal
benefit, by a Stat' ar Federal court, or voluntarily excluded
from coverer transact,on; by any Federal department
(5) Have not w,Ihin a trrea-vear period precedmo this applica.
tion been convicted of or had a civil judgment rendered agamst
them for commission of fraud cr a criminal offense in connec-
tion with of iaining. atterrlehng to obtain. or per'ormirg a
public (Federal, State, or local) transaction or contract under a
public transaction,; violation of Federal or State antRrust statutes
or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or
civilly charged by a governmental entity (Federal, State, or
local) with commission of any of the offenses enumerated in
paragraph (1)(b) of this certification; and
(d) Have not within a three-year period preceding this applica-
tion 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 1383, 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. applicant certifies that it will or will continue to provi: -
a drug -free workplace by:
(a? Publishing a statement notifying employees that the
unlawful manufacture, distribution, dispensing: possession. O-
use of a controlled substance is prohibited in the grantee's
.v.,rkolac? an ; soecifying the actions, Ina; will c? taker, ay2,r5'
employees for violation of such prohibition:
(:) Establishing an on -going drug -free awareness program t::
inform employees about—
(1) The dangers of drug abuse in the workplace:
i21 The grantee's policy of maintaining a druo-free workclace
(;) Any availatle drug counseling, rehabilitation, and employe-
assistance programs: and
(4) The penalties that may be imposed upon employees for
cr;JC abuse violations occu'ring in the workplace:
:1 Making it a reeuirement that eac`: employ-3e to be en: a:-:
1- the pertcrnanoe of the arant be cr:en a c-. of :`e st3:_
Vent required by paragraph (a);
(�t) Notifying the employee in the statanent require oy car:-!'
c•aoh (a) t,7i:, as a conditicn of emcio;timent under tr'e cra':.
,^e er9ployee wtll—
:: I Z::=" a.:']' . 3.1' Q:: .-;..=s :"J. .'.1al�,r- A: 1 - A_ 3. 7 A`,:� 4:. 4',. ., . -- t
(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 convic-tion.
Employers of convicted employees must provide notice, including
position title, to: Department of Justice, Office of
Justice Programs, ATTN: Control Desk, 633 Indiana Avenue,
N.W., Washington, D.C. 20531. Notice shall include the iden•
tification 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 enforce-
ment, or other appropriate agency;
(g) Making a good faith effort to continue to maintain a drug -
free workplace through implementation of paragraphs (a), (b),
(c), (d), (e), and (f).
8. 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 (Street address, city, county, state, zip
code)
Check ❑ If there are workplaces on file that are not indentified
here.
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 ap.
plication for Department of Justice funding. States and State
agencies may elect to use OJP Form 4061/7.
Check ❑ if the State has elected to complete 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—
A. As a condition of the grant, I certify that I will not engage
in the unlawful manufacture, distribution, dispensing, posses-
sion, 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. 1
will report the conviction, in writing, within 10 calendar days
of the conviction, to: Department of Justice, Office of Justice
Programs. ATTN: Control Desk, 633 Indiana Avenue. N.W.,
Washington, D,C. 20531.
As the duly authorized representative of the applicant. 1 her3by certify that the applicant will comply with the above certifications.
1. Grantee Name and Address:
City of Lubbock Police Department
1015 9th Street
P.O. Box 2000
Lubbock, TQxas 79457
2. Application Number and/or Project Name 3. Grantee tnSNendor Nunoa'
Law Enforcement and Corrections Family Support
4. Typed Name and Title of Authorized Representative
Ken A. Walker, Chief of Police
5. Signature
IRS & EIN #: 75-6000590
6. D3'a
May 15, 1998
Instructions for Completion of SF-LLL, Disclosure of Lobbying Activities
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt r
covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for ea
payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agen
a Member of Congress, an officer or employee of Congress, or any employee of a Member of Congress in connection with a covered Fede
action. Complete all Items that apply for both the initial filing and material change report. Refer to the Implementing guidance published by i
office of Management and Budget for additional information.
1. identifythe type of covered Federal action forwhich lobbying activity
is and/or has been secured to Influence the outcome of a covered
Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. if this is a
foilowup report caused by a material change to the information
previously reported, enter the year and quarter in which the change
occurred. Enter the date of the last previously submitted report by this
reporting entity for this covered Federal action.
4. Enterthe full name, address, city, state and zip cede of the reporting
entity. Include Congressional District, if known. Check the appropriate
classification of the reporting entity tttat dasignates 1 it is, or expects
to be, a prime orsubaward recipient. Identify the tier of the subawardee,
e.g., the first subawardee of the prime is the 1 st tier. Subawards include
but are not limited to subcontracts, subgrants and contract awards
under grants.
5.1f the organization filing the report in hem 4 checks -Subawardee",
then enter the full name, address, city, state and zip code of the prime
Fuderal recipient, Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan
commitment. Include at least one organizational level below agency
name, If known. For example, Department of Transportation, United
States Coast Guard.
7. Enter the Federal program name or description for the cover
Federal action (item 1). It known, enter the full Catalpg of Fede
Domestic Assistance (CFDA) number for grants, cooperative agre
merits, loans, and loan commitments.
B. Enter the most appropriate Federal Identifying number available f
the Federal action identified in hem 1(e.g.. Request for Proposal (RF
number; Invitation forSid (IFS) number grant announcement numbe
the contract, grant, or loan award number; the application propcs
control number assigned by the Federal agency). include prelixe
e.g., -RFP-DE-90-001
9.For a covered Federal action where there has been an award or loa
commitment by the Federal agar.cy, enter ttte F r'aral amount of th
award loan commitment for the prime entty identified in item 4 or ;
10. (a) Enter the full name, address, city, state and zip coda of th
registrant under the Lobbying Disclosure Act of 1995 engaged by th
reporting entity identified in item 4 to influence the covered Federz
action.
(b) Enter the full names of the individual(s) performing services, an,
include full address if different from 10 ja). Enter Last Name. Firs
Name, and Middle Initial (h11).
11. The cortifying official shall sign and data the form, print his/he
name, title, and telephone number.
AutnorL-od for Local Aep-=ductlon
Standard For- , I # (irsd)
Disclosure of Lobbying Activities Approved by oMa o34s:
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(Sae reverse side for Instructions.)
Public Reporting Burden Ibr this collection of Information Is estimated to average 30 minutes per response, Inducing the it= br ravlewing fnstructio
saardrrg existing data sources, gathering and maintaining Cie data needed, and completing and reviewing the conecton of Information. Send comma
regarding this burden estimate or any other aspect of this collection of Information, including suggestions tot reducing this burden, b tie Office of L"nagem.
and Budget. Paperwork Reduction Project (0343.0046), Washington, D.C, 20503.
1. Type of Federal Action:
❑B a_ contract
b. grant
c. cooperative agreement
d. ban
e. loan guarantee
I. loan Insurance
2. Status of Federsl Action:
0 a. bidloffer/application
b. Initial award
c. post -award
4. Name and Address of Reporting Entity:
DPrime a Subawardee Tier , it known
Lubbock Police Department
P.O. Box 2000
Lubbock, Texas 79457
Congressional District, if known:
6. Federal Department/Ageney:
Department of Justice
and
National Institute of Justice
3. Report Type:
®a. Initial filing
b. material change
For Material Change only:
yew quarbw—�
data of test report
S. If Reporting Entity in No. 4 Is Subawardea, enter Name and Addtr,u e
Prime:
Congressional District, It known:
7. Federal Program Name/Des=iptlon:
Law Enforcement and Corrections
Family Support
CFDA Number, If applicable:
S. Federal Action Number, if known: i 9. Award Amount, if known:
i s 99,378.00
10a. Name and Address of Lobbying Registrant b. Individuals Performing SeMces (indudingaddrom lfdrferent from No. toa.)
(f individual, Iasi name, first name, Ml): (last narm, first name, M):
N/A N/A
11. Information requested through this form is authorized by Sec.319,
Pub. L. 101.121. 103 Slat. 750, as amended by sec. 10; Pub. L. 104• Signature:
65. Stat. 700 (31 U.S.C. 1352). This disclosure of lobbying activities '
is a material representation of fact upon which reliance was placed
by the above when this transaction was made or entered into. This Print Name: Ken A. Wa 1 ker
disclosure is required pursuant to 31 U.S.C. 1352. This in, ormaLcn
will be reported to the Congress semiannually and will be available
for public inspection. Any person who tails to file the required j Title: Chief of Police
disclosure shall be subject to a civil penalty of not less than S 10,000
and not more than $100,000 for each such failure. ; Telephone No.: (806) 775-2750 Date: 05/15 98
edatal'Us8 0r1fy % j .r 4 i V. X
Aulhor+.zed for Local Reproduction
-,zt . 1.rd Farm-LLL (1'6)
Privacy Certificate Guidelines
The following summarizes 28 CFR 22.23 and should be
used as a guideline in completing the Privacy Certificate
1. Data identifiable to a specific individual will not be
used or revealed unless it is research or statistical infor-
mation being used for research and statistical purposes.
2. It may be used or revealed on a "need to know" basis to:
a. Officers. employees. and subcontractors of the recipient
of the assistance.
b. Persons or organizations may receive transfers of infor-
mation for research and statistical purposes only if an in-
formation transfer agreement is entered into in which the
recipient is bound to use the information only for research
and statistical purposes and must take adequate adminis-
trative and physical precautions to ensure the confidenti-
ality of the information.
3. Employees with access to data on a need -to -know basis
will be advised in writing of the requirement of confidenti-
ality of identifiable research and statistical information
and will agree to abide by this requirement in writing.
4. Subcontracts requiring access to identifiable data will do
so according to an information transfer agreemcnt that sets
out the confidentiality of the information and the requirement
That it may, only be used for research or statistical purposes.
7. Private persons from whom identifiable data is obtained
or collected shall be advised either orally or in writing
that the data will only he used for research or statistical
purposes and that compliance with requests for informa-
tion i; not mandatory. if the notification requirement is to
be waived. an explanation must he given on or attached to
the Privacy Certificate.
6. Adequate precautions must be taken to ensure admini:
trative and physical security of identifiable data.
7. A log indicating that identifiable data has been trans-
ferred to persons other than National Institute of Justice
staff. or grantee/contractor staff or subcontractors of other
Office of Justice Programs Bureaus. shall be maintained
and will state whether such data,has been returned or if
alternative arrangements have been made for future main
tenance of such data.
8. Project plans will be designed to preserve the anonym-
ity of persons to whom the information relates. including.
where appropriate. name -stripping, coding of data. or
other similar procedures.
9. Project findings and reports prepared for dissemination
will not contain information that can reasonably be ex-
pected to be identifiable to a private person.
10. Upon completion of a research or statistical project.
the security of research or statistical information shall be
protected by either:
a. Complete physical destruction of all copies of the mate-
rials or the identifiable portions of the materials after a 3-
year required recipient retention period or as soon as
authorized by law: or
b. Removal of identifiers from data and separate mainte-
nance of a name -code index it, a secure location.
If you choose to keep a name -code index, you must main-
tain procedures to secure such an index.
11. Privacy Certificates must be signed and dated b%- the
Principal Investigator(s) and included as part of the appli-
cation submission.
d
Fy �
4` x f i Z3
PRIVACY CERTIFICATE
The grantee, City of Lubbock, agrees to provide administrative and physical security of
identifiable data and to preserve the anonymity of individuals and of agencies or departments
of Federal, State, or local governments participating in this research. To comply with this
regulation, the following elements are incorporated into the grant application or contract
proposal.
Brief description of project:
The purpose of this proposal is to develop and implement a multi -modal, didactic
training program for law enforcement and correctional officer's and their significant
others and to test the effectiveness of this program to increase adaptive family
responses to stress reactions, thus reducing stress for officers and their families.
Procedures developed to preserve anonymity:
A database, in SPSS form, will be maintained solely for this research project.
Identification numbers will be assigned to individual respondents to protect
confidentiality. The same identification number will be used for the individual
participants at pre -test and follow-up. Identification numbers will also link responses of
spouses or significant others and their officers. The computer on which the data will be
stored will be kept in a locked research facility in the TTUHSC Department of
Neuropsychiatry. Hard copies of the completed instruments will be stored in a locked
file cabinet in the research facility.
Procedures for storing data:
Refer to procedures to preserve anonymity above.
Access to data is limited to the following individuals:
Principal Investigator(s): Ken A. Walker. Chief of Police / SterlinQ Shumway, Ph. D.
Project Staff.
Subcontractors: Texas Tech University Health Sciences Center, Department of
Neuropsychiatry
KAW DISK WA:PRIVACY CERTIFICATE
Disposition of data will occur in the following manner:
Preparation of manuscripts will begin following analysis of the data in month 15.
Results of the study will be submitted in the form of journal articles to at least one law
enforcement journal (Journal of Police Science and Administration) and to at least one
family / systemic therapy journal (Journal of Marriage and Family Therapy). The
manual will also be published and made available to correctional agencies and
clinicians wanting to replicate the program. Results will also be submitted for either an
oral presentation or a poster presentation at one law enforcement convention and one
family therapy convention. Targeting both the law enforcement and the family therapy
professionals with the information obtained from this research will ensure that the
results are in the hands of the people who would ultimately make such programs
available to other correctional officers. Refer to Appendix B for more specific detail as
to the timeline for this project.
Identify any conditions that would require waiving an element of the Privacy Certificate and
explain.
Project personnel, including subcontractors, have been advised of these procedures and have
agreed in writing to comply with all procedures to safeguard privacy and confidentiality.
Signatures: z
Ken A. Walker Chief of Police
Date: _ May 15, 1998
KAW DISK 3/A:PRIVACY CERTIFICATE 2