Loading...
HomeMy WebLinkAboutResolution - 6315 - Grant Proposal - Law Enfrocement Family Support - 05_27_1999Resolution No. 6315 May 27, 1999 Item No. 16 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 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 27th of May , 1999. day J��MJL J�d-- WINDY S-I-JONAAAYOR ATTEST: Kayt It Darnell, City Secretary APPROVED AS TO CONTENT l/ Ken A. Walker, Chief of Police APPROVED AS TO FORM: Dan Y Sald)i,-�Assistant City Attorney KAW disk 4/aTsych Grant resolution May. 1999 OMB Approval No. 0348-0043 ArrLIUMium rum 2. DATE SUBMITTED IdentifierEDERAL FEDERAL ASSISTANCE une1. TYPE OF SUBMISSION: + 3. DATE RECEIVED BY STATE State Application Identifier AgDlicabon PreapInAration ❑ Construction ❑ Construction 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier ❑ Non -Construction ❑ Non -Construction 5. APPLICANT INFORMATION Legal Name: Organizational Unit City of Lubbock Address (9fm city, county, state, and zip code): Name and telephone number of the person to be contacted on matters involving this application (ghe area code) 1015 9th Street P. 0. Box 2000 Ken A. Walker Lubbock, Lubbock County, TX 79457 (806) 775-2750 B. EMPLOYER IDENTIFICATION NUMBER (EIN): 7. TYPE OF APPLICANT: (enter appropriate letter In box) Ld A. State H. Independent School Dist. _ 0 1 B. County I. State Controlled Institution of Higher learning C. Municipal J. Private University 6. TYPE OF APPLICATION: D. Township K. Indian Tribe ❑ New ❑ Continuation ® Revision E. Interstate L Individual F. Intermunicipal M. Profit Organization If Revision, enter appropriate letter(s) in box(es): G. Special District N. Other (Specify): A. Increase Award B. Decrease Award C. Increase Duration 9. NAME OF FEDERAL AGENCY: D. Decrease Duration Other (spec1(y): Department of Justice and National Institute submitted and denied last year of Justice 1Q CATALOG OF FEDERAL DOMESTIC 11. DESCRIPTIVE TITLE OF APPLICANTS PROJECT: ASSISTANCE NUMBER: Law Enforcement Family Support: Solicitation for Research, Evaluation, Development, and Tom: N/A Demonstration Projects 12. AREAS AFFECTED BY PROJECT (cities, couno'eA states, etc.): Lubbock, Lubbock County, TX 13. PROPOSED PROJECT: 14. CONGRESSIONAL DISTRICTS OF: Start Date EndingDate a. Applicant b. Project ) i 11/01/9 04/30/01 District 13 - Thornberry District 13 - Thornberry 15. ESTIMATED FUNDING: I& IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS? a. YES. THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE a' Federal $ 00 99 ,$87 STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON: DATE N/A D. Appkant $ 119,145 oo C. State t —Q— .00 b NO. ❑ PROGRAM IS NOT COVERED BY E.O.12372 F OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW d. Local ( see B ap $ licant) .00 e. Dow $ .00 I. Program Income $ .00 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? It `Yes, attach an explanation. El No g. TOTALYes : 'oo 219,032 IS. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATIOWPREAPPLICATION ARE TRUE AND CORRECT, THE DOCUMENT HAS BEEN OULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED i a. Typed Name of Authorized Representative b. Tittle c. Telephone number Ken A. Walker SEE ATTACHED LETTER Chief of Police (806) 775-2750 d. Signature of Authorized Representative W1 q S1 t Mayo e. Date Signed ✓ June 14, 1999 Pfevious Ed1ions Not Usable — Standard Form 424 (REV 4-88) 4& Prescribed by OMB Circular A-102 Kayt a Darnell, City Secretary Law Enforcement Family Support A Proposal for Development and Evaluation of a Stress Management Program for Officers and Their Spouses Ken Walker, Chief of Police Sterling T. Shumway, Ph.D. Charette A. Dersch, M.S. Rudy Arredondo, Ed.D. TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER School of Mcdicine-Department of Psychiatry 3601 4th Street Lubbock, Teas 79430 (806) 743-2800 FAX #1 (806) 743-2784 May 14, 1999 Dr. Barbara Pence RE: Justification of less indirect cost for grant submission Dear Dr. Pence: The indirect costs for this grant have been reduced from 48% to 8% due to the following reasons: • The grant discourages indirect costs. • TTUHSC is prohibited from submitting this grant due to university status. This grant requires a local municipality to submit this grant and the City of Lubbock extended an invitation to us to collaborate with them. City of Lubbock has waived their 22% indirect costs for the purposes of securing this grant. • The primary purpose of this grant is for training purposes. Sincerely, _ w� 0 f,�/�I Dr. Rudy Arredondo Director S vVL-kD (EO�ISAPPROVED: i , te An EEO/AJfirmatitvAction Institution KEN A. WALKER, CHIEF OF POLICE P.O. BOX 2000 LUBBOCK, TEXAS 79457 (806) 775-2750 FAX: (806) 775-2781 May 17, 1999 TO WHOM IT MAY CONCERN: I have been employed as a police officer for 27 years and have served as a police chief the last 17 years. During my career, I have known many officers who have experienced stress related problems at work and at home. Several of these problems have ruined their careers and in some cases their marriages. Job performance suffers because of stress related issues. Excessive sick leave, discipline problems, numerous Internal Affairs complaints, lack of productivity and burnout are among the problems supervisors face as a result of an officer's work related stress. Police officers experience a number of different illnesses due to stress. Among those are heart problems and ulcers. Alcohol related illnesses and suicide are also problems that police officers encounter. The divorce rate is high among police officers. Families are affected in ways that administrators might never see. Because of the type of work in which an officer is involved, families have to learn how to deal effectively with the stress and be able to function successfully at home. When an officer is involved in a critical situation such as a shooting, they are required to undergo at least one session with a psychologist. From that point, it is determined whether or not the officer needs to see the psychologist again. However, the spouse and children are not involved in this process. Those situations can cause a tremendous amount of stress that will obviously be taken into their home. I believe in order for a program to be successful, it is very important to include the people closest to the officer. KAW DISK VA:PSY GRANT LETTER Since the mid 70's, we have attempted to provide psychological services to officers who were experiencing these problems. In some cases, the services provided helped the situation but in most cases the problems continued. In each case, psychological services were provided after problem behavior was observed. The opportunity to collect information about stress related issues from different families who are directly involved in police work would prove to be an asset and would greatly enhance our ability to create a better working environment for police officers. If this grant is funded, we hope to develop a psychological services program for law enforcement officers to prevent these problems rather than treat an existing condition. I strongly believe that, to be effective, a prevention program must involve the whole family since family members will be able to identify problems long before they are evidenced in the work place. Our department is committed to this research project and will provide all the necessary resources to make this program a success. We hope to develop a prevention program that will not only help Lubbock Police Officers, but one that can serve as a model for other law enforcement agencies. Sincerely, Ken A. Walker Chief of Police KAW DISK 4/A PSY GRANT LETTER 2 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 items, 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 OJP. The `Application Identifier" is the number assigned by your jurisdiction, if any. If your jurisdiction does not assign 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 OJP 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 Service. Generally, this number can be 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. 11 Descriptive Title of Applicants Project: Type in the: (1) title of the program as it appears in the solicitation or announcement; (2) name of the cognizant Federal agency, ex. U. S. Department of Education; and (3) applicant's fiscal year, i.e. twelve month audit period, ex: 10/1/95 - 9/30/96. 12 Areas Affected by Project: Identify the geographic area(s) of the project. Indicate "Statewide" or "National", 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 which the project will be located as well as the Congressional District(s) the project will serve. Indicate "Statewide" or "National", if applicable. 15 Estimated Funding: In line "a," enter the Federal funds requested, not to exceed the dollar amount allocated in the program announcement. Indicate any other resources that will available to the project and the source of those funds on lines "b-f," as appropriate. 16 State Executive Order 12372: Some states require you to submit your application to a State "Single Point of Contact" (SPOC) to coordinate applications for Federal funds. If your State requires a copy of your application, indicate the date submitted. If a copy is not required, indicate the reason. (Refer to the "Administrative Requirements" section of the program announcement, for more information.) The SPOC is not responsible for forwarding your application. 17 Delinquent Federal Debt: This question applies to the applicant organization. Categories of debt include delinquent audit allowances, loans, and taxes. 18 Authorized Representative: Type the name of the person legally authorized to enter into agreements on behalf of your agency. This signature on the original application must be signed in blue ink and/or stamped as `original" to help identify the original. Rev. s/% '�� °� U.S. DEPARTMENT OF JUSTICE �;;`,(//' OFFICE OP JUSTICE PROGRAMS s„� OFFICE OF THE COMPTROLLER CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS; AND DRUG -FREE WORKPLACE REQUIREMENTS Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the instructions for certification Included in the regulations before completing this form. Signature of this form provides for compliance with certification requirements under 28 CFR Part 69, 'New Restrictions on Lobbying' and 28 CFR Part 67, "Government -wide Debarment and Suspension (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 public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes implemented at 28 CFR Part 69, for persons entering Into a grant or cooperative agreement over $100,000, as defined at or commission embezzlement, theft, forgery, 28 CFR Part 69, the applicant certifies that: bribery, falsification destruction of records, making false statements, or receiving stolen property; (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) If 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 Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL,'Disclosure of Lobbying Activities,' in accordance with its instructions; (c) The undersigned shall require that the language of this cer- tification be included in the award documents for all subawards at all tiers (including subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all sub - recipients shall 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 28 CFR Part 67, Section 67.510— A. The applicant certifies that it and its principals: (a) Are not presently debarred, suspended, proposed for debar- ment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three-year period preceding this applica- tion been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connec- tion with obtaining, attempting to obtain, or performing a (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 1988, and Implemented at 28 CFR Part 67, Subpart F, for grantees, as defined at 28 CFR Part 67 Sections 67.615 and 67.620— A. The applicant certifies that it will or will continue to provide a drug -free workplace by: (a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition; (b) Establishing an on -going drug -free awareness program to Inform employees about— (1) The dangers of drug abuse in the workplace; (2) The grantee's policy of maintaining a drug -free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and (4) The penalties that may be Imposed upon employees for drug abuse violations occurring in the workplace; (c) Making it a requirement that each employee to be engaged In the performance of the grant be given a copy of the state- ment required by paragraph (a); (d) Notifying the employee in the statement required by para- graph (a) that, as a condition of employment under the grant, the employee will— OJP FORM 406116 (3-91) REPLACES OJP FORMS 40612. 406113 AND 4061/4 WHICH ARE OBSOLETE. OMB APPROVAL NO. 1121-0140 EXPIRES: 1131196 ASSURANCES The Applicant hereby assures and certifies compliance with all Federal statutes, regulations, policies, guidelines and requirements, Including OMB Circulars No. A-21, A-110, A-122, A-128, A-87; E.O. 12372 and Uniform Administrative Requirements for Grants and Cooperative Agreements-28 CFR, Part 66, Common Rule, that govern the application, acceptance and use of Federal funds for this 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. 11. 3. It will comply with provisions of Federal law which limit certain political activities of employees of a State or local 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 themselves or others, particularly those with whom they have family, 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 imposed by the Federal Sponsoring agency concerning special requirements of law, program requirements, and other administrative requirements. 8. It will insure that the facilities under its ownership, lease or supervision which shall be utilized in the accomplishment of the protect are not listed in the Environmental protection Agency s (EPA -list of Violating Facilities and that it will notify the Federal grantor agency of the receipt of any communica- tion from the Director of the EPA Office of Federal Activities Indicating that a facility to be used in the project is under consideration for listing by the EPA. 9. It will comply with the flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973, Public Law 93-234, 87 Stat. 975, approved December 31, 1976. Section 102(a) requires, on and after March 2, 1975, the purchase of flood insurance in communities where such insurance is available as a condition for the receipt of any Federal financial assistance for construction or acquisi- tion purposes for use In any area that had been identified by the Secretary of the Department of Housing and Urban Devel- opment as an area having special flood hazards. The phrase 'Federal financial assistance' includes any form of loan, grant, guaranty, insurance payment, rebate, subsidy, disas- fer assistance loan or grant, or any other form of direct or indirect Federal assistance. Signature It will assist the Federal grantor agency in its compliance with Section 106 of the National Historic Preservation Act of 1966 as amended (16 USC 470), Executive Order 11593, and the Archeological and Historical Preservation Act of 1966 (16 USC 569a-1 et seq.) by (a) consulting with the State Historic Preservation Officer on the conduct of investigations, as necessary, to identify properties listed in or eligible for inclu- sion in the National Register of Historic Places that are subject to adverse effects (see 36 CFR Part 800.8) by the activity, and notifying the Federal grantor agency of the existence of any such properties, and by (b) complying with all requirements established by the Federail grantor agency to avoid or mitigate adverse effects upon such properties. It will comply, and assure the compliance of all Its subgrantees and contractors, with the applicable provisions of Title I of the Omnibus Crime Control and Safe Streets Act of 1968, as amended, the Juvenile Justice and Delinquency Prevention Act, or the Victims of Crime Act, as appropriate; the provi- sions of the current edition of the Office of Justice Programs Financial and Administrative Guide for Grants, M7100.1; and all other applicable Federal laws, orders, circulars, or regula- tions. 12. It will comply with the provisions of 28 CFR applicable to grants and cooperative agreements including Part 18, Administrative Review Procedure; Part 20, Criminal Justice Information Sys- tems; Part 22, Confidentiality of Identifiable Research and Statistical Information; Part 23 Criminal Intelligence Systems Operating Policies; Part 30, Intergovernmental Review of De- partment of Justice Programs and Activities; Part 42. Nondis- crimination/Equal Employment Opportunity Policies and Pro- cedures; Part 61, Procedures for Impplementing the National Environmental Policy Act; Part 63, Floodplain Management and Wetland Protection Procedures; and Federal laws or regu- lations applicable to Federal Assistance Programs. 13. It will comply, and all its contractors will comply, with the 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 (as appropriate); Title VI of the Civil Rights Act of 1964, as amended; Section 504 of the Rehabilitation Act of 1973, as amended; Subtitle A, Title II of the Americans With Disabilities Act (ADA) (1990); Title IX of the Education Amendments of 1972; the Age Discrimination Act of 1975; Department of Justice Non -Discrimination Regu- lations, 28 CFR Part 42, Subparts C, D, E, and G; and Department of Justice regulations on disability discrimina- tion, 28 CFR Part 35 and Part 39. 14. In the event a Federal or State court or Federal or State administrative agency makes a finding of discrimination after a due process hearing on the grounds of race, color, religion, national origin, sex, or disability against a recipient of funds, the recipient will forward a copy of the finding to the Office for Civil Rights, Office of Justice Programs. 15, It will provide an Equal Employment Opportunity Program if required to maintain one, where the application is for $500,000 or more. 16. It will comply with the provisions of the Coastal Barrier Resources Act (P.L. 97-348) dated October 19, 1982 (16 USG 3501 et seq.) which prohibits the expenditure of most new Federal funds within the units of the Coastal Barrier Re- sources System. 06 112199 Date OJP FORM 400QV3 (Rev.1-03) PREVIOUS EDITIONS ARE OBSOLETE. ATTACHMENT TO SF-424. (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). B. The grantee may insert in the space provided below the sites) 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 406117. Check ❑ if the State has elected to complete OJP Form 406117. 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, 1 certify that 1 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, l 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, I hereby certify that the applicant will comply with the above certifications. 1. Grantee Name and Address: City of Lubbock Police Department 1015 9th St. Pi 0. Box 2000 -LiAbeek, TY.-TT457 2. Application Number and/or Project Name 3. Grantee IRS/Vendor Number Law Enforcement Family Support 4. Typed Name and Title of Authorized Representative Ken A. Walker, Chief of Police 5. Signature IRS & EIN #: 75-6000590 June 12, 1999 6. Date 'U.S. Government Printing Office: 19% • 405-=140014 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 of a 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 each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or any employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the Initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional Information. 1. Identif ythe type of covered Federal action for which 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. it this is a followup 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 reportby this reporting entity for this covered Federal action. 4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, I known. Check the appropriate classification of the reporting entity that designates R R Is, or expects lobe, a prime or subaward 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 Item 4 checks "Subawardee", then enter the full name. address, city, state and zip code of the prime Federal recipient, Include Congressional District. ff known. S. Enter the name of the Federal agency making the award or ban 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 covered Federal action (item 1). If known, enter the full Catalpg of Federal Domestic Assistance (CFDA) number for grants, cooperative agree- ments, loans, and loan commitments. 8. Enterthe most appropriate Federal Identifying number available for the Federal action identified in Rem 1(e.g.. Requestfor Proposal(RFP) number; Invltatlon f or Bid (IFB) number, grant announcement number; the contract, grant, or loan award number; the application proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001." 9.For a covered Federal action where there has been an awardor ban commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in Rem 4 or 5. 10. (a) Enter the full name, address, city, state and zip code of the registrant under the Lobbying Disclosure Actof 1995 engaged bythe reporting entity identified in Item 4 to influence the covered Federal action. (b) Enter the full names of the Individual(s) performing services, and include full address If different from 10 ja). Enter Last Name, First Name, and Middle Initial (MI). 11. The certifying official shall sign and date the form, print his/her name, title, and telephone number. Authorized for Local Reproduction Standard Forrn4-LL (1/96) Disclosure of Lobbying Activities Approved by OMB 0348-OM Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse side for Instructions.) Public Reporting Burden for this collection of information Is estimated to average 30 minutes per response. Including the time br reviewing Instructions, searching existing data sources, gathering and maintalning the data needed, and completing and reviewing the collection of Information. Send comments regarding bus burden estimate or any other aspect of this collection of information. Including suggestions for reducing this burden, b the Office of Management and Budget. Paperwork Reduction Prcject (0348-0046), Washington. D.C. 20503. 1. Type of Federal Action: 2. Status of Federal Action: 9. Report Type: a. contract a. bid/offer/application a. initial fling b. grant b. initial award ® b. Material change c. cooperative agreement c. post -award For Material Change Only: d. loan year e. loan guarantee f. loan Insurance date of lest report 4. Name and Address of Reporting Entity: S. if Reporting Entity In No. 4 Is Subawardee, enter Name and Address of ® Prime F� Subawardee Tler , f known; Prime: Lubbock Police Department P.O. Box 2000 Lubbock, TX 79457 l Congressional District, if known: 6. Federal Department/Agency: Department of Justice and National Institute of Justice 6. Federal Action Number, it known: 10a. Name and Address of Lobbying Registrant (If individual, last name, first name, MI): N/A Congressional District' if known: 7. Federal Program Name/Descriptlon: Law Enforcement Family Support CFDA Number. If applicable: 9. Award Amount, it known: S b. Individuals Performing Services (Including address it differentfrom No.10a.) (last name, first name, MI): N/A 11. Information requested through this form is authorized by Sec.319, Pub. L.101-121,103 Stat. 750, as amended bysec.10; Pub. L.104- Signature: Zia 65, Stat. 700 (31 U.S.C.1352). This disclosure of lobbying activities 1 7 is a material representation of fact upon which reliance was placed I by the above when this transaction was made or entered into. This I Print Name: Ron A- w,a1 kPr _ disclosure is required pursuant to 31 U.S.C.1352. This information will be reported to the Congress semiannually and will be available for public inspection. Any person who falls to file the required I Twe Chief of Police disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. ; Telephone No.: (806) 775-2750 Date. 06/ 12/99 Authorized for Local Reproduction Standard Form-LLL (1/96) Privacy Certificate Guidelines The following summarizes 28 CFR 2223 and should be used as a guideline in completing the Privacy Certificate. I. 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 informalwn transfer agreement that sets out the confidentiality of the information and the requirement that it may only be used for research or statistical purposes. 5. Private persons from whom identifiable data is obtained or collected shall be advised either orally or in writing that the data will only be used for research or statistical purposes and that compliance with requests for informa- tion is not mandatory. If the notification requirement is to be waived, an explanation must be given on or attached to the Privacy Certificate. 6. Adequate precautions must be taken to ensure adminis- 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 in 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 by the Principal Investigator(s) and included as part of the appli- cation submission. 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 grand application or contract proposal. Brief description of project: The purpose of this proposal is to develop and implement a multi -modal, didacticltreatment program for law enforcement 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 confidentiality: 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 post-test. 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 competed instruments will be stored in a locked file cabinet in the research facility. Procedures for storing data: Refer to procedures to preserve confidentiality above. Access to data is limited to the following individuals: Principle Investigators: Ken A. Walker. Chief of Police / Sterling�Shumway, Ph. D. Project Staff: Rudy Arredondo, Ed.D., Charette A. Dersch_ M.S., Therapist Educator. and Research Project Administrator Subcontractors: Texas Tech University Health Sciences Center. Department of Neuropsychiatry 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 and one family therapy conference. 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 Signature: / / en A. Walker„Chief of Police Date: June 12, 1999 1)