Directives - Table of Contents Directives - (Archived) Table of Contents
• Record Type: Notice
• Old Directive Number: 07-02 (CSP 02)
• Title: FY 2008 Instructions for (1) Integrated 23(g) State Plan Grants and 21(d) On-site Consultation Cooperative Agreements; (2) 23(g) Public Employee Only State Plan Grants; and (3) 23(g) State Plan Grants without 21(d) Funding
• Information Date: 04/12/2007
• Standard Number: 1908
• Status: Archived

Archive Notice - OSHA Archive

NOTICE: This is an OSHA Archive Document, and may no longer represent OSHA Policy. It is presented here as historical content, for research and review purposes only.


OSHA NOTICE

DIRECTIVE NUMBER 07-02 (CSP 02) EFFECTIVE DATE: 4/12/07
SUBJECT: FY 2008 Instructions for (1) Integrated 23(g) State Plan Grants and 21(d) On-site Consultation Cooperative Agreements; (2) 23(g) Public Employee Only State Plan Grants; and (3) 23(g) State Plan Grants without 21(d) Funding


ABSTRACT

Purpose: This Notice contains instructions and forms for submission of FY 2008 applications for (1) Integrated Application for 23(g) State Plan Grants and 21(d) On-site Consultation Cooperative Agreements; (2) 23(g) Public Employee Only State Plan Grants; and (3) 23(g) State Plan Grants without 21(d) funding. States are to submit an application that includes either a one-year performance plan or a two-year performance plan. Financial documents will continue to be submitted on an annual basis.

Scope: This Notice applies to States that operate both section 23(g) State Plans and section 21(d) On-site Consultation projects and must submit an integrated application; the four States with public employee only State Plans; and the three States that provide private sector consultation under the State Plan. It does not apply to 21(d) On-site Consultation projects in States under Federal enforcement jurisdiction.

References: OSHA Instruction CSP 02-00-001 (TED 3.6), Consultation Policies and Procedures Manual; 29 CFR 1908; CSP 01-00-002 (STP 2-0.22B), State Plan Policies and Procedures Manual; Uniform Administrative Requirements for Grants and Cooperative Agreements with State and Local Governments (OMB Circular A-102); and Cost Principles for State and Local Governments (OMB Circular A-87).

Expiration Date: This Notice expires on May 31, 2008.

Cancellations: None.

Action Offices: National, Regional, and State Offices.

State Impact: Affected States (see Scope) must adhere to the requirements applicable to them as set out in this Notice in submitting their FY 2008 grant applications.

Originating Office: Directorates of Cooperative and State Programs and of Administrative Programs.

Contacts: Directorate of Cooperative and State Programs
Office of State Programs and Office of Small Business Assistance
USDOL - OSHA
Frances Perkins Building, Room N3700
200 Constitution Ave., NW
Washington, DC 20210 202-693-2200


By and Under the Authority of

Edwin G. Foulke, Jr.
Assistant Secretary






Executive Summary:

This Notice contains instructions and forms to assist States and Regional staff in preparing and reviewing the Integrated Application for 21(d) On-site Consultation Cooperative Agreements and 23(g) State Plan Grants, the application for 23(g) Public Employee Only State Plan Grants, and the application for 23(g) State Plan Grants without 21(d) funding. Each application must contain either a one-year or a two-year performance plan.

Significant Changes:

Outlined within this Notice are significant changes relating to:

  1. Requirement for additional Supportive Cost detail in certain Object Classes (personnel, fringe benefits, contracts, equipment, other, indirect costs); sample Supportive Cost Breakout format (Appendix B - Exhibit IX).

  2. Relocation of the Tables for Performance Plans and Salt Lake Technical Center Memorandum of Agreement to Appendix B – Exhibit X and Appendix B – Exhibit XI, respectively.

  3. Opportunity to submit a two-year Performance Plan; opportunity to submit a streamlined application during the second year of a previously submitted two-year Performance Plan (Iowa).

  4. The pages of the grant should be numbered sequentially and the specified forms/format used wherever possible.

  5. Opportunity to submit an electronic grant application using the Grants.gov system as part of a pilot project.

  6. Requirement to submit all FY 2008 quarterly and closeout SF 269 – Financial Status Reports electronically using the DOL E-Grants System.

  7. States which provide consultation services through their 23(g) grant must separately identify the staffing and total funding devoted to this program.

  8. States developing alternatives or supplements to the Integrated Management Information System (IMIS) must separately identify the contracts and total funding devoted to this project.

  9. 21(d) and 23(g) OSHA Restrictions and Conditions have been updated.






TABLE OF CONTENTS

  1. Purpose

  2. Scope

  3. References

  4. Expiration Date

  5. Action Information

    1. Responsible Office

    2. Action Offices

      1. National Office

      2. Regional Offices

      3. States

  6. Significant Changes

  7. Strategic Plans

    1. Basic Principles

  8. Performance Plans

  9. Documents Required for Application Submission

    1. Documents

    2. Requirements

      1. General Requirements for All Applications

      2. 21(d) Requirements

      3. 23(g) Requirements

EXHIBITS

Appendix A

Exhibit I -  Cooperative Agreement for OSHA On-site Consultation under Sections 21(c) and 21(d) of the Occupational Safety and Health Act of 1970

Exhibit IIa -  Integrated 21(d) and 23(g) Assurances and Certifications Non-Construction Programs (includes Lobbying Certification, 21(d) OSHA Restrictions and Conditions, and 23(g) OSHA Restrictions and Conditions)

Exhibit IIb -  23(g) Assurances and Certifications Non-Construction Programs (includes Lobbying Certification, 23(g) OSHA Restrictions and Conditions)

Exhibit IIIa -  Cooperative Agreement (Form OSHA 110)

Exhibit IIIb -  Grant Agreement (Form OSHA 110)

Exhibit IV -  Application for Federal Assistance (SF-424) and Budget Information – Non-Construction Programs (SF-424A)

Exhibit V -  23(g) Financial Guidelines


Appendix B

Exhibit I -  Projected Program Activities – 21(d) On-site Consultation

Exhibit II -  Equipment Inventory- 21(d) On-site Consultation

Exhibit III -  Equipment Procurement Listing – 21(d) On-site Consultation

Exhibit IV -  Annual Training Plan – 21(d) On-site Consultation

Exhibit V -  Accompanied Visit Plan – 21(d) On-site Consultation

Exhibit VI -  Personnel Break Out Chart – 23(g) and 21(d)

Exhibit VII -  Supporting Details of Anticipated Costs – 21(d) On-site Consultation (format) - Part A: Consultation

Exhibit VIII -  Supporting Details of Anticipated Costs – 21(d) On-site Consultation (format) - Part B: Administration

Exhibit IX -  Supportive Cost Breakout Chart – 23(g) State Plans (suggested format)

Exhibit X -  Tables for Performance Plans: Part I – Program Activities Projections; Part II – Performance Goals

Exhibit XI -  Memorandum of Agreement for Laboratory Services (Salt Lake Technical Center) – 23(g) State Plans


Appendix C

Exhibit I -  OSHA 23(g) State Plan and 21(d) On-site Consultation FY 2007 Final Base Award Levels - Funding Chart







Application for Integrated 21(d) On-site Consultation Cooperative Agreements and 23(g) State Plan Grants, 23(g) Public Employee Only State Plan Grants, and 23(g) State Plan Grants without 21(d) funding.

  1. Purpose. This Notice contains instructions and forms for submission of FY 2008 applications for the Integrated Application for 23(g) State Plan Grants and 21(d) On-site Consultation Cooperative Agreements, the 23(g) Public Employee Only State Plan Grants, and the 23(g) State Plan Grants without 21(d) funding. States are to submit an application that includes either a one-year performance plan or a two-year performance plan. Separate financial documents are required for the 21(d) cooperative agreement and the 23(g) grant. Financial documents will continue to be submitted on an annual basis.

  2. Scope. This Notice applies to States that operate section 23(g) State Plans, and section 21(d) On-site Consultation projects in State Plan States. It also applies to Public Employee Only State Plans and to the three States that provide private sector consultation under their State Plan. It does not apply to 21(d) On-site Consultation projects in Federal jurisdiction States.

    Instructions for the 21(d) cooperative agreement applications in Federal enforcement States are contained in the On-site Consultation Cooperative Agreement Application FY 2008. General instructions for 23(g) grant preparation are contained in chapter 5 of OSHA Instruction CSP 01-00-002 (STP 2-0.22B).

  3. References. OSHA Instruction CSP 02-00-001 (TED 3.6), Consultation Policies and Procedures Manual; 29 CFR 1908; CSP 01-00-002 (STP 2-0.22B), State Plan Policies and Procedures Manual; Uniform Administrative Requirements for Grants and Cooperative Agreements with State and Local Governments (OMB Circular A-102 codified in 29 CFR 97); and Cost Principles for State and Local Governments (OMB Circular A-87).

  4. Expiration Date. This Notice expires on May 31, 2008.

  5. Action Information.

    1. Responsible Office. Directorate of Cooperative and State Programs (DCSP), Office of State Programs (OSP) and Office of Small Business Assistance (OSBA) in consultation with the Assistant Secretary.

    2. Action Offices.

      1. National Office. National Office personnel are responsible for reviewing and approving the applications, and verifying that the applications meet all required financial, operational, and policy requirements.

        1. Directorate of Administrative Programs (DAP). The Division of Grants Management is responsible for reviewing financial documents, posting funding award levels in the Payment Management System, transmitting the award letters to each recipient and administering all financial aspects of the cooperative agreement/State Plan grant. The Division of Grants Management will provide copies of the application to the Office of Small Business Assistance and the Office of State Programs.

        2. Directorate of Cooperative and State Programs. The Office of Small Business Assistance and the Office of State Programs are responsible for reviewing the application and discussing any issues with the appropriate Regional Staff. The Office of State Programs has overall responsibility for coordinating comments among DCSP staff and ensuring that DCSP issues are reflected in the award letters transmitted by DAP.

      2. Regional Offices. Throughout the application and review process, the Regional Administrator remains the point of contact with the State(s). Regional Administrators must grant approval to any State desiring to submit a two-year performance plan based on the quality of prior performance plans and the expectation of reasonable progress toward achievement of outcome/results oriented goals. Regional Offices must coordinate with State Plans and On-site Consultation Project Managers within their jurisdiction and provide assistance in the development, submission and revisions of grant applications. They must discuss and resolve any issues with appropriate staff in DCSP and DAP. By August 15, 2007, the Regional Administrator must submit a transmittal memorandum for each State application, reflecting recommendations for approval or disapproval of the application, a one-year or a two-year performance plan and, if appropriate, changes to the 5-year Strategic Plan. The transmittal package must include two copies of the application with original signatures on the financial documents. In addition, the transmittal memorandum must reflect the Region's assessment of any unresolved issues in the application and any questionable items along with specific suggested language for any restrictions which should be placed on the cooperative agreement/State Plan grant award, if an appropriate State response has not been received prior to processing in the National Office. Regions are urged to resolve all issues prior to submission so that the application may be expeditiously approved. The National Office package must be forwarded to the attention of:
        Arlene Williams
        U.S. Department of Labor
        Occupational Safety and Health Administration
        Division of Grants Management - DAP
        200 Constitution Avenue, NW - Room N-3419
        Washington, DC 20210
      3. State Program and On-site Consultation Project Managers in State Plan States. The Office of Management and Budget (OMB Circulars A-102 and A-110) requires that financial awards be made at least 10 days prior to the beginning of the grant or agreement period. States must follow the instructions detailed in this Notice when submitting the application. States are responsible for coordinating with their Regional Administrator to agree on a schedule that will allow submission of the application package to the National Office by August 15, 2007.

        1. States wishing to participate in a pilot project to submit their grant applications electronically using the Grants.gov system must coordinate with their Regional Administrator and the Office of Grants Management to agree on a schedule that will allow electronic submission of the final grant package to the National Office by August 15, 2007. States participating in the pilot must also submit a hard copy of their final application to allow assessment of the electronic submission process. Instructions on electronic submission of grants will be provided separately to participating States and Regions.

  6. Significant Changes.

    1. States must provide more detail in the Supportive Cost Breakout for certain Object Classes (contracts, equipment, other, fringe benefits, indirect costs); a sample Supportive Cost Breakout format is provided in Appendix B – Exhibit IX.

    2. The Tables for Performance Plans and the Salt Lake Technical Center Memorandum of Agreement have been relocated to Appendix B – Exhibit X and Appendix B – Exhibit XI, respectively.

    3. States have the option of submitting a two-year performance plan for FY 2008 and FY 2009. States in the second year of a two-year performance plan in FY 2007 (Iowa) can submit a streamlined application that includes financial documents; a brief, general assessment by the State, based on available data, of the progress made toward its first-year goals; and any resultant updates to the second year of the performance plan previously submitted. Instructions regarding these submissions can be found in Sections VIII and IX.

    4. States will have the opportunity to submit electronic grant applications using Grants.gov as part of a pilot project. Instructions on electronic submission using Grants.gov will be provided to those states that agree to participate in the pilot.

    5. States are required to submit all FY 2008 quarterly and closeout SF 269 – Financial Status Reports electronically using the DOL E-Grants System regardless of whether they participate in the electronic grants submission pilot. (Training will be provided.)

    6. The pages of the grant should be numbered sequentially and the specified forms/format used wherever possible.

    7. States which provide consultation services through their 23(g) grant must separately identify the staffing and total funding devoted to this program.

    8. States developing alternatives or supplements to the Integrated Management Information System (IMIS) must separately identify the contracts and total funding devoted to this project.

    9. OSHA Restrictions and Conditions for 21(d) and for 23(g) have been updated.

    Application Instructions

  7. Strategic Plans.

    1. Basic Principles. The following basic principles govern States' development of Strategic and annual/biennial Performance Plans.

      1. Each State Plan must have a five-year Strategic Plan made up of outcome-oriented strategic and performance goals. If a State's five-year Strategic Plan expires in FY 2007, the FY 2008 grant application must also contain a new five-year Strategic Plan.

      2. In addition to its strategic and performance goals, each State's occupational safety and health program must continue to satisfy the mandated activities of the OSH Act and 29 CFR Parts 1902 and 1908 or 1956 (e.g., standards, enforcement program, prohibition against advance notice) and so certify in its application and demonstrate in actual performance.

      3. All State Plans must include in their Strategic Plan a goal directed towards the reduction of fatalities, injuries, and illnesses. Although this goal need not include specific percentage rate reduction targets, as in OSHA's goal in the Department of Labor's Strategic Plan, the State's reduction of injury/illness/fatality rates will be included in OSHA's assessment of the achievement of the national goal(s). In addition, States must develop reasonable performance goals that are broad enough to encompass all major components of the State program, including private and public sector enforcement, consultation, compliance assistance, training and cooperative programs even if they choose to adopt only one strategic goal. Support activities, such as laboratories, need not be addressed specifically in strategic goals.

      4. As part of the application, each State Plan must develop a one-year or a two-year Performance Plan describing the specific actions to be undertaken by the State to accomplish its strategic and performance goals during the period covered. This Performance Plan will serve as the required grant narrative and must include performance goals that are broad enough to encompass all major components of the State program including public sector enforcement, 21(d) and 23(g) On-site Consultation programs, and compliance assistance. Two-year performance plans should identify specific performance goals for each of the two years.

      5. State strategic and performance plans must contain one or more outcome/results oriented goals. If performance on a goal is measured only by activities, the lack of an outcome/results oriented goal must be justified. Plans relying solely on activity based goals and measures will not be acceptable.

      6. OSHA will evaluate each State Plan's performance on whether it makes reasonable progress towards accomplishing the strategic and performance goals contained in the strategic plan and the significance of the actual results achieved. OSHA will review State performance using the methods agreed upon by OSHA and the State in its annual monitoring plan.

      7. State Plans developing strategic plans with strategic and performance goals that rely on data that differ from those used by Federal OSHA (e.g., targeting reductions based on data from State-based systems, such as workers' compensation) are responsible for identifying the data necessary to establish an appropriate measurement and reporting system. These data are to be agreed upon by the States and Regions. States with goals similar to those of OSHA, such as reductions in injuries and illnesses in specific areas of emphasis, can track their goal-related activity through OSHA's Integrated Management Information System (IMIS).

      8. The focus of a State Plan's occupational safety and health program, as identified by the State's strategic and performance goals, establishes the parameters within which the State's program operations will be evaluated to determine whether its program is at least as effective as Federal OSHA's. The State will still be expected to continue to meet its mandated responsibilities under the OSH Act and to so certify in the grant application and through demonstrated performance.

  8. Performance Plans.

    1. States have the option, with approval of the Regional Administrator, of submitting a one-year or two-year Performance Plan. The Performance Plan consists of a narrative section covering basic program information and two tabular sections covering one- or two-year performance goals and projected activities. The Performance Plans must describe the specific activities the State will perform to accomplish its performance goals, must be aligned with the State's five-year Strategic Plan and must identify the expected outcome of these activities. Each Performance Plan must include a section that addresses the data elements and informational needs outlined below. For States submitting a two-year performance plan, the performance plan should include goals for each year of the plan.

    2. Any State desiring to submit a two-year performance plan must notify and obtain the Regional Administrator's approval prior to beginning preparation of the application. Regional Administrators should premise their approval on the State's prior experience in developing and making reasonable progress in achieving outcome/results oriented goals and a review of the outcome/results oriented goals in the State's Strategic Plan.

    3. All State performance plans, whether one- or two-year, must contain one or more outcome/results oriented goals. If performance on a goal is measured only by activities, the lack of an outcome/results oriented goal must be justified. Applications premised solely on activity goals will not be accepted.

    4. In addition to providing information on compliance and consultation staffing and projections as to the number of inspections (separately for private and public sectors) and consultation visits (separately for private sector 21(d) or 23(g) and 23(g) public sector) anticipated during the upcoming year (or each of two years for States choosing to submit two-year performance plans), States must provide projections regarding the following compliance assistance activities: Voluntary Protection Program participants (current number, anticipated growth, and total anticipated at the end of the grant period by general industry, construction and public sector, as applicable); Cooperative Programs similar to OSHA's Partnerships and Alliances or other State developed programs for joint cooperative efforts with employers, employees, groups (current number, anticipated growth, and total at the end of period); Outreach Participants (total number of trainees/participants anticipated to be affected by State Outreach activities during the period, e.g., formal training, workshops, seminars, speeches, conferences, informal worksite training; and Safety and Health Achievement Recognition Programs (SHARP) participants (current number, anticipated growth, and total anticipated at the end of the grant period.)

    5. The following table shows the contents of the State's Performance Plan, depending on whether the State has both 23(g) and 21(d) programs (integrated application), includes private sector consultation under its 23(g) program, or is a Public Employee Only program.


      Performance Plan Elements
      21(d) On-site Consultation Project & 23(g) State Plan1 23(g) State Plan only2 Public Employee State Plan3
      Overview: A comprehensive overview of the State's current occupational safety and health program. YES YES YES
      Profile of the State Agency: Provide a detailed organizational chart of the components involved in the State OSHA effort. In addition, the total number of allocated staff and a break out of compliance, compliance assistance, and On-site Consultation staff, expressed in full-time equivalents (FTEs), need to be included. (See Sample of Personnel Breakout Chart, Appendix B – Exhibit VI.)
      State Demographic Profile. Number of covered employers broken out by major North American Industrial Classification System (NAICS) Division and number of covered employees, by major NAICS Division, including separate identification of State and local government employers and employees.

      Identification of Covered Issues. List those issues that the State's OSH program covers and those that remain a Federal responsibility.
      YES YES YES
      Mandated Activities: Activities mandated under the OSH Act (i.e., inspections and citations) are considered core elements of an effective occupational safety and health program. They should be tied to the State's strategic goals where possible. The Performance Plan should discuss the performance of mandated activities as strategic tools wherever appropriate to achieve State goals. For example, issuing standards, conducting inspections, and issuing citations are among the activities which could be used to achieve the strategic goal of reducing injuries and illnesses.

      Where the mandated activities are neither tied to specific strategic goals nor addressed through the State Activity Mandated Measures report, they are covered by the grant assurances. (See Appendix A, Exhibit IIa/IIb – 23(g) OSHA Restrictions and Conditions – Item 1.)
      YES YES YES
      Internal Quality Assurance Program for 21(d) On-site Consultation Projects. If a 21(d) On-site Consultation Project has made any significant changes to its Internal Quality Assurance program, those changes must be described in detail. Indicate if no changes have occurred. YES NO NO
      Projected State Plan Activities for one year (One-Year Performance Plan) or each of two years (Two-Year Performance Plan) (See Appendix B, Exhibit X, Part I for 23(g) and Appendix B, Exhibit I for 21(d)).
      Inspections. Provide total projections broken out by safety and health, as well as by private sector and public sector.

      Consultation Visits in Private Sector. Provide total projections broken out by safety and health for anticipated number of consultation visits in the private sector.

      Consultation Visits in Public Sector. Provide projections broken out by safety and health for the anticipated number of consultation visits in the public sector.

      Compliance Assistance. Provide the current number, the projected growth, and end-of-year total for:

      • Voluntary Protection Programs (by general industry, construction, public sector as applicable).
      • State Cooperative Programs (e.g., Partnerships, Alliances and other similar programs).
      • Outreach Participants/Trainees affected by outreach activities during the period.
      • Safety and Health Achievement Recognition Program (SHARP) participants.
      YES YES YES
      Performance Goals:

      For each performance goal in the State’s Strategic Plan that is to be addressed, the State must:

      1. Establish objective and measurable one-year or two-year performance goals to be achieved by the State. For two-year performance plans, goals should be identified separately for each of the two years.

      2. Identify the performance indicators (including activity, intermediate outcome, and primary outcome measures) that will be used to assess progress toward achievement of the State's performance goals. (See Appendix B, Exhibit X – Part II.)

      3. Succinctly and completely describe the enforcement and compliance assistance strategies and activities (including private and public sector consultation) that will be applied to accomplish the one-year or two-year performance goals.

      The one-year or two-year performance goals should be presented in the format illustrated in Appendix B, Exhibit X. When enforcement and 21(d) On-site Consultation share a performance goal, the strategy, indicator, data source, and baseline must clearly describe the differences.

      The submission for the second year of two-year performance goals should include a brief, general assessment, based on available data, of the progress made toward achievement of the first year's goals, and any resultant revisions to the second year of the performance plan. This may be in the form of replacement pages to the previously submitted Appendix B, Exhibit X or other appropriate format.
      YES YES YES
      Projected 21(d) On-site Consultation Program Activities: In addition to discussing 21(d) On-site Consultation activities as they relate to each performance goal above, the total numbers of projected 21(d) activities also must be provided in the format illustrated in Appendix B, Exhibit I for Year One and Year Two. When enforcement and 21(d) On-site Consultation share a performance goal, the strategy, indicator, data source, and baseline must clearly describe the differences. YES NO NO
      _________________________
      1 Alaska, Arizona, California, Hawaii, Indiana, Iowa, Maryland, Michigan, Minnesota, Nevada, New Mexico, North Carolina, Oregon, South Carolina, Tennessee, Utah, Vermont, Virginia, Wyoming. States in the second year of a Two-Year Performance Plan (Iowa) need only provide updates and revisions to the previously submitted documents.
      2 Kentucky, Puerto Rico, Washington.
      3 Connecticut, New Jersey, New York, Virgin Islands.

  9. Application Submission

    1. Documents. The following tables list the documents to be included in the State's application submission.



      Application Documents
      21(d) On-site Consultation Project & 23(g) State Plan1
      23(g) State Plan only2

      Public Employee State Plan3


      Reference
      Table of Contents 2 copies 2 copies 2 copies  
      21(d) Cooperative Agreement 2 copies with original signatures N/A N/A Appendix A – Exhibit I
      OSHA-110 form – 21(d) Cooperative Agreement 2 copies with original signatures N/A N/A Appendix A – Exhibit IIIa
      OSHA-110 form – 23(g) Grant Agreement 2 copies with original signatures 2 copies with original signatures 2 copies with original signatures Appendix A – Exhibit IIIb
      SF-424 – 21(d) Application for Federal Assistance 2 copies with original signatures N/A N/A Appendix A – Exhibit IV
      SF-424 – 23(g) Application for Federal Assistance 2 copies with original signatures 2 copies with original signatures 2 copies with original signatures Appendix A – Exhibit IV
      SF-424A – 21(d) Budget Information, Non-Construction Programs 2 copies N/A N/A Appendix A – Exhibit IV
      SF-424A – 23(g) Budget Information, Non-Construction Programs 2 copies 2 copies 2 copies Appendix A – Exhibit IV
      Combined Assurances & Certifications with:

      21(d) OSHA Restrictions & Conditions
                            and
      23(g) OSHA Restrictions & Conditions
      2 copies with original signatures N/A N/A Appendix A – Exhibit IIa
      Assurances & Certifications with:
      23(g) OSHA Restrictions & Conditions
      N/A 2 copies with original signatures 2 copies with original signatures Appendix A – Exhibit IIb
      Projected Program Activities – On-site Consultation 2 copies N/A N/A Appendix B – Exhibit I
      Equipment Inventory – 21(d) On-site Consultation 2 copies N/A N/A Appendix B – Exhibit II
      Equipment Procurement Listing – 21(d) On-site Consultation 2 copies N/A N/A Appendix B – Exhibit III
      Annual Training Plan – 21(d) On-site Consultation 2 copies N/A N/A Appendix B – Exhibit IV
      Accompanied Visit Plan – 21(d) On-site Consultation 2 copies N/A N/A Appendix B – Exhibit V
      Personnel Breakout 2 copies 2 copies 2 copies Appendix B – Exhibit VI
      Supporting Details of Anticipated Costs, Part A – Consultation 21(d) 2 copies N/A N/A Appendix B – Exhibit VII
      Supporting Details of Anticipated Costs, Part B – Administration 21(d) 2 copies N/A N/A Appendix B – Exhibit VIII
      Supportive Cost Breakout 23(g) 2 copies 2 copies 2 copies See section IX.B.3.c and d; Appendix B-Exhibit IX
      MOA – Salt Lake Technical Center 23(g) State Plans (Only States using SLTC for analysis of all samples are required to submit MOA.) 2 copies with original signatures, if applicable 2 copies with original signatures, if applicable 2 copies with original signatures, if applicable Appendix B – Exhibit XI
      FY 2008 Annual Performance Plan
         or
      FY 2008/2009 Two-Year Performance Plan with:

      -    Overview of the Project/State Plan -    Profile of the State Agency
      -    State Demographic Profile
      -    Identification of Covered Issues
      -    Mandated Activities
      -    Internal Quality Assurance Program for 21(d) Project
      -    Projected State Plan Activities: Inspections, Consultations, Compliance Assistance, SHARPS
      -    Performance Goals
      -    Organizational Chart
      Or
      2 copies,
      integrated 21(d)/23(g)
      2 copies 2 copies See sections VII, VIII,
      Appendix B, Exhibit X
      FY 2008 2nd year of Two-Year Performance Plan – assessment of progress, updates and revisions to the above documents 2 copies,
      integrated 21(d)/23(g)
      2 copies 2 copies See section VIII,
      Appendix B, Exhibit X
      5-Year Strategic Plan (only if new or updated plan is being submitted) 2 copies,
      integrated 21(d)/23(g)
      2 copies 2 copies See section VII
      _________________________
      1 Alaska, Arizona, California, Hawaii, Indiana, Iowa, Maryland, Michigan, Minnesota, Nevada, New Mexico, North Carolina, Oregon, South Carolina, Tennessee, Utah, Vermont, Virginia, Wyoming. States in the second year of a Two-Year Performance Plan (Iowa) need only provide updates and revisions to the previously submitted documents.
      2 Kentucky, Puerto Rico, Washington.
      3 Connecticut, New Jersey, New York, Virgin Islands.

  10. Requirements.

    1. General Requirements for All Applications.

      1. Funding Level. Funding documents should generally be prepared at the prior year final base award level. (See Appendix C – Exhibit I). If the State does not have the required matching funds for this award level, it should complete the application to reflect the level which it can match.

      2. DUNS Number. Agreements must include a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number to be considered complete. The revised Application for Federal Assistance (Form SF-424) includes space to enter a DUNS number.

      3. Administrative Cap. The 25 percent ceiling on administrative costs remains in effect. Administrative costs include the cost of all management staff above first-line supervisors (salaries, fringe benefits, and related support expenses) as well as costs associated with the approved State Indirect Rate. No more than 25 percent of the total funding (Federal award plus State match) may be budgeted for administrative costs without an approved justification. Some additional requirements apply to the 21(d) program. (See Appendix A, Exhibit I, page 3.) Note: Although submission of the approved indirect cost rate agreement is not required, the Regional Administrator should assure that the indirect costs contained in the grant application are based on the approved indirect cost rate agreement.

      4. OSHANet Participation. State recipients who participate in OSHANet agree to adhere to all requirements for such participation (including hardware and software specifications). All desktops and laptops that connect to the OSHANet must be configured with the OSHA image. Software that is not part of the OSHA standard image must be pre-approved prior to purchase and once approved and received must be approved for installation. All new desktop and laptop computers must be Microsoft (MS) Vista-ready but have MS Windows XP Professional installed as the operating system. All desktops, laptops and servers on the OSHANet are subject to an annual software audit to ensure compliance with E.O. 13103, Computer Software Piracy, the U.S. Copyright Act (Title 17, U.S.C.), USDOL software management and acceptable use policy, and vendor software license agreements. States participating in OSHANet agree to pay OSHA for certain services provided, including an annual service fee and quarterly telecommunication charges. OSHANet States that also choose to use Citrix for remote access will receive annual bills. The fourth quarter payment will be based on an estimated bill. All bills must be paid no later than September 15th. Any adjustments between actual charges and estimates will be made in the first quarter of the following fiscal year, as necessary.

      5. Integrated Management Information Systems for All States (IMIS). Continued participation in IMIS is a program requirement and includes all its components. All 21(d) On-site Consultation projects and 23(g) State Plans will continue to be charged for mainframe processing services provided through IMIS based on quarterly bills. The fourth quarter payment will be based on an estimated bill. All bills must be paid no later than September 15th. Any adjustments between actual charges and estimates will be made in the first quarter of the following fiscal year, as necessary.

      6. Computer Equipment Purchases. State recipients not participating in OSHANet are encouraged to consult with the Directorate of Information Technology prior to expending Federal or State matching funds for the purchase of any data processing/computer equipment or software that will be used to connect (locally or remotely) to, or provide information to, OSHA. Desktop or laptop computers and software that will be used to access OSHA systems including the CSHO and On-site Consultation PC Applications, Whistleblower application, web-based applications as deployed, etc., must meet the minimum OSHA specifications. All new computers must be Microsoft (MS) Vista-ready but have MS Windows XP Professional installed as the operating system. (21(d) projects must have written approval from DCSP for all such purchases.)

      7. Computer Security. All system users (OSHANet and other OSHA applications) must annually sign Rules of Behavior. All OSHA system users must complete the USDOL Annual Computer Security Awareness Training (CSAT) within the required timeframe.

      8. Program Income. States that are collecting fees associated with grant activities should report the estimated amount of income expected to be generated from the grant on line 7 of the Application for Federal Assistance (SF-424A). States should include a narrative description of the program income, including the nature and source of the income, in the grant application. The program income may be reflected as part of the State's matching funds contribution. Also, States must report program income on the Financial Status Report (SF-269) submitted each quarter. For more information on program income, please refer to OMB Circular A-102, Section 2e. The website is: http://www.whitehouse.gov/omb/circulars/a102/a102.html.

      9. Professional Certification. State Plan Grant/Cooperative Agreement funds may be used to pay for the costs associated with professional certification for safety and health staff by a certifying organization that has been accredited by a nationally recognized accrediting organization, including such things as a preparation course, the examination, travel and per diem. Grant/Cooperative Agreement funds may not be used to pay for costs associated with preparation for a second attempt for employees who initially fail at a professional certification examination. However, Grant/ Cooperative Agreement funds may be used to pay for the expenses associated with taking the professional certification examination a second time, including travel and per diem. For those who fail to pass a professional certification examination on their second attempt, grant/cooperative agreement funds may not be used for any additional attempts. Certification costs cannot exceed the percent of time for which an employee is dedicated to the grant/cooperative agreement. Grant/Cooperative Agreement funds may also not be used to pay annual fees for maintaining professional certifications.

    2. 21(d) Requirements.

      1. Salary Target. Each project must devote a minimum of 50 percent of the grant amount (90/10 total) toward consultant salaries and fringe benefits. Project Managers unable to meet this target must provide a written explanation of why they cannot meet this goal and receive prior approval from the Director of DCSP.

      2. Minimum Staffing. At least four professional, full-time equivalents (FTEs) -- two full-time safety specialists and two full-time industrial hygienists or their equivalents -- must be included in each Project's personnel plan. All of the Project's consultants must be employed at least 50 percent of their time in the On-site Consultation Program and must spend at least 50 percent of their time engaged in consultation activity. Any deviation from this minimum must receive prior approval from the Director of DCSP.

    3. 23(g) Requirements.

      1. Matching Funds. States will generally be funded, initially, at the prior year's level. States that are unable to match the full amount available to them should complete the application to reflect the level they can match.

      2. Alternative or Supplement to Integrated Management Information System. States electing to pursue the development of an alternative or supplement to the Integrated Management Information System (IMIS) may use grant funds for this purpose, but there are no additional Federal grant funds available for this purpose.

        1. The State must identify the funding devoted to such a project either by creating an additional category in the Supportive Cost Breakout for this purpose, or appropriately annotating the specific personnel, contract, equipment, etc., items devoted to this effort.

        2. The resulting alternative or supplemental system must continue to provide data to OSHA that are identical to that required by the Federal IMIS and that are submitted in the same manner and to the same extent as though continuing to participate in the IMIS system. Data must be timely submitted through download into IMIS and must be provided in a format that meets OSHA's current as well as any future requirements. There may be no interruption in submission of data to meet future requirements. There may be no interruption in submission of data to OSHA during the development of such alternative or supplemental systems.

      3. Budget Categories. All costs on the Application for Federal Assistance (SF-424A) can be identified under two budget categories, Administration and Program, based on the State's actual organizational structure. (A third category must be added where one hundred percent State funds are used.) States may, however, continue to use the previously required nine categories (general administration; safety inspections; health inspections; consultation and other voluntary programs; training and education; standards; management information systems; laboratories; and review process and non-discrimination) or any others that better reflects the State's actual organizational structure. States that provide private sector consultation services through their 23(g) grant must separately identify the staffing and total funding devoted to this program in a manner that clearly delineates the program. Financial information for all Object Class categories, i.e., personnel, fringe benefits, travel, equipment, supplies, contractual, other, total direct charges, indirect charges, and total object categories must be shown for each of the Budget Categories on the SF-424A.

      4. Object Classes/Supportive Cost Breakout. States are required to provide detailed financial information for the following six object class categories: personnel, fringe benefits, equipment, contractual, other, and indirect charges, based on either the Administration/ Program budget categories or the categories used based on the State's actual organizational structure, in a Supportive Cost Breakout format. States may use the suggested format in Appendix B, Exhibit IX or a form of their own design provided all information is provided.

        1. The personnel information provided on the Supportive Cost Breakout Listing must correspond to the organizational chart included in the Performance Plan and should identify the number of on-board staff and the number of vacant positions. All supervisory positions above the first level of supervision must be reflected in Administration. Compliance Assistance position(s), including those funded during the FY 2006 final award process, must be identified. Activities of this staff must be limited to Compliance Assistance which may also include VPP, Partnerships, Alliances, speeches, training and other cooperative program outreach efforts, but not activities directly related to Compliance or Consultation, including SHARPS. Positions devoted to private sector On-site Consultation must be separately identified.

        2. Fringe benefits should include information on the components and cost formula used.

        3. Equipment having a useful life of over one year and a unit acquisition cost of $5,000 or more must be separately identified.

        4. The contractual information should identify the purpose of each contract, the contractor, if known, and the amount of the contract. Contracts for such things as laboratory sample analysis, equipment calibration, and computer services, especially for the development of alternative or substitute IMIS systems, must be clearly identified.

        5. If not included elsewhere, Other should identify costs associated with such things as equipment calibration, reimbursement to the OSHA Training Institute and associated costs for courses brought to the State, and laboratory sample analysis.

        6. Indirect Costs should be included under Administration only and should be based on an approved indirect cost rate agreement for the grant period.

      5. Salt Lake Technical Center (SLTC). States wishing to use the SLTC services for all their industrial hygiene sample analysis in FY 2008 will need to submit a new Memorandum of Agreement (MOA) with their current fiscal year grant application package. The MOA can be downloaded from the State Plans section of the OSHA Limited Access Page and must be modified to include State-specific information. As indicated in an April 3, 2002 memorandum, States without Memoranda of Agreements may send samples to SLTC on a periodic, as-needed basis. The cost per sample for States that wish to use the SLTC laboratory exclusively is $175; the cost per sample for States that use the SLTC laboratory on an occasional basis is $220.00. There will be a special charge for all States for four exceptional sample types – CO Methoxyhemoglobin calculation - $1,150, Explosibility - $710, Gas Chromatograph/Mass Spectrometer Identification - $465, and Materials Failure - $2,820.

        1. States without Memoranda of Agreement with SLTC must provide the name and address of the laboratory used for sample analysis, identify the funding, and assure its participation in the AIHA Proficiency Analytical Testing (PAT) program. An estimate of the number of samples anticipated for analysis should be provided.

        2. States should include sufficient funds in their grant application, and identify those funds, to cover payment for an appropriate level of sample analysis whether by a State or private lab with occasional use of SLTC or on an ongoing basis through an MOA with SLTC.

      6. OSHA Training Institute (OTI). States wishing to have the OSHA Training Institute deliver courses within their State, at the State's request, are expected to reimburse OSHA for the cost of the travel and per diem expenses for OTI instructors, shipping charges, consultant trainer fees, equipment rental and training facility rental related to the training.

      7. Format. The pages of the grant should be numbered consecutively and the specified forms/format used wherever possible.







Appendix A – Exhibit I

Cooperative Agreement for OSHA On-site Consultation under Sections 21(c) and
21(d)
of the Occupational Safety and Health Act of 1970

Between the State/Commonwealth/Jurisdiction of _________________________________ and the Occupational Safety and Health Administration (OSHA), United States Department of Labor.

  1. AUTHORITY AND PARTIES TO AGREEMENT.

    1. Pursuant to Sections 21(c) and 21(d) of the Occupational Safety and Health Act of 1970 (hereinafter called the Act), it is hereby agreed that the Assistant Secretary of Labor for Occupational Safety and Health (hereinafter called the Assistant Secretary) and the _________________________________ (hereinafter called the State) which affirms that it has been authorized by the Governor to enter into this agreement with full power to perform the obligations hereunder and to receive and expend Federal funds as well as state funds as required herein will execute all provisions of this agreement.

    2. Nothing herein shall preclude the Assistant Secretary from exercising Federal responsibility and authority under the Act or preclude the State from exercising its responsibility and authority under state law when not in conflict with the Federal Act and the terms of this agreement.

  2. AGREEMENT TERMS.

    1. Either party may terminate this agreement upon 30 days notice to the other party.

    2. It is agreed by both parties that substantive work and costs incurred under this agreement will be managed and scheduled in a manner to assure adequate program coverage and activity throughout the entire 12-month performance period, without the necessity of requesting a budget modification to increase the amount of Federal funds authorized.

    3. This agreement incorporates the following documents which the State has agreed to submit.

      q Application for Federal Assistance (SF-424)
      q Budget Information -- Non-Construction Programs (SF-424A)
      q Certifications, Assurances, Lobbying Restrictions, and OSHA Restrictions and Conditions
      q Cooperative Agreement (Form OSHA-110)
      q Performance Projections
      q Annual Training Plan
      q Accompanied Visit Plan
      q Supporting Details of Anticipated Costs

    4. Any and all substantive modifications to the conditions and terms stated in this agreement shall be reduced to writing as amendments, numbered and signed by both principal parties to this agreement.

  3. PURPOSE AND SCOPE.

    1. The State shall provide consultation services, including training and education, whereby employers, particularly those with smaller businesses and with high hazard workplaces (as defined or approved by OSHA), receive assistance in:
      (1) Identifying any safety and health hazards in their workplaces.

      (2) Controlling or eliminating these hazards successfully.

      (3) Establishing or improving a workplace safety and health program.

      (4) Understanding all requirements of applicable Federal (or State) law and implementing regulations.
    2. The statewide project operated under this agreement shall conform fully with the requirements in the Code of Federal Regulations (29 CFR 1908), all related formal directives issued by the Assistant Secretary and the appendices attached to this agreement.

  4. REIMBURSEMENT.

    The Assistant Secretary will reimburse the State one hundred percent (100%) of the allowable costs of all OSHA required or approved training and out of state travel. All other allowable training costs, and related travel and per diem, will be reimbursed at ninety percent (90%). All such training, travel and per diem must be directly related to the activity performed under this agreement.

  5. ALLOCATION OF COSTS

    The Supporting Details of Anticipated Costs that itemizes the costs by category (Consultation and Administration) and object class shall be submitted with the application. The Supporting Details of Anticipated Costs should correspond to the information on the SF-424A. In order to ensure uniformity and comparability among agreement submissions, Consultation and Administration costs shall be determined and set forth as follows:

    1. Consultation. Consultation costs consist of all direct costs associated with the immediate delivery of consultative services to employers and employees. Costs include but are not limited to: the salaries and fringe benefits of On-site Consultation staff engaged in promotion, scheduling, visit preparation, hazard identification, program assistance, training and education, off-site assistance, report preparation, correction verification and similar authorized consultative activities; and related materials, supplies, equipment and staff training. They also include the consultation portion of total computer costs. (Computer costs should be distributed between consultation and administration in the proportion to which computer services support each function.) On-site consultation staff include safety consultants, health consultants, consultant trainees and consultant trainers who meet the minimum qualifications defined in 29 CFR 1908.8(b). Also included are costs of immediate first level consultant supervisors, except those costs associated with accompanied visit activity. Additionally, costs of direct clerical support to consultants and first-level consultant supervisors are charged to Consultation.

    2. Administration. Administrative costs consist of all direct costs associated with the management and support of the On-site Consultation program and all indirect costs. These costs include but are not limited to: the salaries and fringe benefits of personnel engaged in executive, fiscal, data collection, personnel, legal, audit, procurement, data processing, communications, maintenance and similar functions; and related materials, supplies, equipment and staff training. They also include the administration portion of total ADP costs. (ADP costs should be distributed between consultation and administration in the proportion to which ADP services support each function.) Additional administrative costs extend to the salaries and fringe benefits of direct program management positions such as project directors, program monitors and program review officers; and costs of direct clerical support to these positions. Indirect costs require an approved rate. The rate must be approved by the authorizing Federal agency and for the grant period covered by the application.

        Consultation Administration
      Positions Covered Safety consultant (S), safety consultant trainee (TS), safety supervisor (S/S), industrial hygiene consultant (H), industrial hygiene consultant trainee (TH), industrial hygiene supervisor (H/S) and direct clerical support (SEC) to these positions. Salaries of positions for management (MGT) and direct clerical support (SEC) to these positions.
      Personnel Salaries for positions listed in Consultation: Positions covered.

      For consultants and first level consultant supervisors who also serve in a managerial capacity for the project, salary costs shall be distributed between Administration and Consultation in proportion to the percent of time spent in performing (1) program management and (2) consultant and/or (3) consultant supervisory activities. Salaries reflecting (a) consultant time should be listed separately from salaries reflecting (b) time providing first level supervision to consultants and salaries of clerical staff that provide direct support to consultants and consultant supervisors.
      Salaries for positions listed in Administration: Positions covered.

      For management personnel who also serve as consultants and/or consultant supervisors, salary costs must be distributed between Administration and Consultation in proportion to the percentage of time spent in performing (1) program management, (2) consultant duties, and/or (3) supervision of consultants.
      Fringe Benefits Fringe Benefits for positions listed in Consultation: Positions covered.

      Costs include payments for retirement, Social Security, workers' compensation, life insurance, medical insurance, etc. Include the cost formula for each fringe benefit.

      For consultants and first level consultant supervisors who also serve in a managerial capacity for the project, fringe benefit costs shall be distributed between Administration and Consultation in proportion to the percent of time spent in performing (1) program management and (2) consultant and/or (3) consultant supervisory activities. Fringe benefits reflecting (a) consultant time should be listed separately from fringe benefits reflecting (b) time providing first-level supervision to consultants and fringe benefits of clerical staff that provide direct support to consultants and consultant supervisors.
      Fringe benefits for positions listed in Administration: Positions covered.

      Costs include payments for retirement, Social Security, workers' compensation, life insurance, medical insurance, etc. Include the cost formula for each fringe benefit.

      For management personnel who also serve as consultants and/or first level consultant supervisors, fringe benefit costs shall be distributed between Administration and Consultation in proportion to the percentage of time spent in performing (1) program management, (2) consultant duties, and/or (3) supervision of consultants.
      Certification Costs: Contact Henry Payne at Payne.Henry@dol.gov with questions regarding certification. For Consultants seeking professional certification in safety or health, Cooperative Agreement funds may be used to pay for the costs associated with a professional certification examination preparation course approved by the project manager, including travel and per diem. Additionally, if needed, a Project Manager may use Cooperative Agreement funds to pay for the costs associated with applying for and taking a professional certification examination, including travel and per diem.

      Project Managers may not use Cooperative Agreement funds to pay for costs associated with a second preparation course for those Consultants who fail on their first attempt at a professional certification examination. However, a Project Manager may use Cooperative Agreement funds to pay for the travel and/or per diem related to taking the professional certification examination a second time, and if needed, costs associated with taking of the professional certification examination a second time.

      For those Consultants who fail to pass a professional certification examination on their second attempt, a Project Manager may not use Cooperative Agreement funds to pay for any additional costs related to that employee seeking that specific professional certification.

      A Project Manager may not use Cooperative Agreement funds to pay for any costs associated with seeking professional certification from any certifying organization that is not accredited by a nationally recognized accrediting organization. Additionally, Project Administrators are not authorized to pay annual maintenance fees for maintaining professional certifications from Cooperative Agreement funds.

      Project Managers must use 90/10 funds for employee preparation or certification; the Cooperative Agreement cannot pay for certification costs that exceed the percent of time for which that employee is dedicated to the Cooperative Agreement. For example, if a safety professional is dedicated at 0.5 FTE, then no more than 50% of the cost of the examination preparation or examination fees may be charged to the Cooperative Agreement.
      For Project Managers seeking professional certification in safety or health, Cooperative Agreement funds may be used to pay for the costs associated with a professional certification examination preparation course approved by the employee’s supervisor, including travel and per diem. Additionally, if needed, Cooperative Agreement funds may be used to pay for the costs associated with applying for and taking a professional certification examination, including travel and per diem.

      Cooperative Agreement funds may not be used to pay for costs associated with a second preparation course for those Managers who fail on their first attempt at a professional certification examination. However, Cooperative Agreement funds may be used to pay for the travel and/ or per diem related to taking the professional certification examination a second time, and if needed, costs associated with taking of the professional certification examination a second time.

      For those Managers who fail to pass a professional certification examination on their second attempt, Cooperative Agreement funds may not be used to pay for any additional costs related to that employee seeking that specific professional certification.

      Cooperative Agreement funds may not be used to pay for any costs associated with seeking professional certification from any certifying organization that is not accredited by a nationally recognized accrediting organization. Additionally, Project Administrators are not authorized to pay annual maintenance fees for maintaining professional certifications from Cooperative Agreement funds.

      Projects must use 90/10 funds for Managerial preparation or certification; the Cooperative Agreement cannot pay for certification costs that exceed the percent of time for which that Manager is dedicated to the Cooperative Agreement. For example, if a Manager is dedicated at 0.5 FTE, then no more than 50% of the cost of the examination preparation or examination fees may be charged to the Cooperative Agreement.
      Travel Travel for positions listed in Consultation: Positions covered.

      Costs shall include travel required to conduct promotional visits, On-site Consultation visits, off-site assistance, travel to OTI courses, regional and national On-site Consultation Program meetings. Intra-agency travel, such as that related to flexi-place programs, must have prior approval from the Regional Administrator. Appropriate supporting details for out of state travel (per diem, airfare, registration fees, miscellaneous, etc.) must be reported in the Annual Training Plan. Deviations from this plan involving out of state travel to courses and/or locations other than those proposed must be approved in writing by the Regional Administrator prior to the actual travel. Travel for the purpose of performing accompanied visits shall be charged to Administration.

      Attendance at professional development conferences such as Voluntary Protection Program Participants’ Association (VPPPA), American Industrial Hygiene Association (AIHA), American Society of Safety Engineers (ASSE), and National Safety Council (NSC) are not considered OSHA-required training and, therefore, may not be funded with 100% Federal funds. A Project Manager may use cooperative agreement funds to provide an opportunity for each professional safety or health employee to attend a professional development conference of three-to-five days duration generally once every two years. However, the percentage of cooperative agreement funds used to pay for the individual’s attendance at such a conference may not exceed the percentage of time for which that employee is dedicated to the cooperative agreement. For example, if a safety professional is dedicated at 0.5 FTE, then no more than 50% of the cost of attending the conference may be charged to the cooperative agreement.

      Costs associated with attendance and travel to professional development conferences of individuals in positions that are not funded by the cooperative agreement may not be allocated to the cooperative agreement.

      See Administration for the Annual On-site Consultation Training Conference.
      Travel for positions listed in Administration: Positions covered and for all personnel conducting accompanied visits.

      Costs shall include travel required to attend safety and health conferences (subject to the restrictions in V.A.3., above), regional and national On-site Consultation program meetings and professional development/training courses. Appropriate supporting details for out of state travel (per diem, airfare, registration fees, miscellaneous, etc.) must be reported in the Annual Training Plan. Deviations from this plan involving out of state travel to courses and/or locations other than those proposed must be approved in writing by the Regional Administrator prior to the actual travel.

      Attendance at the Annual On-site Consultation Training Conference is required for all Project Managers, and to the extent that funds are available for the safety/ health supervisors and senior consultants. The conference is considered required Federal travel and, therefore, may be funded with 100% Federal funds. The cost of travel for all participants to the Annual On-site Consultation Training Conference must be charged to administration.
      Equipment Includes the costs of consultant technical equipment having a useful life of more than one year and a unit acquisition cost of $5,000 or more, except as defined in Special Provisions VI.B.

      All equipment so defined shall be listed in the Approved On-site Consultation Equipment Procurement Listing.
      Includes the costs of office equipment and machinery having a useful life of more than one year and a unit acquisition cost of $5,000 or more, except as defined in the Special Provisions VI.B.

      All equipment so defined shall be listed in the Approved On-site Consultation Equipment Procurement Listing.
      Supplies Includes the costs of all tangible consultant technical property and materials other than equipment as defined above. Please itemize and describe all supply costs. Includes the costs of all tangible office property and desktop materials other than equipment as defined in this section. Please itemize and describe all supply costs.
      Contracts Includes the costs of contracts with all sources, whether non state government, state government or private sources, for the provision of services associated with consultant field activities (e.g., occupational health consultation, laboratory sample analysis in states having a Plan approved under Section 18 of the Act, and consultant health monitoring and medical examinations). The detail for laboratory sample analysis costs shall include the number of samples projected for the fiscal year. Include the costs of contracts with all sources, whether non state government, state government or private sources, for the provision of administrative support services (e.g., service contracts for maintenance of office equipment, leasing of photocopiers, fiscal services, etc.).
      Other Includes the costs of equipment calibration and repair services for equipment which cannot be serviced by the OSHA Cincinnati Laboratory (list all equipment), non travel costs of required or approved training for consultants (limited to tuition fees, registration fees, textbooks, course materials, etc.) and costs of all other miscellaneous consultative items which are not allocated above. Miscellaneous costs include but are not limited to: the proportion of rent, utilities, communications, data processing, postage, freight, etc. associated with the delivery of consultative services by On-site Consultation staff; subscriptions to safety and health journals; and training aids, instructional programs and promotional materials which are used by consultants to perform On-site Consultation activities. Includes non travel costs of required or approved training for management personnel (limited to tuition fees, registration fees, textbooks, course materials, etc.) and costs of all other miscellaneous administrative items that are not allocated above. These costs include but are not limited to: the proportion of rent, utilities, communications, data processing, postage, freight, etc. associated with the management of the On-site Consultation program by administrative staff.
      Total Direct Charges The total of all of the costs for Consultation. The total of all of the costs for Administration.
      Indirect Charges N/A Includes charges based on an approved indirect cost rate agreement for the grant period.


  6. SPECIAL PROVISIONS.

    1. A listing of approved positions is contained in Appendix B – Exhibit VI, Staffing Chart for this agreement. Key personnel include project managers, supervisors, and consultants. Any changes in these positions must be approved by the Regional Administrator.

    2. Microcomputer equipment (hardware and software), regardless of unit cost, requires the written prior approval of DCSP and must be listed in Appendix B – Exhibit III, On-site Consultation Equipment Procurement Listing.

    3. Unless a State has made special provisions for such, substantive programmatic work may not be transferred to another agency (sub-recipient) under this agreement.

    4. Unless a State having a Plan approved under Section 18 of the Act has designated a State agency/facility for this purpose, the laboratory designated by OSHA to provide analysis of samples for all projects shall be:

      Wisconsin Occupational Health Laboratory
      2601 Agriculture Drive
      Madison, WI 53718
      Telephone 608-224-6210
      Fax 608-224-6213
      Contact: Mr. Terry Burk

    5. The Federal cost principles applicable to this project are:

      1. Cost Principles for State and Local Governments (OMB Circular A 87)

      2. Cost Principles for Educational Institutions (OMB Circular A 21)

    6. Financial reporting forms required of all projects and their frequency of submission are:

      1. Department of Health and Human Services - Payment Management System Federal Cash Transactions Report (PSC 272, PSC 272 A through E) is due in the Regional Office 30 days after the end of each Federal fiscal quarter. Recipients are to submit two signed copies of the report.

      2. Financial Status Report (SF-269) is due 30 days after the end of each Federal fiscal quarter with the close-out report due 90 days after the end of the performance period. All reports will be electronically submitted using the DOL E-Grants System to report the status of all funds awarded.

        (a) Quarterly Reporting. Recipients that have accounting systems which prohibit them from meeting the Office of Management and Budget (OMB) requirements on the submission of financial reports, as outlined in this section, must have written approval from the Regional Administrator to establish an alternative schedule for submission of financial reports. The approved state-specific schedule must also be submitted to the National Office for inclusion in the official file.

        (b) Close-out Reporting. All agreements must be closed 90 days after the end of the performance period (generally December 31) using the DOL E-Grants system for electronic transmittal.

        (c) Close-out Extensions. Recipients unable to close out by December 31 are required to request a close-out extension in writing by December 1, providing an explanation of why they cannot close out in a timely manner. An interim (preliminary) Financial Status Report (covering October - December) is due in the Regional Office on January 31, even when a close-out extension has been approved. All close-out extensions must be coordinated in advance with, and transmitted to, the National Office for inclusion in the official file, and any extensions beyond February 28 must be approved by the National Office.

      3. Cooperative Agreement (Form OSHA-110) must accompany the Application for Federal Assis¬tance (SF-424). This is the only time this form is completed.

      4. Other performance reports and copies of forms that may be required for program management purposes will be distributed as necessary.

    7. Unless different instructions are provided by the Director of Cooperative and State Programs or through the OSHA Directives system, all reports required under this agreement, and all requests for agreement modification, shall be delivered (or mailed) to the Regional Administrator.

    8. It is agreed that OSHA may unilaterally modify this agreement whenever necessary to conform to new regulations, new applications, or official interpretations of DOL or OMB regulations.

  7. ADDITIONAL SPECIAL PROVISIONS.

    The following special provisions are added to this agreement.

    1. Approval of this agreement is contingent upon Congressional action on the Department of Labor's appropriation for FY 2008.

    2. It is hereby certified by the State that matching state funds are or will be available during the tenure of this agreement.

    3. In no case shall the State be liable for more than 10 percent of actual expenditures (exclusive of one hundred percent [100%] Federal funds) under this agreement.

    4. Where appropriate, restrictions to the agreement may be added by the Assistant Secretary to ensure that the recipient fully complies with specific terms and condi¬tions of the Cooperative Agreement, DOL administrative requirements set forth at 29 CFR Parts 95 and 97 (Institutions of Higher Education), or provisions set forth in 29 CFR 1908. When an agreement is approved subject to the inclusion of one or more restrictions, it is hereby understood by the recipient that such approval is granted contingent upon meeting the conditions specified within the prescribed timeframe.

    5. Recipients shall prepare their agreement packages for the maximum amount they can match within the authorized amount. If a recipient is unable to match the authorized award, the award amount will be reduced to reflect the amount the recipient is able to match. These reductions will carry over into subsequent years. Additionally, cost-of-living increases will be based on executed award amounts, not proposed funding levels.

OPTIONAL INSERT(S) TO THE COOPERATIVE AGREEMENT

Below are formats for four "Additional Special Provisions" which, if appropriate, would be inserted in the agreement following paragraph VII.E.

Two provisions pertain to Items VI.C. and D. of the agreement:

Substantive programmatic work is being transferred to another agency (sub-recipient) under this agreement, as follows:
Scope of transfer:
Agency name:
Address:
Telephone number: (__)
Contact person:
As a State having a Plan approved under Section 18 of the Act, ____________ designates the following State laboratory to provide analysis of samples:
Agency name:
Address:
Telephone number: (__)
Contact person:
Estimated number of samples:
One provision pertains to paragraph V., "Allocation of Costs."

Allowable travel costs and per diem expenses related to travel, but not salaries or other costs, will be reimbursed to the State under the terms of this agreement when the following conditions are met:
q The travel is intended for the purposes of properly administering the agreement or furthering On-site Consultation operations.

q The travel was approved in the initial agreement or received the prior written approval of the Regional Administrator.

For some States, the following provision applies (insert "Safety" or "Health" as appropriate):

A. This agreement covers on-site consultation for_______only; a separate agreement between OSHA and the State will cover_______.

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL



TITLE



APPLICANT ORGANIZATION

DATE SUBMITTED





Appendix A – Exhibit IIa
(For use by all states except Connecticut, Kentucky, New Jersey, New York,
Puerto Rico, Virgin Islands and Washington)
Integrated 21(d) and 23(g) Assurances and Certifications
Non-Construction Programs




Note: Certain of these assurances may not be applicable to your project. If you have questions, please contact the awarding agency. Some Federal awarding agencies may require applicants to certify to additional assurances. If this is the case, you will be notified.

As the duly authorized representative of the applicant, I certify that the applicant:

  1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non Federal share of project costs) to ensure proper planning, management and completion of the project described in this application.

  2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives.

  3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest or personal gain.

  4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.

  5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C §§4728 4763) relating to prescribed standards for merit systems for programs funded under one of the nineteen statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 CFR 900, Subpart F).

  6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88 352), which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685 1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101 6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92 255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91 616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd 3 and 290 ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) Title VI of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d) and section 188 of the Workforce Investment Act of 1998 (P.L. 105-220), as it relates to the prohibition against national origin discrimination for persons with limited English proficiency (pursuant to Executive Order 13166 issued August 11, 2000); (j) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and (k) the requirements of any other nondiscrimination statute(s) which may apply to the application.

  7. Will comply with Executive Orders 12876, 12900, 12928, and 13021 by strongly encouraging contractors to provide subcontracting opportunities to Historically Black Colleges and Universities, Hispanic Serving Institutions, and Tribal Colleges and Universities.

  8. Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91 646), which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases.

  9. Will comply with the provisions of the Hatch Act (5 U.S.C. §§1501 1508 and 7324 7328), which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds.

  10. Will comply, as applicable, with the provisions of the Davis Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§327 333), regarding labor standards for federally assisted construction sub-agreements.

  11. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234), which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance, if the total cost of insurable construction and acquisition is $10,000 or more.

  12. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in flood plains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of Federal actions to State (Clean Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. §§7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93 523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93 205).

  13. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §§1271 et seq.), related to protecting components or potential components of the national wild and scenic rivers system.

  14. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. §§ 469a 1 et seq.).

  15. Will comply with P.L. 93 348, regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance.

  16. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89 544, as amended, 7 U.S.C. §§2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance.

  17. Will comply with the Lead Based Paint Poisoning Prevention Act (42 U.S.C. §§4801 et seq.), which prohibits the use of lead-based paint in construction or rehabilitation of residence structures.

  18. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, "Audits of States, Local Governments, and Non-Profit Organizations."

  19. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this program.

  20. In accordance with Section 516 of the 1989 Department of Labor Appropriation Act, agrees that when issuing statements, press releases, requests for proposals, bid solicitations or other documents describing the grant project or program shall clearly state: (1) the percentage of the total costs of the program or project which will be or is being financed with Federal money; and (2) the dollar amount of Federal funds for the project or program.

  21. In accordance with the Drug Free Workplace Act of 1988, certifies that it will provide a drug free workplace by:

    (a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, pos¬session, 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 a 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 statement required by paragraph (a);

    (d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will --
    (1) Abide by the terms of the statement; and
    (2) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction;
    (e) Notifying the agency within ten days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction;

    (f) Taking one of the following actions, within 30 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; or
    (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency;
    (g) Making a good faith effort to continue to maintain a drug free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f).

    Lobbying Certification

  22. The undersigned certifies, to the best of his or her knowledge and belief, that;

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

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

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

    This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each failure.

    (d) Section 18 of the Lobbying Disclosure Act of 1995, signed by the President on December 19, 1995, requires that any organization described in section 501(c)(4) of the Internal Revenue Code of 1986 which engages in lobbying activities shall not be eligible for the receipt of Federal funds constituting an award, grant or loan.

    (1) This is to certify that we are____/are not____ an IRS 501(c)(4) entity.

    (2) As an IRS (501(c) (4)) entity, we have____/have not____ engaged in lobbying activities.

21(d) OSHA Restrictions and Conditions

As the duly authorized representative of the applicant, I certify that the applicant:

  1. Takes responsibility for encouraging employers to request consultative assistance and shall publicize the availability of its consultative service and the scope of the service that will be provided.

  2. Explains to employers that the employer receiving On-site Consultation program services remains under statutory obligation to provide safe and healthful working conditions to their employees.

  3. Explains to employers that no referrals will be made to OSHA enforcement unless the employer fails to eliminate a serious hazard identified by a consultant.

  4. Explains to the employer the requirements for participation in the Safety and Health Achievement Recognition Program (SHARP).

  5. Explains to employers requirements for attainment of Pre-SHARP status.

  6. Assigns priority in scheduling to requests from businesses with the most hazardous operations, with primary attention to smaller businesses. Preference is given to the smaller businesses that are in high hazard industries or that have the most hazardous conditions at issue in the request.

  7. Prepares appropriately for visits including making the appropriate provisions for the personal safety and health of the consultant(s) conducting the visit or activity.

  8. Conducts a hazard survey consisting of an opening conference, an examination of those aspects of the employer's safety and health program that relate to the scope of the visit, a walk-through the workplace, and a closing conference.

  9. Retains the right to confer with employees during an on-site visit.

  10. During the opening conference, explains the relationship between On-site Consultation and enforcement and also explains the employer's obligation to protect employees if certain hazardous conditions are identified.

  11. Focuses on-site activity primarily on those areas, conditions, or hazards within the requested scope of the visit.

  12. During on-site activity, advises the employer of the employer's obligations and responsibilities under applicable Federal or State law and implementing regulations.

  13. When identifying hazards, indicates to the employer, using the consultant's best judgment, whether the situation would be classified as a serious or other-than-serious hazard.

  14. Informs the employer that the employer is obligated to take immediate action to eliminate employee exposure to a hazard that in the best judgment of the consultant, poses an imminent danger.

  15. Establishes a time frame for the correction of each serious hazard identified during on-site activity, and provides the employer with a "List of Hazards", and advises the employer to post the "List" until the hazard is corrected or for three days, whichever is longer.

  16. Ensures that employers granted extensions for the correction of serious hazards, demonstrate having made a good faith effort to correct the hazard within the established time frame; show evidence that correction has not been completed because of factors beyond the employer's control; and show evidence that the employer is taking all available interim steps to safeguard the employees against the hazard(s) during the correction period.

  17. Informs the employer that the employer's failure to correct an identified serious hazard within the established time frame (or extension of the time frame) results in notification of the appropriate OSHA enforcement authority.

  18. Ensures that the appropriate OSHA enforcement authority is notified, if an employer fails to take the action necessary to correct a serious hazard within the established time frame or any extensions granted.

  19. Prepares and sends to the employer a written report containing substantive findings or recommendations

  20. Preserves the confidentiality of information which identifies employers who have requested the services of the On-site Consultation Program as well as information pertaining to and/ or obtained during an on-site visit, such as the employers written report.

  21. Preserves the confidentiality of information pertaining to commercial or trade secrets that may have been obtained during an on-site visit.

  22. Conducts consultative activity independently of any OSHA enforcement activity.

  23. Does not provide to OSHA the identity of, or files pertaining to, employers requesting On-site Consultation program services for any compliance inspection or scheduling activity, except in cases where the employer has failed to eliminate an imminent danger, failed to correct or eliminate a serious hazard, or the employer has elected to participate in SHARP or a cooperative program that permits a deferral from enforcement inspections.

  24. Assures that On-site Consultation visits already in progress have priority over OSHA compliance inspections except in the case of imminent dangers, fatality/catastrophe investigations, complaint investigations, or other investigations deemed critical by the Assistant Secretary.

  25. Terminates on-site visits for imminent dangers, fatality/catastrophe investigations, complaint investigations, or other investigations deemed critical by the Assistant Secretary.

  26. Does not conduct On-site Consultation visits while OSHA enforcement inspections are in progress. On-site Consultation activity shall only take place with regard to those citation items which have become final orders.

  27. Explains to the employer that requirements pertaining to "serious" hazards apply equally to "other than serious" hazards for participation in SHARP.

  28. Uses consultants who are employees of the State and are qualified under State requirements for employment in the field of occupational safety and health.

  29. Applies minimum requirements for consultants that include the ability to recognize hazards and assess employee exposure and risk, knowledge of OSHA standards, knowledge of hazard correction techniques and practices, knowledge of workplace safety and health program requirements, skill in effective written and oral communication, and any additional degrees or experience required by the Assistant Secretary.

  30. Maintains an organized system for monitoring the performance of consultants.

  31. Submits narrative reports and compiles and submits data, such as IMIS data, that is needed for monitoring and evaluation purposes, as required, to the Regional Administrator.

  32. Agrees to pay OSHA for mainframe processing services provided through the Integrated Management Information System (IMIS), based on quarterly bills. The fourth quarter payment will be based on an estimated bill. All bills must be paid upon receipt but no later than September 15th. Any adjustments between actual charges and estimates will be made in the first quarter of the following fiscal year, as necessary.

  33. If participating in OSHANet, agrees to adhere to all requirements for such participation (including hardware and software specifications) and to pay OSHA for certain services provided, including telecommunication charges, an annual service fee for operation and maintenance costs, and annual user fees for remote access. (For items billed quarterly, the fourth quarter payment will be based on an estimated bill. All bills must be paid upon receipt no later than September 15th. Any adjustments between actual charges and estimates will be made in the first quarter of the following fiscal year, as necessary.)

  34. If not participating in OSHANet, agrees to consult with the Directorate of Information Technology, and obtain written approval from DCSP, prior to expending Federal or State matching funds for the purchase of any data processing/computer equipment or software that will be used to connect (locally or remotely) to or provide information to OSHA. Desktop or laptop computers and software that will be used to access OSHA systems including the CSHO and On-site consultation PC and other applications, etc., must meet the minimum OSHA specifications. Specifications will be posted under the IT Help Desk on the Limited Access Page.

  35. Agrees that all new desktop and laptop computers must be Microsoft (MS) Vista-ready but have MS Windows XP Professional operating system installed.

  36. Agrees that all desktops and laptops that connect to the OSHANet must be configured with the OSHA image. Software that is not part of the OSHA standard image must be approved by the Directorate of Information Technology prior to purchase and once received must be approved for installation

  37. Agrees that all OSHA system users will complete the Department of Labor Annual Computer Security Awareness Training (CSAT) within the timeframe prescribed by the Directorate of information Technology.

  38. Agrees that all users of the OSHANet and other OSHA applications will sign annual Rules of Behavior.

  39. Understands that all desktops, laptops and servers connected to the OSHANet are subject to an annual software audit to ensure compliance with Executive Order 13103, "computer Software Piracy," the U.S. Copyright Act, title 17 U.S.C., Department of Labor software management and acceptable use policy, and vendor software license agreements.

  40. Understands that no section 21(d) or matching State funds may be expended for the purchase of internal peripherals or other modifications, except replacement parts, in conjunction with the NCR equipment, without prior approval from the Directorate of Information Technology. States must maintain an appropriate maintenance and repair contract for their NCR equipment.

  41. Will not expend any 21(d) or matching state funds from this agreement to fund activities or provide services to farms with ten or fewer employees where there has been no temporary labor camp in the previous twelve months. (Only State Plan states may conduct visits on these farms, provided that 100% state funds are used, and the state has an accounting system in place to assure that no section 21(d) or matching funds are expended on these activities.)

  42. Will not expend any 21(d) or matching State funds from this agreement to fund the purchase of equipment and/or to support programmatic efforts under the jurisdiction of and/or funded by another Federal agency.

  43. Will ensure that any funding provided by another Federal agency related to safety and health training and/or equipment will not undermine 21(d) On-site Consultation activity.

  44. States are encouraged to promote safety or health professional certification of their employees by a nationally recognized accrediting organization. Cooperative Agreement funds may be used to pay for the costs associated with a professional certification preparation course and the examination, including travel and per diem. No section 21(d) or matching State funds may be expended for costs associated with a second or subsequent attempt to obtain certification by employees who fail on their first attempt, except for the cost of the examination itself and related travel and/or per diem for a second attempt only. Certification costs cannot exceed the percentage of time for which an employee is dedicated to the grant/cooperative agreement.

  45. No 21(d) or matching State funds may be expended for annual fees associated with maintaining professional certifications.

  46. States agree to pay OSHA for costs associated with the conduct of OSHA Training Institute (OTI) training courses conducted for the State at the State's request. The State will pay for travel and per diem for OTI instructors, shipping charges, consultant trainer fees, equipment rental and training facility rental. All bills must be paid upon receipt but no later than September 15th. Any adjustments between actual charges and estimates will be made in the first quarter of the following fiscal year, as necessary.

23(g) OSHA RESTRICTIONS AND CONDITIONS

A number of restrictions and conditions are applicable to all grantees and are made a part of these assurances and certifications by the Occupational Safety and Health Administration (OSHA). These include program elements mandated by the Occupational Safety and Health Act of 1970 as amended and implementing regulations that are not addressed through other available monitoring and reporting mechanisms, and a number of other restrictions:

  1. The grantee assures that the following mandated program elements are and will continue to be implemented in accordance with all statutory and regulatory requirements: (1) prohibition against advance notice of inspection; (2) employee access to hazard and exposure information; (3) safeguards to protect an employer's trade secrets; (4) employer recordkeeping; (5) legal procedures for compulsory process and right of entry; (6) posting of employee protections and rights; (7) right of an employee representative to participate in walk-around; (8) right of an employee to review a decision not to inspect (following a complaint) and; (9) voluntary compliance programs.

  2. The grantee agrees to pay OSHA for mainframe processing services and telecommunication services provided through the Integrated Management Information System (IMIS), based on quarterly bills. The fourth quarter payment will be based on an estimated bill. All bills must be paid upon receipt but no later than September 15th. Any adjustments between actual charges and estimates will be made in the first quarter of the following fiscal year, as necessary.

  3. State recipients who participate in OSHANet agree to adhere to all requirements for such participation (including hardware and software specifications) and to pay OSHA for certain services provided, including telecommunication charges, an annual service fee for operation and maintenance costs, and annual user fees for remote access. (For items billed quarterly, the fourth quarter payment will be based on an estimated bill. All bills must be paid upon receipt but no later than September 15th. Any adjustments between actual charges and estimates will be made in the first quarter of the following fiscal year, as necessary.)

  4. All desktops, laptops and servers on the OSHANet are subject to an annual software audit to ensure compliance with Executive Order 13103, "Computer Software Piracy," the U.S. Copyright Act, Title 17 of the U.S. Code, Department of Labor software management and acceptable use policy, and vendor software license agreements.

  5. All desktops and laptops that connect to the OSHANet must be configured with the OSHA image. Software that is not part of the OSHA standard image must be pre-approved prior to purchase; once approved and received, it must be approved for installation.

  6. State recipients not participating in OSHANet are encouraged to consult with the Directorate of Information Technology prior to expending Federal or State matching funds for the purchase of any data processing/computer equipment or software that will be used to connect to (locally or remotely) or provide information to OSHA. Desktop or laptop computers and software that will be used to access OSHA systems, including the CSHO and On-site Consultation PC Applications, Whistleblower application, new web-based applications as deployed, etc., must meet the minimum OSHA specifications and use the Windows XP Professional operating system. (Although the Windows 98 version of the stand-alone application will continue to run, no further releases or upgrades will be made, and Microsoft itself discontinued support of Windows 98 as of September 30, 2004.) Specifications will be posted under the IT Help Desk on the Limited Access Page.

  7. All new desktop and laptop computers must be Microsoft (MS) Vista-ready but have Windows XP Professional installed as the operating system.

  8. All OSHA system users must complete the Department of Labor Annual Computer Security Awareness Training (CSAT) within the timeframe required by the Directorate of Information Technology.

  9. All users of the OSHANet and other OSHA applications must sign annual Rules of Behavior.

  10. No section 23(g) grant or matching State funds may be expended for the purchase of internal peripherals or other modifications, except replacement parts, in conjunction with the NCR equipment without prior approval from the Directorate of Information Technology. States must maintain an appropriate maintenance and repair contract for their NCR equipment.

  11. No section 23(g) grant or matching State funds may be expended for the development or operation of a substitute/alternative or supplemental IMIS system unless it provides all data required by OSHA and the OSHA IMIS and its successor, in a timely manner and in an acceptable electronic format. Any State developing an alternative or supplemental system must continue to provide data to OSHA that are identical to that required by the Federal Information System and that are submitted in the same manner and to the same extent as though continuing to participate in the Federal system. Data must be timely submitted through download into IMIS and must be provided in a format that meets OSHA's current as well as any future requirements. There may be no interruption in submission of data to OSHA during the development of such alternative or supplemental systems.

  12. No section 23(g) grant or matching State funds may be expended for programs coming within the jurisdiction of and/or funded by another Federal agency, whether or not the Federal program is administered by the designated State Plan agency.

  13. OSHA reserves the right to transfer title to equipment acquired under this agreement with a unit cost of $5,000 or more.

  14. The grantee agrees to pay OSHA for industrial hygiene sample analysis services provided by the Salt Lake Technical Center (SLTC) laboratory. Any State using the SLTC as its primary analytical laboratory must have a signed Memorandum of Agreement on file. The fourth quarter payment will be based on an estimated bill. All bills must be paid upon receipt but no later than September 15th. Any adjustments between actual charges and estimates will be made in the first quarter of the following fiscal year, as necessary.

  15. The grantee agrees to pay OSHA for costs associated with the conduct of OSHA Training Institute (OTI) training courses conducted for the grantee at the grantee's request. The grantee will pay for travel and per diem for OTI instructors, shipping charges, consultant trainer fees, equipment rental and training facility rental. All bills must be paid upon receipt but no later than September 15th. Any adjustments between actual charges and estimates will be made in the first quarter of the following fiscal year, as necessary.

  16. No section 23(g) or matching state funds may be expended for activities prohibited under OSHA's Appropriation Riders. One hundred percent (100%) State funds only must be used if the State chooses to perform prohibited activities; an accounting mechanism must be in place to assure that no section 23(g) or matching State funds are expended on these activities. (Any State using 100% State funds for such prohibited activities must appropriately utilize available IMIS coding to reflect this.)

  17. States are encouraged to promote safety or health professional certification of their employees by a nationally recognized accrediting organization. State Plan Grant funds may be used to pay for the costs associated with a professional certification preparation course and the examination, including travel and per diem. No section 23(g) or matching State funds may be expended for costs associated with a second or subsequent attempt to obtain certification by employees who fail on their first attempt, except for the cost of the examination itself and related travel and/or per diem for a second attempt only. Certification costs cannot exceed the percentage of time for which an employee is dedicated to the grant.

  18. No 23(g) or matching State funds may be expended for annual fees associated with maintaining professional certifications.

Note: The Restrictions and Conditions related to Information Technology Issues may be further modified prior to the time of grant submission. Updated information will be provided.

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL



TITLE



APPLICANT ORGANIZATION

DATE SUBMITTED




Note: Signature by official with signatory authority for both 21(d) and 23(g) programs applies to assurances and certifications, lobbying restrictions and 21(d) and 23(g) Occupational Safety and Health Administration restrictions and conditions.

Appendix A – Exhibit IIb
(For use by Connecticut, Kentucky, New Jersey, New York, Puerto Rico,
Virgin Islands and Washington)

23(g) Assurances and Certifications
Non-Construction Programs




Note: Certain of these assurances may not be applicable to your project. If you have questions, please contact the awarding agency. Some Federal awarding agencies may require applicants to certify to additional assurances. If this is the case, you will be notified.

As the duly authorized representative of the applicant, I certify that the applicant:

  1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non Federal share of project costs) to ensure proper planning, management and com¬pletion of the project described in this application.

  2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives.

  3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest or personal gain.

  4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.

  5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C §§4728 4763) relating to prescribed standards for merit systems for programs funded under one of the nineteen statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 CFR 900, Subpart F).

  6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88 352), which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685 1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101 6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L.92 255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91 616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd 3 and 290 ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) Title VI of the Civil Rights Act of 1964 (42 U.S.C. §§2000d) and section 188 of the Workforce Investment Act of 1998 (P.L. 105-220), as it relates to the prohibition against national origin discrimination for persons with limited English proficiency (pursuant to Executive Order 13166 issued August 11, 2000); (j) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and (k) the requirements of any other nondiscrimination statute(s) which may apply to the application.

  7. Will comply with Executive orders 12876, 12900, 12928, and 13021 by strongly encouraging contractors to provide subcontracting opportunities to Historically Black Colleges and Universities, Hispanic Serving Institutions, and Tribal Colleges and Universities.

  8. Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91 646), which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases.

  9. Will comply with the provisions of the Hatch Act (5 U.S.C. §§1501 1508 and 7324 7328), which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds.

  10. Will comply, as applicable, with the provisions of the Davis Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§327 333), regarding labor standards for federally assisted construction sub-agreements.

  11. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234), which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.

  12. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in flood plains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of Federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. §§7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93 523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93 205).

  13. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §§1271 et seq.), related to protecting components or potential components of the national wild and scenic rivers system.

  14. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. §§469a 1 et seq.).

  15. Will comply with P.L. 93 348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance.

  16. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89 544, as amended, 7 U.S.C. §§2131 et seq.) pertaining to the care, handling, and treatment of warm-blooded animals held for research, teaching, or other activities supported by this award of assistance.

  17. Will comply with the Lead Based Paint Poisoning Prevention Act (42 U.S.C. §§4801 et seq.), which prohibits the use of lead-based paint in construction or rehabilitation of residence structures.

  18. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, "Audits of States, Local Governments, and Non-Profit Organizations."

  19. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this program.

  20. In accordance with Section 516 of the 1989 Department of Labor Appropriation Act, the grantee agrees that when issuing statements, press releases, requests for proposals, bid solicitations or other documents describing the grant project or program the grantee shall clearly state: (1) the percentage of the total costs of the program or project which will be or is being financed with Federal money; and (2) the dollar amount of Federal funds for the project or program.

  21. In accordance with the Drug Free Workplace Act of 1988, the grantee certifies that it will provide a drug free workplace by:

    (a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, pos¬session, 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 a 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 statement required by paragraph (a);

    (d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will --
    (1) Abide by the terms of the statement; and
    (2) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction;
    (e) Notifying the agency within ten days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction;

    (f) Taking one of the following actions, within 30 days of receiving notice under subparagraph (d) (2), with respect to any employee who is so convicted --
    Taking appropriate personnel action against such an employee, up to and including termination; or

    Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency;
    (g) Making a good faith effort to continue to maintain a drug free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f).

    Lobbying Certification

  22. The undersigned certifies, to the best of his or her knowledge and belief, that;

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

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

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

    This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each failure.

    (d) Section 18 of the Lobbying Disclosure Act of 1995, signed by the President on December 19, 1995, requires that any organization described in section 501(c)(4) of the Internal Revenue Code of 1986 which engages in lobbying activities shall not be eligible for the receipt of Federal funds constituting an award, grant or loan.

    (1) This is to certify that we are____/are not____ an IRS 501(c) (4) entity.

    (2) As an IRS 501(c) (4) entity, we have____/have not____ engaged in lobbying activities.

23(g) OSHA RESTRICTIONS AND CONDITIONS

A number of restrictions and conditions are applicable to all grantees and are made a part of these assurances and certifications by the Occupational Safety and Health Administration (OSHA). These include program elements mandated by the Occupational Safety and Health Act of 1970 as amended and implementing regulations that are not addressed through other available monitoring and reporting mechanisms, and a number of other restrictions:

  1. The grantee assures that the following mandated program elements are and will continue to be implemented in accordance with all statutory and regulatory requirements: (1) prohibition against advance notice of inspection; (2) employee access to hazard and exposure information; (3) safeguards to protect an employer's trade secrets; (4) employer recordkeeping; (5) legal procedures for compulsory process and right of entry; (6) posting of employee protections and rights; (7) right of an employee representative to participate in walk-around; (8) right of an employee to review a decision not to inspect (following a complaint) and; (9) voluntary compliance programs.

  2. The grantee agrees to pay OSHA for mainframe processing services and telecommunication services provided through the Integrated Management Information System (IMIS), based on quarterly bills. The fourth quarter payment will be based on an estimated bill. All bills must be paid upon receipt but no later than September 15th. Any adjustments between actual charges and estimates will be made in the first quarter of the following fiscal year, as necessary.

  3. State recipients who participate in OSHANet agree to adhere to all requirements for such participation (including hardware and software specifications) and to pay OSHA for certain services provided, including telecommunication charges, an annual service fee for operation and maintenance costs, and annual user fees for remote access. (For items billed quarterly, the fourth quarter payment will be based on an estimated bill. All bills must be paid upon receipt but no later than September 15th. Any adjustments between actual charges and estimates will be made in the first quarter of the following fiscal year, as necessary.)

  4. All desktops, laptops and servers on the OSHANet are subject to an annual software audit to ensure compliance with Executive Order 13103, "Computer Software Piracy," the U.S. Copyright Act, Title 17 of the U.S. Code, Department of Labor software management and acceptable use policy, and vendor software license agreements.

  5. All desktops and laptops that connect to the OSHANet must be configured with the OSHA image. Software that is not part of the OSHA standard image must be pre-approved prior to purchase; once approved and received, it must be approved for installation.

  6. State recipients not participating in OSHANet are encouraged to consult with the Directorate of Information Technology prior to expending Federal or State matching funds for the purchase of any data processing/computer equipment or software that will be used to connect to (locally or remotely) or provide information to OSHA. Desktop or laptop computers and software that will be used to access OSHA systems, including the CSHO and On-site Consultation PC Applications, Whistleblower application, new web-based applications as deployed, etc., must meet the minimum OSHA specifications and use the Windows XP Professional operating system. (Although the Windows 98 version of the stand-alone application will continue to run, no further releases or upgrades will be made, and Microsoft itself discontinued support of Windows 98 as of September 30, 2004.) Specifications will be posted under the IT Help Desk on the Limited Access Page.

  7. All new desktop and laptop computers must be Microsoft (MS) Vista-ready but have Windows XP Professional installed as the operating system.

  8. All OSHA system users must complete the Department of Labor Annual Computer Security Awareness Training (CSAT) within the timeframe required by the Directorate of Information Technology (DIT).

  9. All users of the OSHANet and other OSHA applications must sign annual Rules of Behavior.

  10. No section 23(g) grant or matching State funds may be expended for the purchase of internal peripherals or other modifications, except replacement parts, in conjunction with the NCR equipment without prior approval from the Directorate of Information Technology. States must maintain an appropriate maintenance and repair contract for their NCR equipment.

  11. No section 23(g) grant or matching State funds may be expended for the development or operation of a substitute/alternative or supplemental IMIS system unless it provides all data required by OSHA and the OSHA IMIS and its successor, in a timely manner and in an acceptable electronic format. Any State developing an alternative or supplemental system must continue to provide data to OSHA that are identical to that required by the Federal Information System and that are submitted in the same manner and to the same extent as though continuing to participate in the Federal system. Data must be timely submitted through download into IMIS and must be provided in a format that meets OSHA's current as well as any future requirements. There may be no interruption in submission of data to OSHA during the development of such alternative or supplemental systems.

  12. No section 23(g) grant or matching State funds may be expended for programs coming within the jurisdiction of and/or funded by another Federal agency, whether or not the Federal program is administered by the designated State Plan agency.

  13. OSHA reserves the right to transfer title to equipment acquired under this agreement with a unit cost of $5,000 or more.

  14. The grantee agrees to pay OSHA for industrial hygiene sample analysis services provided by the Salt Lake Technical Center (SLTC) laboratory. Any State using the SLTC as its primary analytical laboratory must have a signed Memorandum of Agreement on file. The fourth quarter payment will be based on an estimated bill. All bills must be paid upon receipt but no later than September 15th. Any adjustments between actual charges and estimates will be made in the first quarter of the following fiscal year, as necessary.

  15. The grantee agrees to pay OSHA for costs associated with the conduct of OSHA Training Institute (OTI) training courses conducted for the grantee at the grantee's request. The grantee will pay for travel and per diem for OTI instructors, shipping charges, consultant trainer fees, equipment rental and training facility rental. All bills must be paid upon receipt but no later than September 15th. Any adjustments between actual charges and estimates will be made in the first quarter of the following fiscal year, as necessary.

  16. No section 23(g) or matching state funds may be expended for activities prohibited under OSHA's Appropriation Riders. One hundred percent (100%) State funds only must be used if the State chooses to perform prohibited activities; an accounting mechanism must be in place to assure that no section 23(g) or matching State funds are expended on these activities. (Any State using 100% State funds for such prohibited activities must appropriately utilize available IMIS coding to reflect this.)

  17. States are encouraged to promote safety or health professional certification of their employees by a nationally recognized accrediting organization. State Plan Grant funds may be used to pay for the costs associated with a professional certification preparation course and the examination, including travel and per diem. No section 23(g) or matching State funds may be expended for costs associated with a second or subsequent attempt to obtain certification by employees who fail on their first attempt, except for the cost of the examination itself and related travel and/or per diem for a second attempt only. Certification costs cannot exceed the percentage of time for which an employee is dedicated to the grant.

  18. No 23(g) or matching State funds may be expended for annual fees associated with maintaining professional certifications.

Note: The Restrictions and Conditions related to Information Technology Issues may be further modified prior to the time of grant submission. Updated information will be provided.

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL



TITLE



APPLICANT ORGANIZATION

DATE SUBMITTED




Note: Signature by official with signatory authority for 23(g) programs applies to assurances and certifications, lobbying restrictions and 23(g) Occupational Safety and Health Administration restrictions and conditions.

Appendix A – Exhibit IIIa
U.S. DEPARTMENT OF LABOR

Occupational Safety and Health Administration

COOPERATIVE
AGREEMENT

OSHA 21(d) CONSULTATION
PROGRAM
(1) Page 1 of 1
Region: ________________________
State: ________________________
Grantee: ________________________
Grant Number: E9F8-_________________
Starting Date: October 1, 2007
Ending Date: September 30, 2008
(2) Recipient

Name:

Address:

_________________________________________
Recipient Liaison Representative _________________________________________
Area Code and Telephone Number
(3) U.S. Department of Labor





_________________________________________
OSHA Liaison Representative _________________________________________
Area Code and Telephone Number
(4) Authorized under P.L. 105-197, under Section 21(d)
Percent Total Funds
(Nearest 0.1%)
1. Federal Base Award Amount: _________________________ ____.____%
2.  100% Federal Funds for Travel and Training:
(Please include in line 1)
_________________________  
3.  Total Recipient Share: _________________________ ____.____%
4.  Recipient 100% Funding:
(Please include in line 3)
_________________________  
5. Total State and Federal Funds Allocated to This Agreement
(Line 1 plus Line 3)
_________________________  
Terms and Conditions of the Cooperative Agreement
This COOPERATIVE AGREEMENT consists of the entire application,
Including all attachments, exhibits, enclosures, etc.
 
(5) Recipient Approval

(6) Federal Approval

Signature                                   Date _________________________________________
Type Name and Title
Signature                                   Date _________________________________________
Administrative Programs
    Form OSHA 110
Revised February 2001


Appendix A – Exhibit IIIb

U.S. DEPARTMENT OF LABOR
Occupational Safety and Health Administration

GRANT
AGREEMENT

OSHA 23(g) OPERATIONAL
PROGRAM

Page 1 of 1

(1) Region:
State:
Grantee:
Grant Number:
Starting Date:
Ending Date:
_________________
_________________
_________________
60F8-00__________
_October 1, 2007_
_September 30, 2008_
(2) Recipient
Name:
Address:

________________________________
Recipient Liaison Representative
_______________________________
Area Code and Telephone Number
(3) U.S. Department of Labor



________________________________
OSHA Liaison Representative
_______________________________
Area Code and Telephone Number
(4) Authority for Grant: P.L. 91-596, under Section 23(g)
 
1. Federal Base Award Amount:

2. State Base Award Amount:
(please do not include 100% funding)

3. Total Recipient Share:

4. Recipient 100% Funding:
(please also include in line 3)

5. Total State and Federal Funds
Allocated to This Agreement:
(line 1 plus line 3)

________________



________________

________________


________________



________________

Pct. Total Funds
50%

50%
 

  Terms and Conditions of the Grant:
This GRANT AGREEMENT consists of the entire grant
application, including all attachments, exhibits, enclosures, etc.
 
(5) Recipient Approval



(6) Federal Approval



Signature                                                Date
____________________________
Type Name and Title
                                                                    Date
Administrative Programs
Form OSHA 110       



APPENDIX A – Exhibit IV

Application for Federal Assistance and Budget Information - Non-Construction Programs
(SF-424 and SF-424A)

Forms SF-424 and SF-424A are available on the OMB website, accessible at:
http://www.whitehouse.gov/omb/grants/sf424.pdf

http://www.whitehouse.gov/omb/grants/sf424a.pdf
Please note that the Application for Federal Assistance (SF-424) has been revised to comply with Federal Register Notice [68 FR 38402]. Agreement applications will not be considered complete without providing the information requested in the revised SF-424.



Appendix A – Exhibit V
23(g) Financial Guidelines

Administrative Requirements
The administrative requirements for the State Plan 23(g) are contained in the Uniform Administrative Requirements for Grants and Cooperative Agreements with State and Local Governments (OMB Circular A-102) that has been codified in the Code of Federal Regulations for the Department of Labor – 29 CFR 97. The website is: http://www.dol.gov/dol/allcfr/Title_29/Part_97/toc.htm.

Cost Principles
The cost principles applicable to 23(g) grants are in OMB Circular A-87, Cost Principles for State and Local Governments (Website: http://www.whitehouse.gov/omb/circulars/a087/a087-all.html).

Financial Reports
The following financial reports are required.

Department of Health and Human Services – Payment Management System Federal Cash Transactions Report (PSC 272, PSC 272A through E) is due in the Regional Office 30 days after the end of each Federal fiscal quarter. Recipients are to submit two signed copies of the report.

Financial Status Report (SF-269) is due 30 days after the end of each Federal fiscal quarter with the close-out report due 90 days after the end of the performance period. All reports will be electronically submitted using the DOL E-Grants System to report the status of all funds awarded.
Note: Recipients that have accounting systems that prohibit them from meeting the Office of Management and Budget (OMB) requirements on the submission of financial reports, as outlined in this section, must have written approval from the Regional Administrator to establish an alternative schedule for submission of financial reports. The approved State-specific schedule must also be submitted to the National Office for inclusion in the official file.
Close-out Reporting – All agreements must be closed 90 days after the end of the performance period (generally December 31) using the DOL E-Grants system for electronic transmittal.

Close-out Extensions – Recipients unable to close out by December 31 are required to request a close-out extension from the Regional Office in writing by December 1, providing an explanation of why they cannot close out in a timely manner. An interim (preliminary) Financial Status Report (covering October-December) is due in the Regional Office on January 31, even when a close-out extension has been approved. All close-out extensions must be coordinated in advance with, and transmitted to, the National Office for inclusion in the official file, and any extensions beyond February 28 must be approved by the National Office.






APPENDIX B – Exhibit I
Projected Program Activities – 21(d) On-site Consultation
Year One


Area of Emphasis


Total Visits1

Combined
Totals By
Goal


Recognition2


Exemption3
Recognition and Exemption4

(Equivalent to SHARP)
Pre-Recognition and
Exemption Programs

Other Non-Visit
Related Activities
5
  Safety Health   New Renewal New Renewal New Renewal    
Area of Emphasis                      
Area of Emphasis                      
Area of Emphasis                      
Area of Emphasis                      
Area of Emphasis                      
Local Emphasis Program                      
Other Visits                      
Total by Safety or Health                      
Combined Safety and Health Activities              
---------------------------------
1Enter the total number of visits to include initial, training and assistance, and follow-up.
2Enter the number of projected new and renewal Recognition only sites separately in this column.
3Enter the number of projected new and renewal Exemption only sites separately in this column.
4Enter the number of projected new and renewal Exemption and Recognition only sites separately in this column. (Equivalent to SHARP)
5Activities reflected in this column must be entered on the Intervention Form (Form 66), so that they can be captured in the IMIS. States working with Small Business Development Centers should record activities on this worksheet and on the Intervention Form in order to get credit when the funding formula is calculated.


APPENDIX B – Exhibit I
Projected Program Activities – 21(d) On-site Consultation
Year Two


Area of Emphasis


Total Visits1

Combined
Totals By
Goal


Recognition2


Exemption3
Recognition and Exemption4

(Equivalent to SHARP)
Pre-Recognition and
Exemption Programs

Other Non-Visit
Related Activities
5
  Safety Health   New Renewal New Renewal New Renewal    
Area of Emphasis                      
Area of Emphasis                      
Area of Emphasis                      
Area of Emphasis                      
Area of Emphasis                      
Local Emphasis Program                      
Other Visits                      
Total by Safety or Health                      
Combined Safety and Health Activities              
---------------------------------
1Enter the total number of visits to include initial, training and assistance, and follow-up.
2Enter the number of projected new and renewal Recognition only sites separately in this column.
3Enter the number of projected new and renewal Exemption only sites separately in this column.
4Enter the number of projected new and renewal Exemption and Recognition only sites separately in this column. (Equivalent to SHARP)
5Activities reflected in this column must be entered on the Intervention Form (Form 66), so that they can be captured in the IMIS. States working with Small Business Development Centers should record activities on this worksheet and on the Intervention Form in order to get credit when the funding formula is calculated.


APPENDIX B – Exhibit II
EQUIPMENT INVENTORY – 21(d) On-site Consultation

A complete and current equipment inventory is required of each On-site Consultation Project. The inventory should include information regarding the description, manufacturer, model number, serial number (if applicable), location, condition, acquisition date and acquisition cost of each item of equipment.

Only a list of changes (deletions and additions) to the initial equipment inventory submitted in the previous fiscal year is required in this Agreement package.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 



APPENDIX B – Exhibit III

EQUIPMENT PROCUREMENT LISTING – 21(d) On-site Consultation
FY __________

Federal Catalog # 17.504                                        State:                                        Date:

List all non-expendable, personal property having a useful life of more than one year and a unit acquisition cost of $5,000 or more, and all computer related equipment. Ref: CFR 97.32(g) & OMB Circular A-87, Attachment B, C.1.


Item Description
(include brand and model)
Number
Cost per
Unit

Total
Cost
National Office Use Only
  On Hand
For Purchase
    Approved Title Transfer

Remarks

          Yes No Yes Initials  
EXAMPLE:
Laptop: Toshiba Satellite Pro
4 2 2,300 4,600          
                 






NOTE: List equipment by category: technical, office/administrative. Equipment which was requested and approved but not procured in the previous award year should be clearly identified.


APPENDIX B – Exhibit IV
ANNUAL TRAINING PLAN – 21(d) On-site Consultation
State: ___________                        FY: ____________                        Date: ___________

List Personnel by ID Number and Type (Mgt/S/IH/etc.) Training Activity & Location. List Per Diem/ Airfare/Reg. Fee/.. /etc. for Out-of-state training. Indicate by Number the Competency Area that Training will Address*
 
 
 
 
 
 
 
 
 
 
* 1. Hazard Identification
2. Assessment of Risk and Exposure
3. Knowledge of Standards
4. Hazard Correction Techniques
5. Safety and Health Program Requirements
6. Effective Communications
7. Other (specify)

NOTE: Funds sufficient to cover travel requirements to conduct proposed training should be budgeted in Part A: Consultation and Part B: Administration. These costs must be specific to the activities identified as determined by the location and duration of the training. All training included in the plan is eligible for 100% Federal funding, subject to the approval by the Director of the Office of Small Business Assistance.


APPENDIX B – Exhibit V
Accompanied Visit Plan FY ________ – 21(d) On-site Consultation

The plan for accompanied visits should state the policies which will govern this activity for the fiscal year, rather than who will be accompanied by whom on specific visits.

Funds sufficient to cover travel for these activities should be budgeted in Part B: Administration, under Item c.2, Travel, unless the project indicates that travel is local and the costs are nominal in amount.


Appendix B – Exhibit VI
Personnel Breakout Chart – 23(g) and 21(d)



Position


Type of Staff
Number of 23(g) or Cooperative Agreement Funded Staff** Number of 100% State-Funded Staff*** Total Funded Positions
23(g) Staff

Compliance Officers*
Safety – Private
Safety - PubSec
     
Safety – Private
Safety - PubSec
     
 
23(g) Consultants Safety – Private
Safety - PubSec
     
Safety – Private
Safety - PubSec
     
 
Compliance Assistance Specialists      
Total number of 23(g) Allocated State Plan Personnel****      
         
21(d) Staff Managerial      
Consultants Safety**      
Consultants Health**      
Clerical/Data systems support      
Marketing      
Trainers      
  OTHER      
Total Number of 21(d) On-site Consultation Personnel      
* Include all allocated positions/FTE, or portion thereof, devoted to field enforcement activities (on-site, case documentation, informal conference, hearing, and other CSHO related activities).
** Expressed in allocated FTEs based on percentage of time allocated to grant/agreement.
*** Consultants spending less than 50% of their time conducting 21(d) visits should be funded by the state and included in the column for 100% State Funded Staff.
**** Include all allocated administrative and program positions, including those itemized above. (Columns will not add.)


Appendix B – Exhibit VII
SUPPORTING DETAILS OF ANTICIPATED COSTS – 21(d) (format)

PART A: CONSULTATION
A. PERSONNEL: (List all positions having salary charged to Consultation.) Total  
Position       Type1    Status2  Cond.3   Location      % Time 21(d)      Salary
1. Consultant Subtotal:      
2. Supervisory consultant/clerical Subtotal:      
B. FRINGE BENEFITS: (List Cost Formula[s]) Total  
1. Consultant Subtotal:      
2. Supervisory consultant/clerical Subtotal:      
C. TRAVEL: (100% Describe in Training Plan) Total  
1. Out-of-State (100% Federal) Subtotal:      
            Training        
            Other (specify)        
2. Within State (90% Federal) Subtotal:      
            Training        
            Promotion        
            Consultative Visits        
            Other (specify)        
D. EQUIPMENT: (tech/list in Equipment Listing) Total  
E. SUPPLIES: (tech/itemize & describe) Total  
F. CONTRACTS: (all sources) Total  
1. Lab Analysis (include #samples) Subtotal:      
2. Industrial Hygiene Services Subtotal:      
3. Other (specify) Subtotal:      
G. OTHER: (items not covered elsewhere) Total  
1. 100% non-travel costs of training Subtotal:      
2. Other (itemize and describe) Subtotal:      
H. TOTAL OF DIRECT CHARGES:
        (A. through G.)

Total
 

_________________________
1S—TS—S/S—H—TH—H/S—SEC

2Encumbered/Vacant

3Previously Approved/New


APPENDIX B – Exhibit VIII
SUPPORTING DETAILS OF ANTICIPATED COSTS – 21(d) (format)

PART B: ADMINISTRATION
A. PERSONNEL: (List all positions having salary charged to Administration.)
Total
 
Position       Type1    Status2  Cond.3   Location      % Time 21(d)      Salary
B. FRINGE BENEFITS: (List Cost Formula[s]) Total  
C. TRAVEL: (100% Describe in Training Plan) Total  
1. Out-of-State (100% Federal) Subtotal:      
            Training        
            Annual On-site Consultation Training
            Conference
       
            Other (specify)        
2. Within State (90% Federal) Subtotal:      
            Training        
            Promotion        
            Accompanied visits        
            Other (specify)        
D. EQUIPMENT: (office/list in Equipment Listing) Total  
E. SUPPLIES: (office/itemize & describe) Total  
F. CONTRACTS: (all sources) Total  
1. Computer Costs Subtotal:      
2. Lease of office equipment Subtotal:      
3. Service of office equipment Subtotal:      
4. Other (specify) Subtotal:      
G. OTHER: (items not covered elsewhere) Total  
1. 100% non-travel costs of training Subtotal:      
2. Other (itemize and describe) Subtotal:      
H. TOTAL OF DIRECT CHARGES: (A. through G.) Total  
I. INDIRECT CHARGES: Total  
J. TOTAL ADMINISTRATION: (H. plus I.) Total  

_________________________
1MGT – SEC

2Encumbered/Vacant

3Previously Approved/New


Appendix B – Exhibit IX
23(g) Supportive Cost Breakout Worksheet (Sample Format)

A. PERSONNEL
Title Program Type* Name Annual      Salary % of
participation
Administration Program Federal
Share
State
Match
State 100% Funded Total Cost
                     
                     
                     
                     
*Indicate whether position(s) is Enforcement (safety/health), 23(g) Consultation, Compliance Assistance, Outreach /Training/ Cooperative Programs, Standards, Mgm't. Information Systems, Laboratories, Review Process, Non-discrimination.

B. FRINGE BENEFITS (Provide Cost Formula[s])
Item Administration Program Federal Share State Match State 100 % Funded Total Cost
             
             
             
Subtotal            


C. TRAVEL
Item Administration Program Federal Share State Match State 100 % Funded Total Cost
Out-of-State            
             
             
Subtotal            
             
In-State            
             
             
Subtotal            


D. EQUIPMENT (Itemize and Describe. Provide detail on equipment costing $5,000+ with a useful life of 1+ years.)
Item Administration Program Federal Share State Match State 100 % Funded Total Cost
             
             
             
Subtotal            


E. SUPPLIES
Item Administration Program Federal Share State Match State 100 % Funded Total Cost
             
             
             
Subtotal            


F. CONTRACTUAL (Itemize and Describe. Provide detail on purpose of each contract, contractor name, as well as cost.)
Item Name of contractor Administration Program Federal Share State Match State 100 % Funded Total Cost
               
               
               
Subtotal              


G. OTHER (Itemize and Describe)
Item Administration Program Federal Share State Match State 100 % Funded Total Cost
             
             
Subpart            


H. TOTAL DIRECT CHARGES
  Total Cost Administration Program Federal Share State Match State 100 % Funded
Sum of A through G            


I. TOTAL INDIRECT CHARGES (Include in Admin. Provide information on Indirect Cost Rate used.)
  Administration Federal Share State Match State 100 % Funded Total Cost
Total          


J. TOTAL CHARGES
  Administration Program Federal Share State Match State 100 % Funded Total Cost
Sum of H and I            



Appendix B – Exhibit X
Tables for Performance Plan

Part I: 23(g) Program Activity Projections Safety
Year One
Safety
Year Two
Health
Year One
Health
Year Two
Private Sector Inspections        
Public Sector Inspections        
Public Sector Consultation Visits        
Private Sector Consultation Visits, if applicable        
  Year One * Year Two *
VPP Participants – general industry Current     New     Total Current     New     Total
VPP Participants – construction Current     New     Total Current     New     Total
VPP Participants – public sector Current     New     Total Current     New     Total
Cooperative Programs ** Current     New     Total Current     New     Total
SHARP Participants Current     New     Total Current     New     Total
Outreach Participants*** Total Total


  Part II: Performance Goals
Strategic Goal #
Performance Goal #  
Year One Performance Goal #  
Year Two Performance Goal #  
Strategy  
Performance Indicator(s) (including activity, intermediate outcome, and primary outcome measures)  
Data Source(s)  
Baseline  
Comment  
Strategic Goal #
Performance Goal #  
Year One Performance Goal #  
Year Two Performance Goal #  
Strategy  
Performance Indicator(s) (including activity, intermediate outcome, and primary outcome measures)  
Data Source(s)  
Baseline  
Comment  
Strategic Goal #
Performance Goal #  
Year One Performance Goal #  
Year Two Performance Goal #  
Strategy  
Performance Indicator(s) (including activity, in intermediate outcome, and primary outcome measures)  
Data Source(s)  
Baseline  
Comment  
Note: Year Two data applicable only for Two-Year Performance Plan.

* Total projected at the end of the year; not necessarily the sum of "Current" and "New".

** Cooperative Programs: Programs similar to OSHA's Partnerships and Alliances and other State programs for joint efforts by employers, employees, other groups.

*** Outreach Participants: Projected number of Trainees/participants in formal training, workshops, seminars, speeches, conferences, informal worksite training, etc., during the year.

Appendix B – Exhibit XI

Memorandum of Agreement

Under Section 18 of the Occupational Safety and Health Act of 1970

between the [name of State Plan agency]

and

the Occupational Safety and Health Administration (OSHA),
United States Department of Labor

for Laboratory Services by the Salt Lake Technical Center (SLTC)

Establishing conditions under which the [State agency], which operates a State Plan approved by the Occupational Safety and Health Administration (OSHA) under Section 18 of the Occupational Safety and Health Act of 1970 will pay the Occupational Safety and Health Administration – Salt Lake Technical Center for laboratory services related to analysis of industrial hygiene samples collected during State occupational safety and health compliance activities.

I. Terms of Agreement

A. OSHA through its Directorate of Science, Technology and Medicine – Salt Lake Technical Center will provide analytical services with regard to all industrial hygiene samples gathered during compliance-related activities (and On-site Consultation program activities in the public sector) by the [State Plan agency]. This service is being provided at the State's request. SLTC will provide the same analytical services to the [State Plan agency] as are provided to the Federal OSHA program, in the same manner and to the same extent. Specific policies and procedures for receipt and analysis of samples and delivery of results will be provided and agreed upon separately between the State and SLTC. Samples will be subject to the same chain of custody, priority and quality assurance procedures as the Federal program; expert witness testimony, when required, will be provided by the SLTC to the [State Plan agency]. Participation in State Plan enforcement litigation will be governed by the policy established in the January 21, 1998, memorandum from the Office of the Solicitor of Labor to the Assistant Secretary (63 FR 35611).

B. The [State Plan agency] agrees to utilize the services of the OSHA Salt Lake Technical Center as its primary/exclusive laboratory for compliance-related sample analysis, and to follow the policies and procedures established for sample gathering and submission by the Federal program. Samples gathered as a result of On-site Consultation program activities in the private sector, whether pursuant to a Section 21(d) On-site Consultation Agreement or under the State Plan, may not be submitted to the SLTC for analysis. Samples collected during either compliance or consultation program activity in the public sector will be accepted for analysis by the SLTC.

II. Cost and Payment

A. The SLTC laboratory will provide these laboratory services at a cost of $175 per sample analyzed. This will include all related activity including expert technical advice and consultation and testimony, as mutually agreed appropriate. There will be a special charge rate for four exceptional sample types:

  -CO Methoxyhemoglobin Calculation
-Explosibility
-GC/MS* Identification
-Materials Failure
$1,150
$ 710
$ 465 (* Gas Chromatograph/Mass Spectrometer)
$2,820


Quarterly accountings of numbers of samples analyzed for the State will be provided together with a bill requesting payment. The fourth quarter payment will be based on an estimated bill. All bills must be paid upon receipt but no later than September 15, 2008. Any adjustments between actuals and estimates will be made in the first quarter of the following fiscal year.

B. The [State Plan agency] anticipates a sample workload of approximately [ # samples] per year and will pay the U.S. Department of Labor, Occupational Safety and Health Administration, for all services provided upon receipt of billings, but no later than September 15, 2008. The [State Plan agency] will include sufficient funds for these expenses in its annual State Plan grant application and will pay OSHA with Federal and State grant funds allocated to the program. The [State Plan agency] understands that the additional Federal staff and resources necessary to provide this service are being made available by OSHA based on the expectation of State Plan payment for at least the estimated number of samples.

III. Contacts

The [State Plan agency] contact for purposes of this agreement is [Name, title, address, phone, fax, e-mail].

The OSHA contact for SLTC is:
Dean Lillquist, Director
Salt Lake Technical Center
USDOL-OSHA
8660 South Sandy Parkway
Sandy, UT 84070-6424
Phone: (801) 233-4902
The OSHA contact for bill processing is:
James Digan, Director
Office of Program Budgeting
and Financial Management
USDOL-OSHA
200 Constitution Ave., NW, Room N-3419
Washington, DC 20210
Phone: (202) 693-2111
E-mail : digan.jim@dol.gov
IV. Other Services

The Salt Lake Technical Center will continue to provide other services to the [State Plan agency], such as assistance from the Health Response Team (HRT), in the same manner as currently provided. Requests for such services are to be coordinated through the Regional Office.

V. Period of Agreement

This agreement is entered into for the period October 1, 2007 through September 30, 2008, and may/will be renewed annually thereafter, on a fiscal year basis.

________________________________
Administrative Programs
Occupational Safety and Health Administration
U.S. Department of Labor

________________________________
Authorized State Representative
State Plan agency
Signed __________ , 2007




Signed __________ , 2007







Appendix C – Exhibit I

OCCUPATIONAL SAFETY & HEALTH ADMINISTRATION
STATE PLAN STATES – 23(g) OPERATIONAL GRANTS
and
21(d) On-site CONSULTATION
FY 2007 FINAL BASE AWARD LEVELS



STATE
23(g) FY 2007 State Plan Final Base Award Level 21(d) FY 2007 On-site Consultation Final Base Award Level
Alaska $1,393,500 $627,000
Arizona $1,813,000 $709,000
California $23,013,900 $5,161,000
Connecticut (PEO) $614,000 -----
Hawaii $1,686,400 $460,000
Indiana $2,188,000 $759,000
Iowa $1,608,900 $604,000
Kentucky $3,308,600 -----
Maryland $3,916,600 $867,000
Michigan $9,893,100 $1,614,000
Minnesota $3,900,300 $942,000
Nevada $1,132,400 $587,000
New Jersey (PEO) $1,895,800 -----
New Mexico $828,000 $493,000
New York (PEO) $3,163,000 -----
North Carolina $5,180,570 $1,304,000
Oregon $5,105,700 $326,000
Puerto Rico $2,438,800 -----
South Carolina $1,765,000 $760,000
Tennessee $3,278,900 $884,000
Utah $1,300,200 $464,000
Vermont $725,800 $393,000
Virgin Islands (PEO) $201,000 -----
Virginia $3,319,800 $993,000
Washington $6,901,600 -----
Wyoming $520,000 $422,000



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NOTICE: This is an OSHA Archive Document, and may no longer represent OSHA Policy. It is presented here as historical content, for research and review purposes only.


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