| Forms & Certifications |
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The information on this webpage is associated with all ARS, ERS and NASS extramural agreements.
CERTIFICATIONS
Registration in the System for Award Management (SAM) is required for eligibility for a Federal award. Registrations must be updated annually by Federal recipients.
Effective, February 1, 2020, SAM became the central repository for common government-wide certifications and representations required for Federal recipients. This eliminated the need for Federal recipients to complete forms & certifications for each Federal award. ARS, ERS and NASS will use current SAM certifications and representations to comply with award requirements.
| USDA Certifications. The following USDA certifications are required when Certifications and Representations have not been made in SAM. The links to the forms in the table below will take you to the USDA Electronic Forms page (https://www.usda.gov/forms/electronic-forms). At the USDA Electronic Forms page, scroll down to search for the Prefix-Form No, then download the form(s) for completion. | |
| Prefix Form No | Subject |
| AD-1047 | Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions |
| AD-1048 | Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions |
| AD-1049 | Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative I - For Grantees Other than Individuals |
| AD-1050 | Certification Regarding Drug-Free Workplace Requirements (Grants) Alternative II - For Grantees Who are Individuals |
| AD-1052 | Certification Regarding Drug-Free Workplace State and State Agencies, Federal Fiscal Year |
| AD-3030 | Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants |
| OMB Lobbying Forms | |
| Prefix Form No | Subject |
| OMB 4040-0013 V1.1 |
Certification Regarding Lobbying Every time a potential recipient applies for or receives a grant or cooperative agreement in excess of $100,000, it must file a written certification that states that no Federal funds have been paid for lobbying. |
| OMB 4040-0013 SF-LLL-V2.0 |
Disclosure of Lobbying Activities Used by applicants and recipients to disclose lobbying activities that have been secured to influence the outcome of a Federal action. |
FORMS
Pre-Award Forms:
| Form |
Title/Description |
|---|---|
|
OMB No. 4040-1010 |
Project/Performance Site Location(s)– this OMB form provides the Agency “Place of Performance” information. |
| Organization Information, Representations, Assurances and Certifications | |
| Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants |
Management and Financial Reports:
|
Form |
Description |
|---|---|
|
REE-157 |
RSA Management Report Template - for Research Support Agreements (originally ARS-157). NOTE: The Cooperator may use this template or their own reporting template. |
|
RPPR |
Research Performance Progress Report (RPPR) - The RPPR has been mandated by the Federal Office of Management and Budget and coordinated by the National Science Foundation. Accomplishments, "how have the results been disseminated to communities of interest," must include information addressing the sharing of publications, including published data. |
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RPPR Cover Page Data Elements template for Cooperator use for submission of the RPPR. |
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Federal Financial Report - applicable for all awards. - When used by the non-Federal entity for Non-Assistance Cooperative Agreements, refer to 7 CFR part 550, 550.123(a) for financial reporting conditions (“a financial report must contain an itemization of actual dollar amounts expended on the project during the reporting period (in line with the approved budget), and cumulative totals expended for each budget category from the start date of the award.”). |
Payment/Reimbursement:
|
Form |
Description |
|---|---|
|
(OMB No. 4040-0012) |
SF-270 Request for Advance or Reimbursement |
Budget:
| Form |
Description |
|---|---|
|
OMB No. 4040-0001 |
Grants.gov Research & Related Budget (Total Fed + Non-Fed) - Acceptable for use with Non-Assistance Cooperative Agreements |
|
OMB No. 4040-0001 |
Grants.gov Research & Related Budget 3.0 - Acceptable for use with Grant Agreements and Cooperative Agreements |
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Grant and Cooperative Agreement Budget, dated 11/2018. Previous versions are obsolete. |
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| REE-454 | Non-Assistance Cooperative Agreement Budget, dated 11/2018. Previous versions are obsolete. |
Tangible Personal Property Report:
|
Form |
Description |
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Report Form and Instructions (2 pages, 29 kb)
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Disposition Request/Report (2 pages, 27 kb)
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Supplemental Form and Instructions (2 pages, 26 kb)
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Other Documents:
|
Form |
Description |
AD-475-C |
Civil Rights Poster: “AND JUSTICE FOR ALL” This poster (AD 475C; Sep 2019) is to be prominently displayed in all offices where there is a USDA presence and where it may be read by customers. Recipients of federally funded agreements are required to display this poster in their facilities where it can be viewed by customers. "And Justice for All" posters must be displayed in a specific size: 11" width x 17" height. |
