Fill and Sign the Hanz Employment Contract Form

1 SUPPLEMENTAL INSTRUCTIONS Submission of Application for Hazardous Materials Worker Health and Safety Training Cooperative Agreements RFA: ES-04-005 Supplemental instructions and guidelines for Grant Application Form PHS 398 (Rev. 05/2001) GENERAL INFORMATION Applicants seeking support under the NIEHS Hazardous Materials Worker Health and Safety Training Cooperative Agreement Program should follow these special instructions where referenced. Where no special instructions are given the regular instructions for Grant Application Form PHS 398 (Rev. 05/2001) should be followed. It is essential that the application be well organized, clearly written and complete in all details. That is, all information necessary for review must be contained within the body of the application. Information of a reference nature that is not essential for review should be placed in an appendix. All appendix materials will be made available to assigned reviewers only. Material submitted to other solicitations or part of currently funded cooperative agreements or grants will not be made available to the review committee unless it is incorporated in the current application. It is also essential that the application be as concise as possible. Verbose, poorly organized applications are not likely to do well in review. For planning purposes, applicants should submit one application which contains separate budgets and training plans for up to a five-year period (FY 2005 through 2010), that may respond to any or all of the targeted training programs which are identified in this solicitation. If applying for more than one program [i.e., Hazardous Waste Worker Training (HWWT), Minority Worker Training (MWT), EPA-Brownfields Minority Worker Training (BMWT), Hazmat Disaster Preparedness Training (HDPT) separate budget pages (Form Pages 4 and 5), and a separate training plan, must be submitted for EACH program as well as composite Form Pages 4 and 5 summarizing direct costs for all programs. The instructions below are designed to correspond to the format contained in the instructions for PHS 398, beginning with I.C. I. PREPARING YOUR APPLICATION C. SPECIFIC INSTRUCTIONS - Forms 1. Form Page 1 1. Title of Project. Use the title Worker Health and Safety Training Cooperative Agreement on all applications. 2. Check the "yes" box; use ES-04-005 for Number; and Worker Health and Safety Training, NIEHS. 3. Follow PHS 398 instructions. Note that NIEHS staff “conduct official business only with principal investigators and 2 institutional officials.” 4. Check the "no" box. Human Subjects review is inapplicable. PHS 398 instructions. Note 5. Check the "no" box. Animal welfare is inapplicable. instructions. 6. Self explanatory. (Anticipated start date for these cooperative agreements is 9/1/2005 with an anticipated end date of 8/31/2010.) 7a. Self explanatory. Note PHS 398 instructions. If applying for more than one program (HWWT/MWT/BMWT/HDPT) direct costs should reflect the total direct costs of the composite Form Page 4 budget page for these programs (separate budget pages are required if applying for more than one program, as well). 7b. Self explanatory. Follow PHS 398 instructions. Facilities and Administrative (F&A) costs are limited to 8 per cent of total direct costs excluding equipment, amounts in excess of the first $25,000 of each sub-contract each year, and tuition and related fees. The calculations for F&A costs should be shown separately for each program budget on separate CHECKLIST FORM PAGE FORM PAGE , section 3, F&A COSTS. Reference specific instructions for Checklist Form Page Form Page below. 8a. Self explanatory. Note PHS 398 instructions. Direct costs should reflect the total direct costs of the composite Form Page 5 budget page for all programs applied for (HWWT/MWT/BMWT/HDPT). 8b. Self explanatory. Note PHS 398 instructions. F&A costs are limited to 8 per cent of total direct costs excluding equipment, amounts in excess of the first $25,000 of each sub-contract each year, and tuition and related fees. The calculations for F&A costs should be shown separately for each program budget on separate Checklist Form Page, section 3, F&A COSTS. Reference specific instructions in Checklist Form Page. 9. Follow PHS 398 instructions. 10. Self explanatory. Refer to RFA ES-04-005 Eligible Institutions. Note PHS 398 instructions. 11. Self explanatory. Note PHS 398 instructions. 12. Self explanatory. Note PHS 398 instructions. 13. Follow PHS 398 instructions. address. 14. Follow PHS 398 instructions. 15. Self explanatory. Note PHS 398 Note instructions for generic e-mail Note PHS 398 instructions. NOTE: Type the name of the Principal Investigator at the top of each printed page and each continuation page. Number pages consecutively at bottom center. Do not use suffixes such as 5a, 5b, etc. 2. Form Page 2 3 DESCRIPTION. Follow these instructions: Include one sentence stating which of the 4 programs (HWWT, MWT, BMWT, HDPT) you are applying for, indicating the total cost (direct plus F&A) for each. State the application's broad, long-term objectives and specific aims for worker health and safety training. This abstract provides a preview to reviewers as to program scope and content. As such, it is essential that it capture the character of the proposed training program. It should describe the proposed hazardous material and waste worker populations targeted for training including: size, types of work, and geographic locations. It should project the number of workers anticipated to be trained. This abstract is meant to serve as a succinct and accurate description of the proposed work when separated from the application. If the application is funded, this description, as is, will become public information. Therefore, do not include proprietary/confidential information. THE ABSTRACT MUST NOT EXCEED THE SPACE PROVIDED ON THIS PAGE. PERFORMANCE SITES. KEY PERSONNEL. Follow PHS 398 instructions. Follow PHS 398 instructions. 3. Form Page 3 TABLE OF CONTENTS. Follow PHS 398 format except for the following: Change "Research Plan" to "Training Plan". The Introduction to Revised Application and Introduction to Supplemental Application are not applicable and should be deleted. The Training Plan should summarize the program, its scope, target population and progress to date. The following outline should be used and should replace items a-j in the outline in the PHS 398 Table of Contents: a. Specific Aims b. Background and Significance c. Progress Report/Compliance with Terms of Prior Award(s) d. Administration, Staff, Advisory Board e. Target Populations f. Training Program g. Training Facilities and Institutional Resources h. Quality Control and Evaluation Plan i. Consultants/Collaborators j. Consortium/Contractual Arrangements k. Literature Cited Personnel Table Checklist Form Page Letters of Support Appendix Items a-k must not exceed 25 pages. Applicants are advised to be clear and concise in the presentation of the required information to keep within the 25 page limit. If applying for more than one program [i.e., HWWT, MWT, BMWT and the HDPT a separate training plan should be submitted for each program, each keeping within the 25 page limit. 4. Form Page 4 4 DETAILED BUDGET FOR INITIAL BUDGET PERIOD. Note that, if applying for more than one program (HWWT/MWT/BMWT/HDPT), a separate Form Page 4 must be submitted for EACH program with the respective Form Page 5. The pages must be identified at the top right corner by the appropriate program (HWWT/MWT/BMWT/HDPT). One composite Form Page 4 must be submitted with one composite Form Page 5, reflecting total direct costs for all programs combined. Mark these pages on the top right corner "Composite". List direct costs only. DO NOT include program income or F&A costs. These shall be indicated on the Checklist Form Page Form Page, sections 2 and 3. Personnel. Follow PHS 398 instructions. Consultant Costs. Follow PHS 398 instructions. Consultants must be identified and their time/effort listed. Equipment. Supplies. Follow PHS 398 instructions. Follow PHS 398 instructions. Travel. Follow PHS 398 instructions. Patient Care Costs. This item is not applicable. Alterations and Renovations. Follow PHS 398 instructions. Other Expenses. Follow PHS 398 instructions. List any student incentive costs here. Enter the number of students and the total student incentive amount for each student. Fully justify these expenses on separate pages as follows. Applications which request student incentives must contain a strong justification substantiating the need for them, the rationale as to why such support cannot be provided by other means, and the degree of any cost sharing proposed by awardees. Request for student incentives will be given close scrutiny. List any trainee/student travel costs here. Describe the purpose for any travel and subsistence expenses, giving the numbers of trips involved, the destinations, and the number of students for whom funds are requested. Applications which request travel funds for students must contain a strong justification which substantiates the need for such funds, the rationale as to why such support cannot be provided by other means, and the degree of any cost sharing proposed by awardees. Requests for student travel funds will be given close scrutiny. Consortium/ Contractual Costs. Follow PHS 398 instructions. Be sure to include separate itemized budget pages (Form Pages 4 and 5) for each subcontract or consortia member with the respective primary applicant form pages. The sum of all consortia costs (i.e.: direct costs and F&A (8%) cost combined) go here. 5 5. Form Page 5 BUDGET FOR ENTIRE PROPOSED PERIOD OF SUPPORT. Note that, if applying for more than one program (HWWT/MWT/BMWT/HDPT), a separate Form Page 5 must be submitted for EACH program with the respective Form Page 4. The page must be identified at the top right corner by the appropriate program (HWWT/MWT/BMWT/HDPT). One composite Form Page 5 must be submitted with one composite Form Page 4, reflecting total direct costs for all programs combined. Mark these pages on the top right corner "Composite". Follow PHS 398 instructions. All items in requested budgets must be fully explained and adequately justified. Failure to do so may result in deletions or reductions by reviewers. Use continuation pages as necessary, reproducing the blank page in the application packet. 6. BIOGRAPHICAL SKETCH FORMAT PAGE. Follow PHS 398 instructions. 7. OTHER SUPPORT FORMAT PAGE. Follow PHS 398 instructions as stated on p. 43. Ensure that the suggested format is used and that the information is complete, accurate and up to date. 8. RESOURCES FORMAT PAGE. Follow PHS 398 instructions. Use a separate Form Page for the primary applicant, each consortia, and each training site, identifying each page appropriately. Substitute "training facility" for “laboratory”. 9. Training Plan (formerly Research Plan) If applying for more than one program (HWWT/MWT/BMWT/HDPT) a separate Training Plan must be submitted for EACH program. The pages should be identified at the top right corner by the appropriate program (HWWT/MWT/BMWT/HDPT). Please follow the plan of the Table of Contents (See Form Page 3, TABLE OF CONTENTS of these Supplementary Instructions). To assist review groups in their evaluations, provide clear and concise yet comprehensive information about each topic. At a minimum, each topic in the Table of Contents should be addressed, detailing specific objectives and plans for accomplishing these objectives. Plans should include specific tasks and time frame for each task and should fully address the review criteria in the RFA. Applicants are expected to furnish their own estimates of the time required to achieve specific training and education objectives of the proposed training program and conduct appropriate program evaluations. Any substantial modifications in the program scope and objectives subsequent to an award must be mutually agreed upon by the awardee institution and NIEHS. Because of the varied target audiences for the proposed training and education programs, it is anticipated that a variety of approaches will be responsive to this announcement and that there will be a range of costs among individual awards. a. Specific Aims. State the broad, long-term objectives and concisely and realistically describe what the proposed training is intended to accomplish. 6 b. Background and Significance. Briefly sketch relevant background and the need for the proposed health and safety training. Give the rationale for the proposed training program. Applicants must strongly document the organization's past success in performance and effectiveness in planning, implementing, and operating worker health and safety training programs and employing adult education techniques. Give a summary of worker health and safety activities for the last five years for the major participating organizations in the proposed program. Emphasis should be placed on worker health and safety training and education experience including information on the students trained and their jobs, type of worker health and safety training given, number of workers trained, training duration, outreach activities, and new advances in training. c. Progress Report/Compliance with Terms of Prior Award(s). Applicants who are presently being funded under this program should provide a progress report of their activities. This should include: description of efforts to meet established terms and conditions, attainment of program goals and objectives of prior awards, ability to manage and expend funds in a timely manner in prior budget periods and a summary of collaborative efforts with other awardees and NIEHS program staff. d. Administration, Staff, and Advisory Board. Describe the administrative structure of the proposed program and the distribution of responsibilities within it, including the means by which the program director will obtain continuing advice with respect to the operation of the program. Fully document the principal investigator’s and business official’s experience in leading worker health and safety training programs. Give the number of current faculty and staff engaged in worker health and safety training. List each training faculty member and consultant involved including their role and the extent to which they are employed. Include the per cent of effort of each in the program. Describe the extent to which participating faculty members have collaborated with the program in the past. List technical support staff members and identify their roles in the program. Describe the program's experience with adult education. Document the faculty members' relevant experience and training in appropriate adult education techniques in the area of worker health and safety. A biographical sketch must be provided for each member of the faculty or staff detailing qualifications and experience (Follow the instructions on the "Biographical Sketch Format Page.) Minimum position qualifications and position descriptions must be provided for proposed staff not yet hired. Describe the make-up and role of the Advisory Board. Show plans for how they will be used to assure the quality of the training program including frequency of meetings and how they will advise the Principal Investigator. e. Target Population(s). Describe methods and techniques to be used for identifying and accessing target specific worker population(s) to be trained. Specific descriptions of targeted training populations should reflect the 7 respective regulations of EPA, OSHA, etc. Describe the population(s) to be trained, including size of the target population(s), trades and job categories to be trained, types of hazardous materials and waste operations and emergency response, geographic locations of workers and the degree of health and safety training already received. Provide documented assurances of access to these populations for training. Describe the qualifications of prospective students and the criteria and procedures by which students will be selected. Describe outreach and recruitment plans. Describe the type and give the number of workers who have applied for worker health and safety training given by your organization over the last five years and the number of workers who have completed this training and the resulting benefit of the program to the student and their employers. Applicants for the MWT program should describe target populations for training of young persons who live near hazardous waste sites as referenced by the US House Subcommittee of Appropriations for VA, HUD and Independent Agencies in Report 103-311 (pp. 61-62). f. Training Program. Describe the proposed training program including number of students to be trained, durations of training and anticipated course content and training objectives. Document the program's achievement of the minimum criteria for worker health and safety training for hazardous waste operations and emergency response. Describe curriculum to be used, distribution of course materials, and conduct of direct worker training. Do not include copies of the actual curriculum as appendix material; instead describe in outline form the applicable standards, curricula components, modules, learning objectives and performance measures. The outline for each curriculum must not exceed two pages in length and should be included in the appendix only. Describe the extent of hands-on demonstration and instruction, which simulates hazardous materials and waste operations or emergency response. Describe methods for employing adult education techniques, advanced training technologies, and approaches for training and evaluating instructors. Indicate how the proposed worker health and safety training will be integrated with other specialized training already provided to the proposed target worker population. Specify and highlight the integration of new program initiatives as identified in the RFA with your proposed training plan. Discuss plans for continuing the program independently beyond the cooperative agreement period. Applicants for the MWT and the BMT programs should develop environmental career-oriented projects within the context of other social and health needs of young people in environmentally-contaminated communities, as well as describe mechanisms for facilitating trainee employment and tracking in environmental restoration activities. g. Training Facilities and Institutional Resources. Describe the facilities and resources, which will be used in the proposed program including major equipment items. Describe facilities available for hands-on demonstration and simulation of hazardous materials and waste operations and emergency response. Identify specific facilities and resources to be provided by each participating member of joint programs involving two or more nonprofit 8 organizations. h. Quality Control and Evaluation Plan. Describe how each student's progress will be measured and how the student's performance will be monitored and evaluated. Describe methods and procedures for evaluating appropriateness, quality and effectiveness of worker health and safety training proposed. Evaluation protocols should quantitatively describe a process for assessing instructor effectiveness, trainee retention of knowledge and hands-on skills, and the positive impacts of training activities on work practices and overall worker protection from on-the-job hazards. i. Consultants/Collaborators. 29. Follow PHS 398 instructions on page j. Consortium/Contractual Arrangements. Follow PHS 398 instructions on page 29. k. Literature Cited. Follow PHS 398 instructions on page 29. 10. Personnel Table To assist in the peer review process, it is suggested that an additional table of all professional and non-professional Personnel should be appended to your application using the following format: Name Role in Program Total Level of Effort (%) Affiliations Please list all participating individuals in alphabetical order and only list each individual once. 11. Checklist Form Page Follow instructions in PHS 398. 2. - Program Income. APPLICANTS ARE REQUIRED TO INCLUDE ON THEIR GRANT APPLICATIONS "a reasonable estimate of the amount and source of program income expected to be generated as a result of the project for which support is being sought." IF IT CAN BE DETERMINED THAT THE ACTIVITY WHICH GENERATED THE INCOME IS SUPPORTED IN ANY WAY BY GRANT FUNDS OR WOULD NOT HAVE OCCURRED EXCEPT FOR THE EXISTENCE OF THE GRANT-SUPPORTED PROJECT, THEN THE INCOME SO GENERATED SHALL BE DEEMED TO BE PROGRAM INCOME. Grantees are accountable for general program income as set forth in 45 CFR Part 74 Subpart F and 45 CFR 92.25, AND MUST REPORT THE TOTAL PROGRAM INCOME ON THE FINANCIAL STATUS REPORT LONG FORM, each year. The use of Program Income applicable to this program is the "Additional Costs Alternative," and will be stated on the Notice of Grant Award. All general program income generated by this grant program may be retained by the primary grantee in accordance with the above cited regulations and may be distributed or used in accordance with other written agreement/guidelines established, for the good of the whole grant program. Please indicate specific arrangements your organization has adopted for program income management. 9 3. F&A Costs. Allowable indirect costs for this program are limited to 8% of a modified indirect cost base which excludes amounts over the first $25,000 for each consortia agreement, equipment costs, and tuition and related trainee fees. Show the calculation of indirect costs for the initial year and future years. Example: Grantees will only receive F&A on the first $25,000 per consortia regardless of the period of performance and the number of times the consortia participates. 12. Letters of Support Self Explanatory 13. Appendix No change from instructions in PHS 398. Information essential to the review of the application must be included in the body, not the appendix. Include in the appendix a table of contents of the appendices, curriculum descriptions, as well as a synopsis of other relevant material to be used in your program, and other supplemental information supporting the application. The Appendix will not be duplicated with the rest of the application. II. SUBMITTING YOUR APPLICATION Follow the instructions contained in the PHS 398 and additional instruction in the RFA.