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Forms & Certifications
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Forms & Certifications

Note: All forms are available in .pdf format (unless otherwise noted). If you require the Acrobat Reader, download it here.

Certifications

 

Research Support Agreement Certification Packages:

For "Research Support
Agreement" awards
under $100,000

 

 

 This PDF group contains:
  • AD-1047 - USDA Debarment & Suspension Certification
  • AD-1049 - USDA Drug-Free Workplace Certification
  • AD-3031 - USDA Assurance Regarding Felony Conviction
    or Tax Delinquent Status for Corporate Applicants (applicable
    if IHE is incorporated)
  • Conflict of Interest Policy Certification
For "Research Support
Agreement" awards of
$100,000 or more
  This PDF group contains:
  • AD-1047 - USDA Debarment & Suspension Certification
  • AD-1049 - USDA Drug-Free Workplace Certification
  • AD-3031 - USDA Assurance Regarding Felony Conviction
    or Tax Delinquent Status for Corporate Applicants (applicable
    if IHE is incorporated)
  • Certification Regarding Lobbying
  • Conflict of Interest Policy Certification

   

Individual Certifications - for all awards

Document

Description

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

PDF

Certification Regarding Lobbying

SF-LLL

Disclosure of Lobbying Activities

 AD-3030

Representations Regarding Felony Conviction and Tax Delinquent Status for Corporate Applicants

AD-3031 

Assurance Regarding Felony Conviction or Tax Delinquent Status for Corporate Applicants

REE-26

Organization Information, Representations, Assurances and Certifications

PDF

Conflict of Interest Policy for ARS, ERS & NASS

 

Forms

Management and Financial Reports -
 

Form

Description

REE-157

XLS

RSA Management Report Template - for Research Support Agreements (originally ARS-157)

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.

REE-269

 

Cooperative Agreement Financial Status Report, dated 1/2018. Previous versions are obsolete.      

- Can be used for Non-Assistance Cooperative Agreements awarded prior to 10/8/2016.  

SF-425

 

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

SF-270

(OMB No. 4040-0012)

SF-270 Request for Advance or Reimbursement

 Budget -

Form

Description

 OMB No.

4040-0001

OMB No.
4040-0001

Research and Related Budget (RR Budget)

         REE-455

Grant and Cooperative Agreement Budget, dated 11/2018.  Previous versions are obsolete.

REE-454

Non-Assistance Cooperative Agreement Budget, dated 11/2018.  Previous versions are obsolete.

 

Tangible Personal Property Report -

Form

Description

SF-428-B

 

Final Report Form and Instructions

(2 pages, 29 kb)

 

SF-428-C

 

Disposition Request/Report

(2 pages, 27 kb)

 

SF-428-S

 

Supplemental Form and Instructions

(2 pages, 26 kb)

 

 Other Documents -

Form

Description

AD-475-C
updated

AND JUSTICE FOR ALL” Poster

The "And Justice For All" Civil Rights poster (AD 475C; Sep 2006) is to be prominently displayed in all offices where there is a ARS, ERS, or NASS presence. The poster should be placed where it may be viewed by employees and customers.

Recipients of federally-assisted programs and non-assistance cooperative agreements, such as land-grant institutions, are required to display this poster in their facilities where it can be viewed by customers.