424B Form PDF Details

The 424B form is a document that is used to report the sale or transfer of securities. The form helps to keep track of the various transactions that occur in the securities market, and it must be filed with the SEC within two days of the transaction. Failure to file this form can result in significant penalties. So if you're involved in a security transaction, make sure you file Form 424B as soon as possible. Thanks for reading!

Form Name424B Form
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namessf 424b, sf 424b assurances svog, sf 424b assurances sba, 424b

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OMB Approval No. 0348-0040


Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.


NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such 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


Act of 1973, as amended (29 U.S.C. §794), which


and the institutional, managerial and financial capability


prohibits discrimination on the basis of handicaps; (d)


(including funds sufficient to pay the non-Federal share


the Age Discrimination Act of 1975, as amended (42


of project cost) to ensure proper planning, management


U.S.C. §§6101-6107), which prohibits discrimination


and completion of the project described in this


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


Will give the awarding agency, the Comptroller General


abuse; (f) the Comprehensive Alcohol Abuse and


of the United States and, if appropriate, the State,


Alcoholism Prevention, Treatment and Rehabilitation


through any authorized representative, access to and


Act of 1970 (P.L. 91-616), as amended, relating to


the right to examine all records, books, papers, or


nondiscrimination on the basis of alcohol abuse or


documents related to the award; and will establish a


alcoholism; (g) §§523 and 527 of the Public Health


proper accounting system in accordance with generally


Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee-


accepted accounting standards or agency directives.


3), as amended, relating to confidentiality of alcohol




and drug abuse patient records; (h) Title VIII of the


Will establish safeguards to prohibit employees from


Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as


using their positions for a purpose that constitutes or


amended, relating to nondiscrimination in the sale,


presents the appearance of personal or organizational


rental or financing of housing; (i) any other


conflict of interest, or personal gain.


nondiscrimination provisions in the specific statute(s)




under which application for Federal assistance is being


Will initiate and complete the work within the applicable


made; and, (j) the requirements of any other


time frame after receipt of approval of the awarding


nondiscrimination statute(s) which may apply to the







Will comply with the Intergovernmental Personnel Act of




or has already complied, with the


1970 (42 U.S.C. §§4728-4763) relating to prescribed


requirements of Titles II and III of the Uniform


standards for merit systems for programs funded under


Relocation Assistance and Real Property Acquisition


one of the 19 statutes or regulations specified in


Policies Act of 1970 (P.L. 91-646) which provide for


Appendix A of OPM's Standards for a Merit System of


fair and equitable treatment of persons displaced or


Personnel Administration (5 C.F.R. 900, Subpart F).


whose property is acquired as a result of Federal or




federally-assisted programs. These requirements apply


Will comply with all Federal statutes relating to


to all interests in real property acquired for project


nondiscrimination. These include but are not limited to:


purposes regardless of Federal participation in


(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




as applicable, with provisions of the


Amendments of 1972, as amended (20 U.S.C. §§1681-


Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328)


1683, and 1685-1686), which prohibits discrimination on


which limit the political activities of employees whose


the basis of sex; (c) Section 504 of the Rehabilitation


principal employment activities are funded in whole or




in part with Federal funds.

Previous Edition Usable




Standard Form 424B (Rev. 7-97)


Authorized for Local Reproduction


Prescribed by OMB Circular A-102

9.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 subagreements.

10.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.

11.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 floodplains 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 Clean 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).

12.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.

13.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.).

14.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.

15.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.

16.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.

17.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."

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





Standard Form 424B (Rev. 7-97) Back

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