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Project Safe Neighborhoods (PSN) Forms
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PSN Program

Tiered Subrecipients

The following forms apply to the Project Safe Neighborhoods (PSN) Program.

FY21 PSN Forms
FY21 Standard Conditions

FY20 PSN Forms
FY20 Standard Conditions (Revised 03/20/2022)

FY19 PSN Forms
FY19 PSN Standard Conditions
Application Narrative Questionnaire 
Budget Detail Worksheet

FY18 PSN Forms
FY18 PSNM Standard Conditions 
FY18 PSNN Standard Conditions
FY18 PSNS Standard Conditions


PSN General Forms
Ballistic Vest (Mandatory Wear) Certification
BJA NEPA Checklist
Body Worn Camera Certification
Confidential Funds Certification 
Confidential Funds Policy and Procedures - (Available for agencies with no policy in place.)

Equipment Disposition Form
Lobbying, Suspension, Debarment, and Drug Free Workplace Certification 
Single Audit Exemption Form
Sole Source Justification Approval Form 
Subaward Management Questionnaire (SMQ) (Revised July 26, 2022)
Subrecipient vs. Contractor Determination Checklist (Revised July 26, 2022)
Suitability to Work and/or Interact with Minors Certification (SWIMC)
Suitability to Work and/or Interact with Minors Tracking Sheet (SWIMT) 
Telecommunications and Video Surveillance Services or Equipment Certification (TVS)
Telecommunications FAQ
Third-Party Contract Compliance Checklist

PSN Performance Questionnaire
All recipients receiving funding under the PSN program must submit quarterly performance metrics defined by the U.S. Department of Justice. The form below must be submitted to the assigned grant manager by January 15, April 15, July 15, and October 15 each year the award is open.

PSN Performance Questionnaire

Tiered Subrecipients
The following forms apply to recipients who have entered into a pass-through entity/tiered subrecipient relationship with a third-party. Additional forms may be required based on the tiered subaward project. Please contact your OCJG grant manager with any questions regarding what additional forms may be required.

Third-Party Certificate of Subaward (Revised July 26, 2022)
Third-Party Subaward Compliance Checklist (Revised July 26, 2022)
Third-Party Subaward Risk Assessment 
Third-Party Monitoring Questionnaire (Revised July 26, 2022)
Third-Party Subaward Certification of Audit Exemption