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ATTACHMENT B
<br />CERTIFICATION OF COMPLIANCE WITH THE STATUTORY ELIGIBILITY REQUIREMENTS
<br />OF THE VIOLENCE AGAINST WOMEN ACT AS AMENDED, STOP FORMULA GRANT PROGRAM
<br />(Local Government or Tribal Applicants Only)
<br />NOTE: If the applicant is a community -based victim service provider with criminal justice agencies receiving STOP
<br />Grant funds through their grant, one of the criminal justice agencies must complete this form to be submitted by
<br />the victim service applicant.
<br />Applicants should refer to the laws cited below for further information regarding the certifications to which they are required
<br />to attest. Signature on this form certifies that the Applicant is qualified to receive the STOP Formula Grant Program funds
<br />and is in compliance with relevant requirements under 34 U.S.0 §§ 10441, 10446 through 10451 and 28 C.F.R. Part 90. These
<br />certifications shall be treated as a material representation of fact upon which the Department will rely if it determines to
<br />award the covered transaction, grant, or cooperative agreement. Any federal funds received under this subchapter will
<br />be used to supplement, not supplant, nonfederal funds that would otherwise be available for activities funded
<br />under this chapter.
<br />In addition, to be eligible for funding under the STOP Formula Grant Program, applicants must certify compliance
<br />with the requirements in 34 U.S.C. §§ 10449, 10450, and 10451 and implemented at 28 C.F.R. Part 90, as follows:
<br />(1) Forensic Medical Examination Payment Requirement for Victims of Sexual Assault
<br />(a) A state, Indian tribal government, or unit of local government shall not be entitled to funds under the STOP Formula Grant
<br />Program unless the state, Indian tribal government, unit of local government, or another governmental entity—
<br />(1) incurs the full out-of-pocket cost of forensic medical exams for victims of sexual assault; and
<br />(2) coordinates with health care providers in the region to notify victims of sexual assault of the availability of rape
<br />exams at no cost to the victims.
<br />(b) A state, Indian tribal government, or unit of local government shall be deemed to incur the full out-of-pocket cost of
<br />forensic medical exams for victims of sexual assault if any government entity:
<br />(1) provides such exams to victims free of charge to the victim; or
<br />(2) arranges for victims to obtain such exams free of charge to the victims.
<br />(c) A state or Indian tribal government may use STOP Formula Grant Program funds to pay for forensic medical exams
<br />performed by trained examiners for victims of sexual assault, except that such funds may not be used to pay for forensic
<br />medical exams by any state or Indian tribal government that requires victims of sexual assault to seek reimbursement for
<br />such exams from their insurance carriers.
<br />(d) (1) To be in compliance with this section, a state, Indian tribal government, or unit of local government shall comply with
<br />subsection (b) without regard to whether the victim participates in the criminal justice system or cooperates with law
<br />enforcement.
<br />(2) Filing Costs For Criminal Charges and Protection Orders
<br />A state, Indian tribal government, or unit of local government will not be entitled to funds under the STOP Formula Grant
<br />Program unless it certifies that its laws, policies, and practices do not require, in connection with the prosecution of any
<br />misdemeanor or felony sexual assault, domestic violence, dating violence, or stalking offense, or in connection with the filing,
<br />issuance, registration, modification, enforcement, dismissal, withdrawal or service of a protection order, or a petition for a
<br />protection order, to protect a victim of sexual assault, domestic violence, dating violence, or stalking, that the victim bear the
<br />costs associated with the filing of criminal charges against the offender, or the costs associated with the filing, issuance,
<br />registration, modification, enforcement, dismissal, withdrawal or service of a warrant, protection order, petition for a
<br />protection order, or witness subpoena, whether issued inside or outside the State, tribal, or local jurisdiction.
<br />Washington State STOP Formula Grant Program Renewal Application for FFY 2022 15
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