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HomeMy WebLinkAboutC05-021 Community Services Block Grant
(;.05" O~/- ;2;).
~ 200S-&:CSBG APPLICATION and ~~AN
GRANTEE: Eae:le Countv Health & Human Services - Eae:le Countv Government
ADDRESS: PO Box 660 Eae:le. Colorado 81631
CONTACT PERSON: Kathleen Forinash
TITLE: Health & Human Services Director PHONE: 970-328-8858
E-MAIL: kathleen.forinash{tV,eae:lecountv.us FAX: 970-328-8829
COUNTIES INCLUDED IN THIS PLAN: Eae:le
TOTAL CSBG ALLOCATION: $40.362
PROGRAM PERIOD: March 1. 2005 To Februarv 28. 2006
Total Total Total
Dirietl...rog...... AdminiStrative CSBG FondS
c..t$ c..tS
SeePfl/#e~!ol' de.tJ!!itiORtlI set See Page 2!ordejlttitioR tlIset
by u.s.lJi!pt O!l1efJlt"4IlullUlll by U.S.l!eptIlfHeaJi" ..
smIce$ HUIlUlllSenice$
1. Employment $ $ $
2. Education $ $ $
3. Income Management $ $ $
4. Housing $ $ $
5. Emergency Services $ $ $
6. Nutrition $ $ $
7. Linkages with Other Programs $ 40,362 $ $ 40,362
8. Self-Sufficiency $ $ $
9. Health $ $ $
TOTAL $ 40,362 $ $ 40,362
II. BUDGET -
Cost Category Employment Education Income Housing Emergency Nutrition Linkages Self- Health TOTAL
Management Services Sufficiency
A. Personnel 40,362 $ 40,362
% of time paid
with CSBG
% % % % % % 60% % %
B. Direct $
Operating
C. Indirect / $
Overhead
(administrative)
D. Capital $
Equipment
E. Subcontract $
F. TOTAL 40,362 $ 40,362
List all a2encies and fundin2 yoU plan to subcontract with to provide CSBG services: (Please add additional sheets if necessary)
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i i
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II. BUDGET NARRATIVE
Cost Category Explain each CSBG cost as related to the proposed CSBG plan. Please add additional sheets if necessary
A. Personnel 1.5 FTE paraprofessional home visitors are employed in this program. Professional supervision is provided by .15
FTE Family Development Coordinator. 0.08 FTE is provided for parent training and support groups.
Total Cost $105,249 Salaries : $57,424 FICA: $3,559 Medicare: $833
Work Comp: $3,295 Retirement: $1,978 Health Insurance: $38,161
B. Direct Operating
None attributed to CSBG
C. Indirect / Overhead
None attributed to CSBG
D. Capital Equipment Describe equiprnent needed and your procurement process. The State requires that bids and equipment final invoices are submitted to the State.
None attributed to CSBG
E. Subcontract
None attributed to CSBG
4
VII. CERTIFICATIONS:
The grantee assures that activities implemented with CSBG funds will be:
used to accomplish the State CSBG Goal and Objective stated in the State Plan; and
within the requirements set forth in the Community Services Block Grant Act, Title IV of the Civil Rights Act, the Age
Discrimination Act of 1975, the Rehabilitation Act of 1973, Public Law 103-227, Part C, Environmental Tobacco Srnoke,
also known as the Pro-Children Act of 1994 (Act), Certification Regarding Drug-Free Workplace Requirements, Certification
Regarding Lobbying, Certification Regarding Debarment, Suspension, and Other Responsibility Matters _ Primary Covered
Transactions, Office of Management and Budget (OMB Circular AIIO and AI22), and the current State of Colorado CSBG
Plan.
The grantee also assures that it will:
specifically consider, in a public meeting the designation of any local public or private entity to carry out the county
community service activities under contract with the county, any local community action agency (CAA) which received
federal fiscal 1981-82 funding;
consider, on the same basis as other non-governmental organizations, religious organizations to provide the CSBG services,
so long as the program is implemented in a manner consistent with the Establishment Clause of the first amendment to the
Constitution. Grantees shall not discriminate against an organization that provides assistance under, or applies to provide
assistance, on the basis that the organization has a religious character. (Please review Sec.679 Operational Rule in the CSBG
Act);
provide for coordination between community anti-poverty programs and ensure, where appropriate, that emergency energy
crisis intervention programs under Title XXVI (relating to low-income home energy assistance) are conducted in such
community;
provide, on an emergency basis, for the provision of such supplies and services, nutritious foods, and related services, as may
be necessary to counteract conditions of starvation and malnutrition among low-income individuals;
coordinate, to the extent possible, programs with arid fonn partnerships with other organizations serving low-income residents
of the community and members of groups served, including religious organizations, charitable groups, and community
organizations;
establish procedures under which a low-income individual, community organization, or religious organization, or
representative of low-income individuals that considers its organization, or low-income individuals, to be inadequately
represented on the CSBG board (or other mechanism) to petition for adequate representation;
in the case of public organizations, have a tripartite advisory board which shall have members selected by the organization
and shall be composed so as to assure that not fewer than 113 of the mernbers are persons chosen in accordance with
democratic selection procedures adequate to assure that these members (a) are representative of low-income individuals and
farnilies in the neighborhood served, (b) reside in the neighborhood, and (c) are able to participate actively in the
development, planning, implementation, and evaluation ofprograrn funded.
in the case of private non-profit entities, have a tripartite board that participates in the development, planning,
implementation, and evaluation of the program to serve low-income communities. The board shall be composed so as to
assure that (a) 1/3 of the members are elected officials, holding office on the date of selection, or their representatives, except
that if the number of such elected officials reasonably available and willing to serve on the board is less than 1/3 of the
membership of the board, membership on the board of appointive public officials or their representatives may be counted in
meeting such 113 requirement; (b) not fewer than 1/3 of the members are person chosen in accordance with democratic
selection procedures adequate to assure that these members are representative of low-income individuals and families in the
neighborhood served, and each representative of low-income individuals and families selected to represent a specific
neighborhood within a community resides in the neighborhood represented; and (c) the remainder of the rnernbers are officials
or members of business, industry, labor, religious, law enforcement, education, or other major groups and interest in the
comrnunity served;
prohibit the purchase or improv~L Alt of land, or the purchase, construction, or pennanent improvement (other than low-cost
residential weatherization or other energy-related home repairs) of any building or facility with CSBG funds;
prohibit, including subcontractors, (a) any partisan or nonpartisan political activity or any political activity associated with a
candidate, or contending faction or group, in an election for public or party office, (b) any activity to provide voters or
prospective voters with transportation to the polls or similar assistance in connection with any such election, or (c) any voter
registration activity.
prohibit that persons shall, on the basis of race, color, national origin or sex, be excluded from participation in, be denied the
benefits of, or be subjected to discrimination under, any program or activity funded in whole or in part with CSBG. Any
prohibition against discrimination on the basis of age under the Age Discrimination Act or 1975 (42 U.S.C 6101 et seq.) or
with respect to an otherwise qualified individual with a disability as provided in Section 504 of the Rehabilitation Act of 1973
(29 U.S.c. 12131 et seq.) shall also apply to any such program or activity.
participate in the Results-Oriented Management and Accountability (ROMA) System, and describe outcome measure to be
used to measure performance in promoting self-sufficiency, farnily stability, and/or community revitalization;
make available for public inspection each plan prepared as part of the program planning process. The grantee may, at its
initiative, revise any plan prepared for CSBG funding and shall furnish the revised plan to the Director of the Community
Services Block Grant under the Department of Local Affairs. Each plan prepared for submission shall be made available for
public inspection within the county and/or service area in such a manner as will facilitate review of, and comments on, the
plan;
cooperate with the State, to determine whether grantee performance goals, adrninistrative standards, financial management
requirements, and other requirements of the State, in conducting monitoring reviews including (I) a full on-site review for
each grantee at least once during each 3-year period, (2) on-site review for each newly designated grantee immediately after
the completion of the first year in which funds were received, (3) follow-up reviews with grantees that fail to meet the goals,
standards, and requirement established by the State, and (4) other reviews as appropriate, including reviews of grantees with
other programs that have had other federal, State, or local grants terminated for cause.
make available appropriate books, documents, papers, and records for inspection, examination, copying, or mechanical
reproduction on or off the premises upon reasonable request by the U.S. Controller General, the State, or their authorized
representatives should an investigation of the uses of CSBG funds be undertaken;
in the case of county governments or subgrantees which receive a CSBG award in excess of $1 00,000, cornply with the
following three certifications related to the "Limitation on use of appropriated funds to influence certain Federal Contracting
and financial transactions (P.L. 101-121, Section 319 and USC Title 31 Section 1352)":
1. No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or
employee of Congress, or an ernployee of a Member of Congress in connection with the awarding of any Federal
contract, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative
agreement.
2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of
Congress, or any employee ofa Member of Congress in connection with this Federal contract, grant, loan, or
cooperative agreernent, the undersigned shall cornplete and submit Standard Form LLL, "Disclosure Form to Report
Lobbying," in accordance with its instruction.
3. The undersigned shall require that the language of this certification be included in the award docurnent for subawards
at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that
all subrecipients shall certify and disclose accordingly.
The grantee certifies to the best of its knowledge and belief, that it and its principals:
a) are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
covered transactions by any Federal department or agency;
b) have not within a three-ye~tperiod preceding this proposal been convicted or had a civil judgment rendered against
them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a
public transaction; violation of Federal or State antitrust statues or commission of embezzlement, theft, forgery, bribery,
falsification or destruction of records, making false statements, or receiving stolen property;
c) are not presently indicted for otherwise criminally or civilly charged by a governmental entity (Federal, State or local)
with commission of any of the offenses enumerated in paragraph (b) of this certification; and
d) have not within a three-year period preceding this application had one or more public transactions (Federal, State or
local) terminated for cause or default.
i to any of the statements in this certification, please attach an explanation to this application.)
J.....
CONTRACTOR:
If County Grantee: Chairman of the Board of County Commissioners must sign
If Multi-County Service Agency: Chairman of the Board of Directors with delegated contracting authority must sign.
POSITION TITLE: C;lAaI t'Wltwt DATE: .d2/1 /06
COLORADO CSBG CONTRACTOR/SUBCONTRACTOR SUMMARY SHEET
County: Eagle
Implementing Agency: Eagle County Health & Human Services
(Each agency/subcontractor receiving CSBG dollars must complete this form)
Implementing Agency Contact Person: Kathleen Forinash
Complete Mailing Address, including zip: PO Box 660. Eagle Colorado 81631
Phone Number: 970-328-8858 Fax: 970-328-8829
Email Address: kathleen.forinash@eaglecounty.us
Program Period: March 1. 2005 to February 28. 2006 CSBG Award: $40.362
Select ONE Federal Objective
C Employment C Nutrition -,i.Linkages with Other Programs
C Income Management C Self-Sufficiency CHousing
C Emergency Services C Education C Health
Select ONE National Goal/Outcome:
CGoall Low-income people become more self-sufficient. (Family)
CGoal2 The conditions in which low-income people live are improved. (Community)
CGoal3 Low-income people own a stake in their community. (Community)
CGoal 4 Partnerships among supporters and providers of services to low-income people are achieved. (Agency)
CGoal 5 Agencies increase their capacity to achieve results. (Agency)
-r0816 Low-meome people, especially vulnerable populations, acbleve thele potential by strengthening filmlly
and other supportive systems. (Family)
Select ONE National Direct Measure/Indicator (see CSBG National Goals and Outcome Measures sheet): 6.i.7
(i.e. 6.a, l.n, 2.b, etc.)
Low income Target Population: Pregnant women and children birth to five
(i.e. Seniors, Youth, etc.)
Program Dim'or Signatu~ cJu-u--=-- Date, 9vu<~ I~ 2M5
Name and Title: Kathleen Forimlsh. Director of Eagle County Health & Human Services
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2004 Poverty Guidelines for the
48 Contiguous States and the District of Columbia
Poverty 75% 125% of
Size of family unit Guideline Poverty Poverty
1.................... .................... $9,310 $6,983 $11,638
2...................................... .. 12,490 9,368 15,613
3................ ........................ 15,670 11,753 19,588
4........ ................................ 18,850 14,138 23,563
5............ .... ............ ............ 22,030 16,523 27,538
6.... ...................... ........ ...... 25,210 18,908 31,513
.
7...... ....... ..... ......... ............. 28,390 21,293 35,488
8......... .......... ..................... 31,570 23,268 39,463
For family units with more than 8 members, add $3,180 for each
additional member. (The same increment applies to smaller family sizes
also, as can be seen in the figures above.)
III.-19