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Home My WebLink AboutC06-220 c' .,If ;-or' L' APPLICATION FOR 2. DATE SUBMITTED: Applicant Identifier 08CH0149 FEDERAL ASSISTANCE 6/19/2006 I :. TYPE OP SUBMISSION 3. DATE RECEIVED BY STATE: State Application Identifier Application Preapplication I 0 Construction o Construction 4. DATE RECEIVED BY FEDERAL AGENCY Federalldentifler I 129 Non-Construction o Non-Construction 5. APPLICANT INFORMATION Legal Name: Eagle County Health & Human Services EHS Organizational Unit: - Department: Eagle County HHS Organizational DUNS: 08402447 Division: Early Childhood Address: Name and telephone number of the person to be contacted on matters I Street: 551 \::lroadway involving this application (give area code) POB 660 Prefix: I First Name: Kathleen I City: Eagle Middle Name: County: Eagle Last Name: Forinash State: CO Zip Code: 81631 Suffix: Country: USA Email: kathleen. forinash@eaglecounty.us 6. EMPLOYER IDENTIFICATION NUMBER (EIN) Phone Number (give area code) Fax Number (give area code) ~ -= 970-328-8858 970-328-8829 8. TYPE OF APPLICATION 7. TYPE OF APPLICANT (enter appropriate letter in box) ~ DNew D Continuation ~ Revision Other (specify) If Revision, enter appropriate letter(s) in box(es): 0 9. NAME OF FEDERAL AGENCY: Other (specify) Office of Head Start 10. CATALOG OF FEDERAL DOMESTIC ~.~ 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: ASSISTANCE NUMBER: Region VIII Home Visitor Institute TITLE (Name of Program): Early Head Start 12. AREAS AFFECTED BY PROJECT (Cities, Counties, States etc.): Eagle County 13. PROPOSED PROJECT: 14. CONGRESSIONAL DISTRICTS OF: Start Date: 1/01/2006 lEnding Date: 12/31/2006 a. Applicant3rd District I b. Project 3rd District 15. ESTIMATED FUNDING 16.15 APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS? a Federal $ 5,893 .00 a. YES THIS PREAPPLlCATION/APPlICATION WAS MADE AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON b Applicant $ 1.475 .00 eState $ o .00 Date b. NO 0 PROGRAM IS NOT COVERED BY E.O. 12372 d Local $ o .00 D OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW e Other $ o .00 f Program Income $ o .00 17.IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? g Total $ 7,368 .00 DYes If 'Yes,' attach an explanation. 0 No 18. TOTHE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION ARE TRUE AND CORRECT. THE DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED a. Authorized Representative Prefix I First Name Peter Middle Name I Last Name Runyon Suffix I I b. Title Chair, BoCe /7.. /~) c. Telephone number 970-328-8806 ~. I d. Signature of Authorized Representative /~~~--;;:;:~::;.:;../' e. Date Signed t.,. ~Ii'. ~ t/ i ....... / Standard Form 424 (Rev.9-2003) Prescribed by OMB Circular A-102 BUDGET INFORMATION -Non-Construction Programs OMS Approval No. 0348-00'44 SECTION/A:aUDGeT SUMMARY '''' Grant Program Catalog of Federal Estimated Unobligated Funds New or Revised Budget Function Domestic Assistance or Activity Number Federal Non-Federal Federal Non-Federal Total (a) (b) 1. Program Operation 93.600 $1,475 $1,475 2. T&TA 93.600 $5,893 $5,893 3. 4. 5. T ctals $5,893 $1,475 $7,368 St;CTIONB . B\JDGeT CATEGORIES 6. Object Class Categories GRANT PROGRAM, FUNCTION OR ACTMTY Total (1) Program Operation (2) T&TA (3) (4) a. Personnel b. Fringe Benefits c. Travel d. Equipment e. Supplies f. Contractual g. Construction h. Other $5,893 $5,893 i Total Direct Charges (sum of 6a - 6h) $5,893 $5,893 j. Indirect Costs k. TOTALS (sum of 6a - 6j) $5,893 $5,893 7. Program Income Authorized for Local Reproduction Standard Form 424A (Rev. 7-97) Prescribed by OMS Circular A-102 08CH0149 / 0 2006 Eagle County Health & Human Services EHS Supplemental EHS Grant Application Home Visitor Institute ....^... .....e'....ii , (a) Grant Program (b) Applicant (c) State (d) Other Sources (e) TOTALS .-- 8. NFS $1,475 $1,475 9. 10. 11. 12. TOTAL (sum oflines 8-11) $1,475 $1,475 SeCTIONtr~FORECASTEP.CASH.NeepS Total for 1st Year 1 st Quarter 2nd Quarter 3rd Quarter 4th Quarter 13. Federal $5,893 $1,473 $1,473 $1,473 $1,474 14. Non-Federal $1,475 $369 $369 $369 $368 15. TOTAL (sum of lines 13 -14) $7,368 $1,842 $1,842 $1,842 $1,842 SECTION E . BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BAl.ANCEOF THE PROJEcT FUTURE FUNDING PERIODS (Years) (a) Grant Program (b) First (c) Second (d) Third (e) Fourth 16. 17. 18. 19. 20. TOTAL (sum of lines 16-19) Sl;CTION F . OTHER BUDGET INFORMATION 21. Direct Charges: I 22. Indirect Charges: 23. Remarks: Authorized for Local Reproduction Standard Form 424A (Rev. 7-97) Page2 08CH0149 I 0 2006 Eagle County Health & Human Services EHS Supplemental EHS Grant Application Home Visitor Institute Supplemental EHS Grant Application Eagle County Health & Human Services EHS 08CH0149 I 000 I 2006 Line Item Budget For Head Start and Early Head Start . >::...; (';OSl'VI Line Item 11. Non-Federal Share HS1EHS ~()Sl flJI I ""';"" - (Cash am~in-kll1<i) . .., h.OTHER 1 Depreciation/Use Allowance 2 Rent 3 Mortgage 4 Utilities, Telephone 5 Building & Child Liability Insurance 6 Building Maintenance/Repair and Other Occupancy 7 Incidental Alterations/Renovations 8 Local Travel 9 Nutrition Services 10 Child Services Consultants 11 Volunteers $0 $0 $1,475 12 Substitutes (if not paid benefits) 13 Parent Services 14 Accounting & legal Services 15 Publications/Advertising/Printing 16 Training or Staff Development $0 $5,893 $0 17 Other TOTAL OTHER (6h) $0 $5,893 $1,475 6/19/20064:15:34 PM 8 Supplemental EHS Grant Application Eagle County Health & Human Services EHS 08CH0149 I 000 I 2006 Line Item Budget For Head Start and Early Head Start r-t'\cot for Une Item HS/EHS Cost for - .' Non-Fed~ral Share PrQgrarn OperatiQns - .... (C~sh an(.tirH~ln(.t) ., '/ ., i. TOTAL DIRECT CHARGES $0 $5,893 $1,475 I j. INDIRECT COSTS I I I I k. TOTALS - ALL BUDGET CATEGORIES $0 $5,893 $1,475 6/19/20064:15:35 PM 9 Eagle County Early Head Start 2006 Region VIII Home Visitor Institute Rapid City, South Dakota Aug. 28 - Sept. 1,2006 Budget and Budget Justification: Item Federal Funds Non-Federal Funds Airline tickets from the Eagle Airport to 59 Professional Rapid City, SD for 4 home visitors and 2 $4,500 volunteer hours @ immediate supervisors: $750/each x 6 $25/hour for self- staff = $4500 assessment. 59 hr x $25 = $1,475 Meals: include breakfast $8.05 and $567.30 lunch $11.50 on Monday August 28th (travel day), Dinner M -F 2 $15 per meal. 6 staff (jiJ $94.55/each for week. Lodging: 3 double occupancy rooms $825.60 Shuttle from airport to at the Holiday Inn for 6 staff. Room hotel provided by hotel. rate with tax for week is $275.20 per room. TOTAL REQUEST $5892.90 $1,475 staff attendina: airline ticket meals lodaina TOTAL Araceli Clark, HV $750.00 $94.55 $275.20 Marcella Estrella, HV $750.00 $94.55 Isabel Lova HV $750.00 $94.55 $275.20 Luz Avila, HV $750.00 $94.55 Rosie Moreno, supervisor $750.00 $94.55 $275.20 Jennie Wahrer, supervisor $750.00 $94.55 Total $4,500.00 $567.30 $825.60 $5,892.90 Budget Narrative Eagle County Early Head Start is a home based option program supporting six home visitors and two direct supervisors. Forty-five children and/or pregnant women are enrolled. Because the program is small direct supervision positions are shared to support all components of performance standards. For example, the EHS Program Director and Health Services Manager are combined positions. The split is 75% Director and 25% Health. Direct supervision is provided for health related topics, screens, well child checks, and immunizations. Family & Community Partnership Manager and child Development and Education Manager is also a combined position: 20% for Family and Community Partnership, 80% Child Development and Education Manager. This position also provides direct supervision in all other aspects including disabilities and general day to day home visit supervision. The program values and appreciates the opportunity to participate in this first regional home visitation institute. This training is of particular interest since the focus will be on best practices in home visitation versus child care centers. - 1 - Eagle County Early Head Start 2006 Region VIII Home Visitor Institute Rapid City, South Dakota Aug. 28 - Sept. 1, 2006 Airline tickets are from the Eagle Regional Airport. Price documented June 15,2006, subject to change. Meals include breakfast and lunch on Monday August 28 at $19.55 per person as this is a travel day starting at 5 :30 am. Dinners for all five nights will be included at $15/meal per person. Friday is also a travel day and dinner is included as return time home is after 9 pm. Lodging is for three double occupancy rooms and includes tax. Shuttle from airport to hotel is provided by the hotel. The EHS training budget will be used with actual expenses being reimbursed by the Region VIII Office. All receipts will be saved and submitted via the Eagle County Reimbursement process. This is a projection budget. Actual budget will be submitted following the Institute when actual figures are calculated. -2-