HomeMy WebLinkAboutC17-334 Community Service Block Grant ApplicationCOLORADO
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Department of Local Affairs
Division of Local Government
COMMUNITY SERVICES BLOCK GRANT (CSBG) PROGRAM
2018-2020 APPLICATION AND PLAN
Due October 2, 2017 at 5:00pm
Applications and all attachments must be submitted electronically in one PDF or ZIP file to
leslie.krupa(cDstate.co.us.
A. GENERAL AND SUMMARY INFORMATION
1. Name/Title of Proposed Project: Eagle County Public Health and Environment Community Health Worker Program
2. Applicant: Eagle County Public Health and
Environment
(In the case of a multi -county service area, please provide the name of the "lead" county or organization).
Federal Tax ID#:84-6000762 DUNS #:08-402-4447-FTB
In the case of a multi -county service area, provide the names of all directly participating counties:
Eagle County
3. Chief Elected Official (In the case of a multi -county application, Chief Elected Official of the "lead" county, Private
Nonprofit organizations, please list Board President.). This person will be listed as Signature Authority in the contract.
Name: Jeanne McQueeney Title: County Commissioner
Mailing Address: PO Box 850 Phone: 970-328-8610
City/Zip: Eaqle, 81631 Alt Phone:
E -Mail Address:
ieanne. mcci ueeneyna. eag lecou nty. us
4. Designated Contact Person This person will be listed as Responsible Administrator in the Contract and will receive
all mailings for the application.
Name: Sarah Kennedy Title: Health Promotions Coordinator
Mailing Address PO Box 660 Phone: 970-328-2607
City/Zip: Eagle, 81631 Alt Phone: 970-471-9232
E -Mail Address: Sarah. kennedy(�eaglecounty.us
5a. House District: 26
5b.Senate District: 5
6. Amount of CSBG Projected FFY18 Allocation 1 $42,023.00
7. Mission Statement: Eagle County's mission is to create a better Eagle County for all.
8. Project Description (Provide three -five sentences summarizing your CSBG program. This will be the summary
statement for your Exhibit B - Scope of Work in the contract):
Eagle County Public Health and Environment (ECPHE) coordinates the Total Health Alliance (THA), which is a
network of health care, law enforcement, non-profit, government agencies, and private behavioral health
practitioners in Eagle County committed to linking ideas, resources and people to currently established
organizations and agencies in Eagle County. ECPHE maintains an agreement with Whole Health, Inc. for
Community Health Worker (CHW) services as part of the THA Resource and Stabilization Team (ReST). The
THA Coordinator and CHW develop and maintain relationships with organizations, community members, and
referred clients in order to drive systemic health integration efforts. The ReST and specifically the CHW offer a
connection and linkage to available services which help fill gaps for community members in need of support
overcoming barriers and local organizations in need of additional collaboration, in order to offer their clients
Page 1 of 14, Revised 2017
C 17-334
and patients connection to additional services outside their scope of work.
9. Date of local public hearing (required prior to submission of application)
Attach publication of hearing notice and hearing minutes to application.
B. CHECKLIST OF REQUIRED ITEMS
This checklist includes requirements for completing the Community Services Block Grant (CSBG) Application and
Plan. Eligible entity should mark all items included in the submission.
Submitted
Document Section
Comments (state use only)
®
A. General and Summary Information Page
®
B. Completed Checklist of Required Items
®
®
C. Tripartite Board Membership Roster
5. Board Minutes approving Community Needs Assessment
®
D. Budget Summary
®
E. Project Eligibility
®
F. Project Information
®
G. Community Needs Assessment
• Includes analysis of information collected directly from low-income
individuals (1.2)
• Includes analysis of information from community partners in assessing
needs and resources (2.2)
• Includes data specific to poverty and its prevalence related to (at a
minimum) gender, age and race/ethnicity for service area (3.2)
• Includes both qualitative and quantitative data (3.3)
• Includes key finding on the causes and conditions of poverty in service area
(3.4)
• Reviewed and accepted by tri -partite board as documented in board minutes
(3.5)
®
H. Community Action Plan
• Identify the strategies and services that will be provided to address the
need, problem or situation.
• Description of the expected outcome for the client or community.
• Projected number of clients and percentage of success expected.
• Description of the measurement tool and process that will be used to
determine success.
• Description of how coordination will occur with other programs
• Description of how CSBG funds will be leveraged with other resources
• Description of any innovative initiatives being undertaken
• Outcome -based, anti -poverty focused and ties directly to community needs
assessment (4.2)
• Demonstrates full use of the ROMA cycle and use of a ROMA certified
trainer (4.3)
• Accepted by tri -partite board as documented in board minutes
®
I. Strategic Plan
• Accepted by tri -partite board as documented in board minutes (6.1)
• Addresses reduction of poverty, revitalization of low income communities,
and/or empowerment of people with low incomes to become more self-
sufficient(6.2)
• Contains family, agency and/or community goals (6.3)
• Customer satisfaction data and customer input is included in process (6.4)
Submitted
Attachments Comments
®
1. W-9 Address on W-9 is where payments will be sent.
®
4. Detailed Budget and Narrative Use formprovided.)
❑
5. Board Minutes approving Community Needs Assessment
Page 2 of 14, Revised 2017
❑ 6. Board Minutes approving Community Action Plan
❑ 7. Board Minutes approving Strategic Plan
❑ 8. Organizational Standards Annual Assessment Submit online by 10/2/17.
Page 3 of 14, Revised 2017
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D. BUDGET SUMMARY
1. Please fill out the budget summary table, based on the CSBG projected FFY18 amount.
Revenue
Provide the projected annual allocation given to you by the State CSBG Office.
CSBG Program FFY18 Projected Budget Amount
TOTAL $42,023.00
Expenses
List budget category subtotals from your detailed budget and narrative. Total must match
projected allocation.
Expenditures by Category
FFY18 Projected Budget Amount
Direct Costs
$38202.90
Sub -recipients (grants and
contracts
$
Indirect Costs (If applicable)
$3820.10
TOTAL
$42,023.00
Please attach a detailed budget with narrative on the budget table
provided with application materials Excel spreadsheet format).
2. 1 certify that CSBG funds will not be used for construction related expenses.
3. 1 certify that CSBG funds will not be used for any type of political activity.
IR
4. 1 certify that CSBG funds will be used in accordance with Uniform Guidance.
IK
E. PROJECT ELIGIBILITY
The purpose of the CSBG program is to alleviate the causes and conditions of poverty in communities. Please select the
Federal Objective(s) and National Goal(s) addressed in this application and plan.
1. Federal Objectives, as listed in IM152. (Select one or more objectives to be addressed in the Community
Action Plan submitted.)
❑ Employment
❑ Education and Cognitive Development
❑ Income, Infrastructure, and Asset Building
❑ Housing
❑ Health and Social/Behavioral Development (includes Nutrition)
❑ Civic Engagement and Community Involvement
❑ Services Supporting Multiple Domains
® Linkages (e.g. partnerships that support multiple domains)
❑ Agency Capacity Building
❑ Other (e.g. emergency management/disaster relief)
2. National Goals, as listed in IM152. (Select one or more national goals to be addressed in the Community Action
Plan submitted.)
Grantee will be expected to report on the results of all CSBG-funded programs in relation to these goals in the CSBG IS Final Reports.
❑ Goal 1: Individuals and Families with low incomes are stable and achieve economic security.
® Goal 2: Communities where people with low incomes live are healthy and offer economic opportunity.
® Goal 3: People with low -incomes are engaged and active in building opportunities in communities.
Page 6 of 14, Revised 2017
F. PROJECT INFORMATION - If applying for Linkages only, indicate `not applicable" for questions 1-4 in this section
and proceed to question 5.
1. Applicant must be able to demonstrate that customers of CSBG programs or services will be low-income
individuals and/or families living at 125% Federal Poverty Level or below. Describe how customer eligibility based
on Federal Poverty Level is determined, evaluated and tracked for the purpose of CSBG program activities.
Not Applicable
2. If the proposed project requires customers to complete an application or there is a selection process (e.g.,
emergency assistance, human services program, etc.), describe what procedures will be used to ensure that
customers receiving assistance will be selected through an open and equitable process and that greatest community
needs are addressed.
Not Applicable
3. Please describe the notification process and grievance procedures for customers who are declined assistance.
Not Applicable
4. If sub -recipients determine customer eligibility, please describe monitoring procedures the eligible entity uses to
ensure the federal poverty level income requirement, selection process and notification/grievance procedures as
listed in Question 1-3 are met. If no sub -recipients are used in this program, please indicate "not applicable."
Not Applicable
5. If applying for Linkages, please describe how services provided will involve community partners, coordinate
services and provide and evaluate community outcomes that address poverty. Please note that "information and
referral" type services are not eligible as linkages. Rather, a coordinated and community -driven strategy to
service delivery at the communitv level must be described and Implemented.
CSBG funds will be used to support a CHW Program. ECPHE serves as the backbone for THA; the
neutral convening agency of the CHW Program as well as a network of community organizations,
agencies, and individuals across many sectors focused on behavioral health issues of the community.
Planning and implementation for the proposed project will be led by ECPHE Healthy Communities Unit
staff. The Health Promotion Coordinator has day-to-day responsibilities for the Alliance, including carrying
out the organization's goals and policies. The CHW, through ECPHE's contract with Whole Health, a
subsidiary of Mind Springs Health, the local behavioral health provider, is an integral partner to the
THA. A CHW has been employed to work with a designated care team, made of the same community
organizations and agencies that make up the THA, to provide coordinated case referrals, and support for
identified high -need patients who are in need of additional support in order to get connected to resources
and services.
Although the THA's main focus is on behavioral health issues, much of the support provided by the CHW
to referred clients directly addresses social determinants of health, with almost all clients facing financial
Page 7 of 14, Revised 2017
challenges that contribute to their mental health. ECPHE knows that poverty can be linked to mental
health and can either be a determinant or consequence of poor mental health, with a prevalence of mental
illness for those individuals who are of low economic status (Langner & Michael, 1963).
For clients referred to the program, success will be measured through increase in life functioning using the
18 item, Life Functioning Index, as well as a pre/post client evaluation assessing clients day-to-day living.
The pre/posttest is a validated tool already being used by Whole Health CHWs in five other Colorado
counties. This will be implemented with ReST clients in order to develop a better understanding of the
impact of the CHW's support as clients are better connected to the resources, including financial, that are
available.
G. COMMUNITY NEEDS ASSESSMENT
1. Describe the community needs assessment methods and process used to determine the needs to be
addressed in this Community Action Plan. If serving multiple counties, describe how the community needs
assessment process gathered information from all participating counties. Be sure to include how low-income
as wen as
contnouteo to tnis community neeos assessment.
A Community Health Assessment was conducted in 2012 and again in 2016/2017 using the Nominal Group
Process to identify strengths and concerns in our community. Many different groups, including community
members from low income neighborhoods, multi -sector collaboratives, and government groups, were brought
together to discuss the needs of the Eagle County community. From that process, mental health has
continued to be identified as a community priority.
2. Describe community demographic data specific to poverty and its prevalence related to (at a minimum) gender,
age and race/ethnicity for the service area in this community needs assessment. Identify the source used to
determine this information.
Eagle County has a significantly higher median income level than the state, at $86,729 and $73,817
respectively (Community Commons, abstracted August 2016). Also, the percentage of residents living in
poverty is lower, at 7.8 percent in Eagle County and 12.0 percent in Colorado (QuickFacts, Census.gov;
Community Commons, both abstracted August 2016). However, Eagle County's cost of living is high, so that
even residents that live well above the Federal Poverty Level (FPL) may not make enough income to meet
their basic needs.
In 2015, male full-time employees in Eagle County had an average salary of $48,218, 1.18 times more than
their female counterparts at $41,000, both well below the median income level for the County. The largest
age groups living in poverty are males age 18-24 and 45-54 respectively, and females age 25-34. The most
common race or ethnicity living below the poverty line in Eagle County, CO is white at 49.5%, followed
by Hispanic or Latino at 39.2% (US Census Bureau).
The Self -Sufficiency Standard for Colorado outlines the costs needed to have basics to be able to support
oneself or a family, without public assistance. The standard looks at costs related to housing, food,
transportation, etc. in a county and then computes the salary needed to be able to afford those basics. The
Self -Sufficiency Standard for Eagle County in dollars is $51,641. Income disparity by race/ethnicity is higher
in Eagle County than the state level. With 0 being no disparity and > 40 being high disparity, Eagle County
shows high disparity at 41.75, and the state of Colorado shows some disparity at 33.76. (Community
Commons; The Self -Sufficiency Standard for Colorado 2015, Colorado Center on Law and Policy).
3. Describe how both qualitative and quantitative data were incorporated into the design and execution of the
community needs assessment, Include the community resources available and those that are lacking, as
identified in the community needs assessment. Identify any internal and external sources of data that were used
in the process. Identify any barriers to data collection that were encountered in the process.
Page 8 of 14, Revised 2017
ECPHE has found, and continues to find, through multiple community health assessments that Mental Health
and Substance Abuse are a priority for the community. The Nominal Group process was used to bring to light
the concerns of community members and their thoughts around local gaps, and further local, state and
national data was collected to back up these findings.
Through this process, ECPHE knows that there is a gap in the behavioral health services available. The
closest treatment or respite facilities are located more than two hours' drive by car, and the costs for most are
not feasible as few of the outpatient behavioral health providers in the area take Medicaid. Those that do take
Medicaid are constantly overwhelmed with their caseload.
Additionally, community organizations and community members have taken the initiative to bring this topic
and the need for more help to the attention of others through publicly held walks to support mental health and
suicide prevention, movie screenings, and community discussions. A walk to bring attention to the
importance of mental health was held in May of this year in which over a 100 community members
participated. The walk ended with a resolution read by the Eagle County Board of County Commissioners
acknowledging the importance of mental health and their pledge to support mental health in our communities.
From the information collected through ECPHE's regional health assessment, ECPHE knows that mental
health, substance use, and lack of access to services and housing are a large priority for our community. The
linkages that a Community Health Provider can provide along with collaborative efforts from community
partners can help with this community concern.
4. Based on the results of the community needs assessment, what are the key causes and conditions of poverty
in the service area? What are the needs or conditions (economic or otherwise) contributing to poverty in the
community tnat this aDDncation ano Dian win aooress-!
Eagle County is located in Colorado's Rural Resort Region. Eagle County has a year round population of
approximately 53,000 individuals, with peaks in seasonal workers and tourists increasing the population to
approximately 155,000 during several months out of the year. Peaks in population further strain emergency
rooms and other programs available to year round community members. The region has long been known for
tourism, transient seasonal workers and a resort lifestyle. High cost of living and relatively low and unstable
pay contribute to financial strain. Although the median income for the County is high, the actual salary for
many local residents falls far below median income. Public transportation in the community does not connect
with the all areas in the community, leaving individuals to walk much further distances to needed services
than they would in an urban area. Additionally resources for all health care are extremely limited for low and
middle income residents and seasonal workers. Many behavioral health providers are unable to accept
insurance or Medicaid due to perceived administrative barriers which increases the cost of care if it is
available.
High cost of services is also paired with a lack of options when it comes to housing, transportation, medical
and behavioral health services. There are some social services available to help individuals overcome the
financial barriers; however, navigating the complex medical or social services that are provided to help people
get ahead can be a hurdle in themselves. Further support is needed to promote connectedness to available
help in a cost-effective way.
H. COMMUNITY ACTION PLAN (3 YEARS)
1. What specific strategies and services will be employed through the community action plan to address the needs
identified in the community needs assessment? Click here for examples from the new annual report.
Linkages is the specific strategy utilized.
2. Describe the expected outcomes for the customers or community that will be achieved. Include the projected
Page 9 of 14, Revised 2017
number of unduplicated customers to be served and the projected success rate. Indicate whether each outcome
is a familv. aaencv or communitv level outcome.
The ultimate results will be increased cohesive coordination among key community partners in order to most
effectively advance linkages between agencies and for individuals in need of help from available resources in
Eagle County. ECPHE expects to make connections and linkages between the more than 30 organizations
that are part of the THA, as well as their clients. ECPHE will reach out to additional organizations and
agencies that are currently not a part of the THA, but would benefit from being part of a network of shared
communication. The community level outcome would be an increase in donated time, working with community
partners to support connection to resources which would help community members overcome financial and
behavioral barriers.
3. How will success be measured? Include the outcome indicators, the data collection and/or measurement
tool, the person(s) responsible for evaluation and the frequency of data collection and evaluation. Include
both quantitative and qualitative evaluation techniques. Click here for examples from the new annual report.
For clients referred to the program success will be measured through increase in life functioning using the 18
item, Life Functioning Index, as well as a pre/post client evaluation assessing clients day-to-day living. The
pre/posttest is a validated tool already being used by Whole Health CHWs in five other Colorado counties.
This will be implemented with ReST clients in order to develop a better understanding of the impact of the
CHW's support and enable staff to develop a better "definition of success" for the project.
Success will also be measured through an increase in client referrals from local organizations/agencies as well
as the number of organizations that refer to the THA ReST program. Overall satisfaction with the quality of
linkages provided will be addressed as well. A CHW will be responsible for data reporting and an independent
evaluator will be responsible for the evaluation of data.
4. What other community entities, organizations, or stakeholders recognize the value of this program as
partners in this plan? Please describe how your partners are contributing to this project and how services will be
uescnoe now ouniication of services wiii oe avoioeo.
The THA ReST evolved from community partners and stakeholders who identified the needs for additional
wrap around services for individuals falling through the cracks. It began accepting referrals in July 2016.
Referrals are typically made for clients already connected with at least one medical and/or behavioral health
provider, and need support to prevent another crisis or from re-entering the system. When the ReST receives
a referral from community organizations/agencies, members work together to develop a care plan for the
individual, which is implemented by a CHW. The CHW is trained to help individuals reach their health goals
while connecting them with available medical, behavioral, and social services, as needed, to improve life
functioning, and help reach financial stability. Much of the support provided by the CHW directly addresses
social determinants of health.
The members of the ReST team are made up of individuals from multiple sectors of the community (law
enforcement, social services, and medical/behavioral health personnel). Their collective knowledge helps
create a more robust list of referrals for the client as well as gives them a firsthand look at the program and
what can be offered by the CHW. The ReST members also serve as a needed resource for the CHW when
they need further help in making a connection for a client.
Although other organizations have employees focused on helping clients connect to available resources or
navigate the medical system, the CHW becomes a resource for these employees when their clients/patients
need further help and support that is out of their scope of work. The CHW is able to support clients' needs
while navigating multiple systems, making connections to available resources, working on personal goals,
while offering informal counseling and building resiliency over time. The CHW does not duplicate services but
Page 10 of 14, Revised 2017
rather increases and broadens the support for clients that they had not previously had.
5. Describe how CSBG funds are leveraged with other cash and in-kind resources in the community. In what ways
does Ubb(3 till gaps in services or address unmet needs in the comm
CSBG funds will be leveraged to support a CHW and help link individuals to services in which they are having
trouble accessing, or did not know existed. Besides the THA Coordinator, CHW, and Evaluator, all other
members of the THA ReST are committed volunteers. ECPHE estimates that general members of the THA
contribute a minimum of two days/annually to the THA initiative, and those attending monthly ReST meetings
an additional three days. Further assessment on growth of the program and funds needed for any growth are
required to thoroughly answer this.
Many organizations have a limited amount of time and a large case load that limits the time spent connecting
their clients/patients to available resources. The CHW main focus is to be the link for clients to connect to
available resources and for organizations that may benefit from a collaborative effort where collective
knowledge expands the network of resources. The CHW's time with each client is not limited to a certain
number of visits or time. The CHW spends as much time as needed with each client and referring
organization to get all to a point where each can navigate the medical or social services available with limited
time.
6. How is Results Oriented Management and Accountability (ROMA) — the 5 -step process of assessment,
planning, implementation, achievement of results and evaluation — used in your agency and program? Describe
how you achieve each of the five stens in the process.
Assessment — ECPHE has been in the process of completing a 3 county regional Community Health
Assessment, with Garfield and Pitkin Counties. This draft, which is still in production, is attached to the
application.
Planning — From the last Community Health Assessment mental health/substance abuse was identified as a
community identified priority. Barriers created by social determinants of health, including financial strain, are a
major cause of mental health problems such as anxiety and stress.
Implementation — Due to the barriers created by social determinants of health, including financial strain, the
ReST was created where a CHW offers individualized help and support to referred clients to overcome
barriers affecting their mental health. A referral network is created to more effectively link patients to local,
culturally appropriate and contextually competent professionals and services.
Achievement of results — The CHW will follow each client to measure their life functioning and give a pre/post
assessment to each. Evaluation measures have been created to measure success.
Evaluation — The CHW, along with an independent evaluator, will analyze data and compare pre/post results
and life functioning of clients as well as measure success through any increase in referrals.
7. When was the last ROMA training accessed by the organization? Who attended, and who provided the training?
ROMA training has not yet been accessed by any member of the ECPHE. ROMA training will be accessed as time and
training are available.
Page 11 of 14, Revised 2017
8. Did a Certified ROMA Trainer review this Community Action Plan prior to submission?
❑ Yes — YES, Josiah Masingale, National certified Master ROMA Trainer
❑ No
Provide the name of the Certified ROMA Trainer who completed the review.
I. STRATEGIC PLAN (5 YEARS)
What is the loner -term vision for the CSBG program at your organization or department? How does this vision
address reduction of poverty, revitalization of low income communities, and/or empowerment of people with low
incomes to become more self-sufficient?
The CHW uses existing networks and resources to identify high needs clients. Through this team planning
process the ReST will appropriately refer clients to existing or expanded resources in the community. The
one-on-one support from the CHW promotes connectedness and resiliency to help clients work through
barriers and confidently conquer their challenges. One of the largest barriers to clients is financial, and the
CHW is able to specifically help these individuals make connections to financial resources in order to easy this
burden.
2. What strengths, weaknesses, opportunities and threats contribute to the organization or department's ability
to achieve the long term vision indicated above. Strengths and weaknesses are internal to the organization.
nities and threats are external to the organization.
The strength of the ReST lies with the commitment of the collaborative membership. Around 30 different
organizations are committed to sharing ideas and resources. Additionally, with the focus and efforts of the
Coordinator and CHW specifically on the ReST program, the opportunity to build new relationships and
strengthen existing relationships has arisen. The need for a devoted coordinator and community health
worker has come up against the lack of current sustainable funding, of which the CSBG funding has helped fill
this gap. An opportunity comes from the increased interest and awareness of the importance of the work of
Community Connectors, such as community health workers. Organizations and agencies are becoming
aware that CHW's can be an added resource rather than a duplication in services.
A weakness for ECPHE's clients comes from the lack of available resources in Eagle County with which to
connect clients. Threats to the ReST program come from the lack of communication with other organizations
that offer help to the community but are not willing to work with or communicate with other community
organizations.
3. What long-term family, agency and/or community -goals are addressed by the strategic plan?
Family Goals: Support given and connections made by the CHW to available services help each client to take
control of the challenges they face.
Agency Goals: Agencies and organizations are made aware of and offered support through the CHW to get
their clients/patients needed help and support outside of what they can provide in their scope of work.
Community Goals: Communities where people with low incomes live are healthy and offer economic
opportunity, and people with low -incomes are engaged and active in building opportunities in communities.
Page 12 of 14, Revised 2017
4. NOW was
inciuoeo in the strategic planning process!
From the beginning planning stages, the THA Coordinator has asked community partner organizations and
community members to provide input on the program process so the program best meets the needs of all
involved. After implementation of the program, the THA Coordinator works with community partners to
continuously troubleshoot and problems and address any changes needed in order to refine the process and
serve each agency better. However, specific customer satisfaction information has not been collected.
5. How are the goals in the strategic plan supported by your community action plan? How will progress be
tracked towards the overall vision and goals expressed in your strategic plan?
Community Goals: Communities where people with low incomes live are healthy and offer economic
opportunity, and people with low -incomes are engaged and active in building opportunities in communities.
This program will create linkages for community members and Eagle County community partners. By
evaluating each client and reviewing their life functioning and pre/post assessment we hope that each
individual will be able to get to a point where they are all able to manage the challenges they face without
reliance on help from the Community Health Worker or community resources. When community members can
overcome the poverty and other social barriers they face they have time to focus on other areas of their lives
such as their health and are able to become more engaged in their own community.
It is already informally known that the CHW program has been a benefit to organizations whose work force is
stretched thin as well as a benefit to the clients they serve in extra added support. As the CHW program
continues it is expected the number of different agencies that refer clients to the program will grow and the
overall satisfaction with the quality of provider navigation increases.
Official BoarAction taken on
2C�
Dat
Submission of this form indicates official action by the applicant's governing board
authorizing application for these funds.
...........................................................................................
To the best of my knowledge and belief, statements and data in this application, including the attached
tables and other documentation, are true and correct and the submission of same has been duly authorized
by the governing body of the applicant/lead jurisdiction and other participating jurisdictions, if any.
Page 13 of 14, Revised 2017
Public Entities:
Signature, hief Elected Official
Esi<Nn l� � GI;�yGLN��
-Wame (typed or printed)
Private Entities:
C& C j C -j O''/p i t 4c -
Title
e 12c..
Date
Signature, Board President
Name (typed or printed)
Title
Date
Page 14 of 14, Revised 2017
Agency Name: Eagle County Public Health
CSBG Budget Detail Explanation
A. Direct Personnel (Salary)
Under Item, list the position for which salary is requested. If the position(s) is (are) not filled, record 'To Hire." If there are multiple positions of the same type/title being funded through
CSBG, record the number of positions under Item as well. Be sure to show under computation the annual salary for positions already funded and the percentage of time devoted to the
program. Only time spent on the CSBG program is allowable. Fringe benefits should be noted separately in Section B.
Item Computation Federal Funds
Eagle County Approximately 10% of PH staff time per month to manage CSBG funds. $ 10,970.00
Department of Public
Health - Grant
Management
Personnel (Salary) Total $ 10,970.00
B. Direct Fringe Benefits
Include fringe benefits for individuals paid by CSBG funds. These should not be included in Section A. Under Item, list the position title(s) for which fringe benefits are requested. If the
position(s) is (are) not filled, record "To Hire." If there are multiple positions of the same type/title being funded through CSBG, record the number of positions under Item as well. Be sure
to show under computation the annual fringe amount for positions funded and the percentage of time devoted to the program. Percentages should correspond with Section A.
Item Computation Federal Funds
Eagle County Approximately 10% of PH staff time per month to manage CSBG funds. $ 4,242.00
Department of Public
Health - Grant
Management
Fringe Benefits Total $ 4,242.00
Direct
Item, indicate the type of travel and training requested. Include the number of individuals if known. Show under computation how amount was determined, including training
ation costs, airfare or mileage, accomodations and per diem or meals/expenses
Total
Item, indicate the type of supplies to be purchased, as is reasonable to predict. Include the number of items and/or frequency of purchase. Show under computation how determined.
tes may be based on prior years budget or projections for planned activities.
Supplies Total $
E. Direct Operating Costs -Services
Under Item, indicate the services (such as Emergency Services, Employment Services, Nutrition Services, etc.) to be provided. Show under computation the detail of services provided
(rent/mortgage assistance, bus passes, food boxes, etc.). This section is ONLY for services performed by your agency and does not include sub -recipients.
Item Description of Services - Include federal objective addressed Federal Funds
Linkages Support services and activities that provide information and referral to programs serving eligible $23,030
individuals, projects undertaken by agencies to identify and prioritize the needs of eligible citizens, and
activities that recruit volunteers and coordinate their activities.
Services Total $ 22,990.90
F. Direct Operating Costs -Other
Under Item, indicate any other direct expenses that do not fit in the above categories. Include the quantity or number of items. Show under computation how determined. This section is for
services performed by your agency and does not include sub -recipients.
Item Computation Federal Funds
Other Total $
G. Total Direct Costs (Sections A -F) Federal Funds
Total Direct Costs Add Sections A -F to total direct costs. $ 38,202.90
H. Sub -Recipients (Includes both sub -grants and sub -contractors.)
Under Item, indicate the name of the sub -recipient. Show under description of services whether the sub recipient is a sub -grantee or sub -contractor, the federal objective(s) addressed and
primary use(s) of funds. Please include any supporting documentation such as board minutes showing sub recipients approved, and/or contracts/IGAs/MOUS with sub -recipients.
Item Description of Services - Include federal objective addressed Federal Funds
Sub -Recipients Total $
1. Sub -Recipients allowable for Indirect Expenses (Limited to first $25,000 of each sub-redpient).
a. Total dollar amount
of sub -recipients less
than $25,000 each
m w=cKrow,am
$
b. Number of sub-
recipients more than
$25,000
rti1sxs.moa«n w
a brn,e ueeM ue su am
unn may ee "cwe�a„
c. it from 2b X $25,000
limit
The sub -recipient total allowable for indirect expenses will calculate in the box to the right fa -c). You will add this amount to the total direct charges to
calculate indirect cost rate in the next section.
J. IndUectt ostlRRate I Federal Funds
1. . Federal negotiated indirect cost rate of _% (Please attach supporting documentation.) Enter _% in green cell here:
Federal Funds
2. .X. . De minimus indirect cost rate of 10%. Enter 10% in green cell here: $3820.10
$ 38,202.90
3. Not claiming an indirect cost rate. (May include administrative costs allocated in Sections A -F.)
$
Total Direct Costs
$ 38,202.90
TOTAL Grant Award (Must match projected allocation.)
$ 42,023.00
(Section G):
Allowable Sub Recipient
$
Total (Section 1):
$
Total Costs eligible for
$ 38,202.9038,202.90
Indirect Rate:
The indirect cost rate indicated multiplied by total costs eligible will calculate in the box to the right.
$ 3,820.10
K. Total Program Budget
Federal Funds
Subtotal Direct Costs (Section G)
$ 38,202.90
Subtotal Sub -Recipients (Section H)
$
Subtotal Indirect Costs - Value once rate is applied to Modified Total Direct Costs (Section J, if applicable)
$ 3,820.10
TOTAL Grant Award (Must match projected allocation.)
$ 42,023.00
