before starting the project application...24 cfr part 578 and application requirements set forth in...
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Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember: - Only Collaborative Applicants may apply for CoC Planning funds using this application, andonly one CoC Planning application may be submitted during the FY 2017 CoC Program grantcompetition. - Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Program policy questions and problems related to completing the application in e-snaps maybe directed to HUD the HUD Exchange Ask A Question - Project applicants are required to have a Data Universal Numbering System (DUNS) numberand an active registration in the Central Contractor Registration (CCR)/System for Awardmanagement (SAM) in order to apply for funding under the Continuum of Care (CoC) ProgramCompetition. For more information see the FY 2017 CoC Program NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA, including the General Section Technical Correction, and allrequirements and criteria met. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with the instructions found on eachindividual screen - Before completing the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - HUD reserves the right to reduce or reject any new or renewal project that fails to adhere to24 CFR Part 578 and application requirements set forth in the FY 2017 CoC Program NOFA.
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1A. SF-424 Application Type
1. Type of Submission:
2. Type of Application: CoC Planning Project Application
If Revision, select appropriate letter(s):
If "Other", specify:
3. Date Received: 09/18/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier
6. Date Received by State:
7. State Application Identifier:
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1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: Stark Housing Network Inc
b. Employer/Taxpayer Identification Number(EIN/TIN):
81-4591391
c. Organizational DUNS: 080660057 PLUS 4
d. Address
Street 1: 408 Ninth St. SW
Street 2:
City: Canton
County:
State: Ohio
Country: United States
Zip / Postal Code: 44707
e. Organizational Unit (optional)
Department Name:
Division Name:
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Mrs.
First Name: Melissa
Middle Name:
Last Name: Terrell
Suffix:
Title: Program Administrator
Organizational Affiliation: Melissa Terrell
Telephone Number: (330) 437-3728
Extension: 1728
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Fax Number: (330) 451-6550
Email: [email protected]
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1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (state(s)only):
(for multiple selections hold CTRL+Key)
Ohio
15. Descriptive Title of Applicant's Project: CoC Planning Project Application FY2017
16. Congressional District(s):
a. Applicant: OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL+Key)
OH-013, OH-016, OH-007
17. Proposed Project
a. Start Date: 10/01/2017
b. End Date: 09/30/2018
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Mr.
First Name: Kurt
Middle Name:
Last Name: Williams
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 451-6550
Fax Number:(Format: 123-456-7890)
(330) 451-6550
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 09/18/2017
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1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: Stark Housing Network Inc
Prefix: Mr.
First Name: Kurt
Middle Name:
Last Name: Williams
Suffix:
Title: Executive Director
Organizational Affiliation: Kurt Williams
Telephone Number: (330) 451-6550
Extension:
Email: [email protected]
City: Canton
County:
State: Ohio
Country: United States
Zip/Postal Code: 44707
2. Employer ID Number (EIN): 81-4591391
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$79,890
(Requested amounts will be automatically entered within applications)
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5. State the name and location (streetaddress, city and state) of the project or
activity:
CoC Planning Project Application FY2017 408Ninth St. SW Canton Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
No
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Kurt Williams, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/16/2017
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: Stark Housing Network Inc
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
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accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Mr.
First Name: Kurt
Middle Name
Last Name: Williams
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 451-6550
Fax Number:(Format: 123-456-7890)
(330) 451-6550
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 09/18/2017
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CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
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the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: Stark Housing Network Inc
Name / Title of Authorized Official: Kurt Williams, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 09/18/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: Stark Housing Network Inc
Street 1: 408 Ninth St. SW
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44707
11. Information requested through this form is authorized by title 31U.S.C. section 1352. This disclosure of lobbying activities is a materialrepresentation of fact upon which reliance was placed by the tier above
when this transaction was made or entered into. This disclosure isrequired pursuant to 31 U.S.C. 1352. This information will be available for
public inspection. Any person who fails to file the required disclosureshall be subject to a civil penalty of not less than $10,000 and not more
than $100,000 for each such failure.
I certify that this information is true andcomplete.
X
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Authorized Representative
Prefix: Mr.
First Name: Kurt
Middle Name:
Last Name: Williams
Suffix:
Title: Executive Director
Telephone Number: (Format: 123-456-7890)
(330) 451-6550
Fax Number: (Format: 123-456-7890)
(330) 451-6550
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 09/18/2017
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2A. Project Detail
1a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
1b. Collaborative Applicant Name: Stark County Regional Planning Commission
2. Project Name: CoC Planning Project Application FY2017
3. Component Type: CoC Planning Project Application
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2B. Project Description
1. Provide a description that addresses the entire scope of the proposedproject and how the Collaborative Applicant will use grant funds tocomply with the provisions of 24 CFR 578.7.
The Stark Housing Network (SHN) is the designated Collaborative Applicant forthe Stark County CoC. SHN will utilize the planning funds to ensure compliancewith HEARTH Act provisions outlined in 24CFR 578.7 and furthering of themission of the CoC, which is to prevent and end homelessness in Stark County.The SHN has been developed to manage and coordinate the activities of theCoC. In May 2017 the Homeless Continuum of Care of Stark County approvedthe Collaborative Applicant to be designated to the Stark Housing Network uponits receipt of the IRS recognition as a charitable organization. The SHN receivedits letter of recognition in June 2017. The goals and objectives of the planninggrant are to ensure that all responsibilities of the CoC are being executed whichincludes holding Member Board Committee meetings with published agendasand minutes; annually publishing a request for new members to join; monitoringeach of the CoC and ESG funded recipients (through status reports and onsitemonitoring); ensuring all required policies and procedures are developed,adopted and implemented; that successful outcomes are being achieved;assisting various committees and sub-committees of the Homeless Continuumof Care of Stark County (the CoC) by providing staffing and research on bestpractices, assisting with annual gaps analysis, an annual point-in-time count,ensuring consistent participation of recipients in HMIS and compliance of HMIS,establishing performance targets, assessing project and system- wideoutcomes, developing review and ranking tools to determine need for re-allocation and prioritization of project ranking (committees: Recipient Approval &Evaluation, HMIS, Centralized Intake & Assessment, and System Performance;sub-committees: Youth Homelessness, Quality Assurance Workgroups-Shelter/Outreach, Prevention/Rapid Re-Housing and TransitionalHousing/Permanent Supportive Housing); being the link between CoCcommittees as well as liaison for partnering community groups, such as theHomeless Services Collaborative efforts in the community around increasingemployment opportunities for under/unemployed, discharge planning effortsfrom mental health, healthcare, foster care, and correctional facilities and for thedevelopment of affordable housing. SHN will be responsible for the preparationand writing of the CoC application and the CoC’s geographic area’sConsolidated Plans; continue to assist, through comprehensive review, withimprovements and modifications to further move from a program approach to asystems approach, to bring continuity with overall coordination of ESG, CoC,and State of Ohio funded activities, with providing a more effective, efficientand client-focused stream of housing and services for those experiencinghomelessness and with meeting the federal goals of Opening Doors.
2. Describe the estimated schedule for the proposed activities, themanagement plan, and the method for assuring effective and timelycompletion of all work.
All agencies receiving any type of federal or state homeless funding (HCRP and
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CoC) will be required to submit monthly status reports to the SHN. Statusreports will be required to be submitted by the 15th of each month for thepreceding report period (i.e reports for the month of November are due no laterthan December 15th). Email notices will be sent to those agencies that do notsubmit a report by the 15th of each month. Regular tardiness in submittingmonthly status reports will be noted and discussed at the following quarterlymeeting of the Recipient Approval & Evaluation Committee. Review of statusreports provides the opportunity to intervene if it appears that problems orconcerns may exist, rather than waiting until the onsite monitoring as potentialproblems could be averted prior to becoming more troublesome. Annual on-sitemonitoring began for each CoC and State funded Homeless Crisis ResponseProgram (HCRP), in 2013 with the previous Collaborative Applicant, StarkCounty Regional Planning Commission, and will continue with the SHN. Thescheduling of the on-site monitoring is currently for 6 months after the beginningof the most current grant start date but may be adjusted according to project orsystem needs. Written monitoring reports will be sent to the agencies within 30days of the monitoring, with the agencies given 30 days to respond to anyconcerns or findings following their post-monitoring letter. The HomelessContinuum of Care of Stark County (HCCSC) Board approves of a Work Planannually which details assigned tasks for each committee, sub-committee andworkgroup. The SHN’s assistance with various committees of the HCCSC onmeeting Work Plan assignments has already begun and will be on-going. CoCPlanning Activity reports are sent to the Board monthly prior to HCCSC Boardmeetings to provide opportunity for discussion be Board of CoC PlanningActivities. The SHN will ensure that minutes of all HCCSC Board, Executivecommittee, Committee and Members meetings are taken and posted on theCoC’s website according to the timeframes stipulated in the GovernanceCharter. Accurate and timely posting of minutes is monitored by the HCCSCsecretary. The management of the planning activities will be conducted by theStark Housing Network. The Executive Director of the SHN will have directinvolved in the management plan to ensure effective execution. The ExecutiveCommittee will evaluate the SHN as the Collaborative Applicant on an annualbasis and assure timely completion of all work.
3. How will the requested funds improve the CoC's ability to evaluate theoutcome of CoC and ESG projects?
During this past year, the previous Collaborative Applicant entered into acontract with the Jurisdiction’s ESG recipient (the City of Canton) to assist withthe administering of the ESG program funding. Assistance includes monitoringESG grant recipients, adapting the annual application and scoring tool to alignwith HUD, local CoC, County and City of Canton priorities. The previousCollaborative Applicant prepared the ESG application and it was approved bythe City of Canton. After that, the Collaborative Applicant sent out the Requestfor Proposal to the public. Following this, the applications were scored andevaluated through the CoC’s Recipient, Approval and Evaluation committee.This committee recommended to the City of Canton the priority of ESG fundingfor the applicants and the city approved the recommendation. As the StarkHousing Network, Inc. is the new Collaborative Applicant, the process that wasdescribed is anticipated to be the same. This process has also allowed foreffective collaboration and consistent delivery of ESG funding aligning with CoCpriorities. The requested funds will enable the Stark Housing Network to reviewand monitor CoC and ESG projects, report outcomes, concerns, successes and
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any findings on a quarterly basis to the Recipient, Approval and EvaluationCommittee. These activities will enable the CoC to determine whether or notgoals and performance targets are being achieved and if funding expendituresare being managed properly for both ESG and CoC projects. This process willallow for more project accountability, analysis for future fundingrecommendations and for the CoC and ESG projects are working togethereffectively to form a city and county wide coordinated system of care for thosestruggling with homelessness.
4. How will the planning activities continue beyond the expiration of HUDfinancial assistance?
The County, Cities, providers and various entities within the CoC geographicregion continue to seek the effectiveness of the work of the HomelessContinuum of Care of Stark County (the CoC). The Stark Housing Networkcurrently receives some funding for the administration of State of Ohio fundedhomeless programs. Stark Housing Network also receives funding from citydevelopment block grant from the three cities that receive funding in StarkCounty. Other assistance comes from United Way of Greater Stark County,Sisters of Charity Foundation and Stark Mental Health and Recovery Addiction.It is the CoC’s goal that additional and ongoing funding and leverage supportcan be secured from various sources in order to continue and even planningefforts necessary to continue beyond the expiration of HUD financial assistance.Furthermore, it is expected that CoC Committees will be more prepared tocontinue some of the work that has set in motion by the policies and proceduresnow in place. Efforts to raise awareness and develop community partnershipsaround the HCCSC goals of ending homelessness in Stark County have beenincreased during 2016 and 2017.
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3A. Governance and Operations
1. How often does the CoC conduct meetingsof the full CoC membership?
Semi-Annually
2. Does the CoC include membership of ahomeless or formerly homeless person?
Yes
2a. For members who are homeless or formerly homeless, what role dothey play in the CoC membership? (Select all that apply)
Participates in CoC meetings:X
Votes, including electing Coc Board:X
Sits on CoC Board:X
None:
3. Does the CoC's governance charter incorporate written policies andprocedures for each of the following
a. Written agendas of CoC meetings? Yes
b. Coordinated Entry? (Also known ascentralized or coordinated assessment)
Yes
c. Process for monitoring outcomes of ESGrecipients?
Yes
d. CoC policies and procedures? Yes
e. Written process for board selection? Yes
f. Code of Conduct for board members thatincludes a recusal process?
Yes
g. Written standards for administeringassistance?
Yes
4. Were there any written complaints receivedby the CoC in relation to project review,
project selection, or other items related to 24CFR 578.7 or 578.9 within the past 12
months?
No
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3B. Committees
Provide information for up to five of the most active CoC-wide planning committees,subcommittees and/or workgroups, to address homeless needs in the CoC’s geographic areathat recommend and set policy priorities for the CoC, including a brief description of the role andthe frequency of the meetings. Only include committees, subcommittees and/or workgroups, thatare directly involved in CoC-wide planning and not the regular delivery of services.
Committee Name Role of the Committee(max 750 characters)
MeetingFrequency
Name of Individuals and/orOrganizations Represented
Executive Committee Consists of officers and immediate pastchair of HCCSC. Coordinates, monitors,and ensures the quality and transparencyof the HCCSC's work; develops slate ofBoard candidates for election by HCCSCmembers from recommendationssolicited from those members;recommends committee chairs andmembers; evaluates Board directors andcommittee chairs; develops annualcommittee work plans; plans agendas forBoard meetings; reviews performance ofCollaborative Applicant, HMIS Lead, andCoC Director annually; reviewsgovernance charter in consultation withCollaborative Applicant and HMIS Lead;works with task force of HCCSCmembers every five years to review andrecommend to members changes inBoard selection process
Monthly Sisters of Charity Foundation, Stark Regional PlanningCommission (SCRPC), Stark Mental Health andAddiction Recovery (StarkMHAR), Stark HousingNetwork, Community Volunteer
System PerformanceCommittee
Oversees annual PIT Count; conductsannual gaps analysis; prepare for publicdistribution and annual report on theHCCSC’s performance; recommendssystem priorities for use in rankingrequests for ESG and CoC funding;provides information required to informdevelopment of consolidated plan; workswith government, providers, and fundersto evaluate and allocate funds availablefor homeless programs, including ESGfunds; oversees and synthesizes work ofvarious subcommittees and task forcesthat examine particular issues relating tosystem needs and developsrecommendations for addressing thoseneeds; consult with CoC recipients todevelop performance measures andtracks CoC’s system-wide program inmeeting those measures.
Monthly United Way, SCRPC, City of Massillon, City of Canton,StarkMHAR, Stark Housing Network, ICAN Housing,HMIS/Homeless Hotline, SMHA, Refuge of Hope, StarkCommunity Foundation, Sisters of Charity Foundation,Formerly Homeless
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Recipient Approval &Evaluation Committee
Oversees process of introducing neworganizations to CoC and helping themearn CoC endorsement for efforts toraise funds from private and publicsources; manages a collaborativeprocess for inviting and reviewing CoCand ESG applications; scores and ranksprojects for CoC, ESG, and Ohio’sHomeless Crisis Response Programfunding, using scoring forms it hasdeveloped based on HUD and localpriorities; oversees grievance proceduresfor non-approved applications; works withrecipients to establish performancetargets; assists CoC Director inmonitoring CoC and ESG recipients, by,among other things, reviewing monthlystatus reports, APRs and monitoringreports; and oversees correctivemeasures taken to improve recipients’performance.
Quarterly SCRPC, Stark Housing Network, Sisters of CharityFoundation, Aultman Hospital, City of Canton, PrivateCPA, Stark Mental Health & Addiction Recovery,Formerly Homeless
Central Intake andAssessment Committee
Develops and refines policies andprocedures governing well establishedcentral intake system, including policiesand procedures for evaluating eligibilityfor assistance and for determining andprioritizing who will receive various typesof services, and how much rent eachprogram participants must pay whilereceiving re-housing assistance; collectsinformation about eligibility requirementsfor individual programs and works withprograms to minimize barriers to service;and works closely with the HMISCommittee to determine how coordinatedassessment can be implementedcompletely and cost effectively usingdata system and tools already in place.
Monthly Sisters of Charity, Stark Housing Network, ACF,SCRPC, HMIS/Homeless Hotline, United Way 211,SHMA, StarkMHAR, City of Canton, CommQuest, ICAN,YWCA, Community Volunteers and Formerly Homeless
HMIS Committee Monitors HUD requirements as well asemerging best practices and models foroperation of an HMIS and makesrecommendations to Board for necessaryor desirable improvements in the system;annually reviews, and, as appropriate,revises for Board approval a privacy plan,security plan, and data quality plan forthe HMIS along with other standards,policies and procedures relating tooperation of the HMIS; oversees HMISLead’s and CHO's compliance with theseplans, policies, and procedures; andalerts the CoC Director to any recurring,significant compliance problems.
Monthly StarkMHAR, Stark Housing Network, CommQuest,Sisters of Charity Foundation, Community Volunteer,HMIS/Homeless Hotline, Alliance for Children andFamilies
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4A. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $19,973
Total Value of In-Kind Commitments: $0
Total Value of All Commitments: $19,973
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Match Type Source Contributor Date ofCommitment
Value ofCommitments
Yes Cash Private Sisters of Charit... 08/17/2017 $19,973
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Sources of Match Details
1. Will this commitment be used towardsMatch?
Yes
2. Type of commitment: Cash
3. Type of source: Private
4. Name the source of the commitment:(Be as specific as possible and include the
office or grant program as applicable)
Sisters of Charity Foundation
5. Date of Written Commitment: 08/17/2017
6. Value of Written Commitment: $19,973
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4B. Funding Request
1. Will it be feasible for the project to beunder grant agreement by September 30,
2019?
Yes
2. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
3. Select a grant term: 1 Year
A description must be entered for Quantity. Any costs without a Quantitydescription will be removed from the budget.
Eligible Costs: Quantity AND Description (max 400 characters)
AnnualAssistanceRequested(Applicant)
1. Coordination Activities .35 FTE 749 hrs/yr at a rate of $40.38 - inc. wages, fringes & indirect exp. Facilitatingand/or participating in all members, board and committee meetings and all workgroups established by the CoC. Keeping and/or tracking of minutes of all Board,Committee and Members mtgs; posting items to website, notices to members andpress in accordance with Gov. Charter ($33,597) Attendance at the state and nationalconferences & HUD trainings ($5,000)
$30,245
2. Project Evaluation .10 FTE 208 hrs/yr at a rate of $40.38 – inc. wages, fringes, & indirect exp. Completeevaluation of projects based on analysis of status reports, quarterly APRs &monitoring outcomes. Serve on the Recipient Approval and Evaluation committee toprovide quarterly feedback on all projects. Assist with update status report,application and scoring forms that fairly evaluate projects, reviewing, recommendingfunding and ranking to the CoC Board.
$8,399
3. Project Monitoring Activities .26 FTE 541 hrs/yr at a rate of $40.38 – inc. wages, fringes, & indirect exp. Reviewmonthly/quarterly status reports and APRs, complete annual on-site monitoring andprovide feedback to projects. Assist with problem solving, corrective action, and anyother necessary items following a review of monitoring, status reports or clientgrievances against projects. Report findings and concerns to Recipient, Approval andEvaluation Committee.
$21,846
4. Participation in the Consolidated Plan
.03 FTE 62 hrs/yr at a rate of $40.38 – inc. wages, fringes, & indirect exp. Attend andgive input at all Consolidated Planning Meetings. Participate in consolidated planningfor homelessness. Understand the cop of the Con Plan in its entirety and providefeedback and input to the homeless sections of the Con Plans.
$2,504
5. CoC Application Activities .14 FTE 291 hrs/yr at a rate of $40.38 – inc. wages, fringes, & indirect exp. Developand complete the CoC application. Prepare for and conduct the application workshop,manage the pre-application process and review and assist with project priorityevaluation. Complete the CoC consolidated application and review applicationsubmissions prior to submittal.
$11,751
6. Determining Geographical Area to Be Served by the CoC
$0
7. Developing a CoC System $0
8. HUD Compliance Activities .04 FTE 83 hrs/yr at a rate of $40.38 – inc. wages, fringes, & indirect exp. Work withall CoC and ESG funded programs to ensure the programs are in compliance withHUD regulations. Participate in trainings and webinars. Conduct trainings for CoCrecipients, includes travel expenses and cost of trainers and consultants ($1,793)
$5,145
Total Costs Requested $79,890
Cash Match $19,973
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In-Kind Match $0
Total Match $19,973
Total Budget $99,863
Click the 'Save' button to automatically calculate the Total Assistance
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5A. Attachment(s)
Document Type Required? Document Description Date Attached
1. Other Attachment(s) No
2. Other Attachment(s) No
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Attachment Details
Document Description:
Attachment Details
Document Description:
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5B. Certification
A. For all projects:
Fair Housing and Equal OpportunityIt will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because ofrace,color, creed, sex or national origin in housing and related facilities provided with Federalfinancial assistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, or
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disability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. For Rental Assistance Only.
Supportive Services.It will make available supportive services appropriate to the needs of the population served andequal in value to the aggregate amount of rental assistance funded by HUD for the full term ofthe rental assistance.
D. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall attach an explanation behind this page.
Name of Authorized Certifying Official: Kurt Williams
Date: 09/18/2017
Title: Executive Director
Applicant Organization: Stark Housing Network Inc
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me to
X
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criminal, civil, or administrative penalties .(U.S. Code, Title 218, Section 1001).
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6A. Submission Summary
Page Last Updated
1A. SF-424 Application Type No Input Required
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 09/18/2017
1E. SF-424 Compliance 08/16/2017
1F. SF-424 Declaration 08/16/2017
1G. HUD 2880 08/16/2017
1H. HUD 50070 08/16/2017
1I. Cert. Lobbying 08/16/2017
1J. SF-LLL 08/21/2017
2A. Project Detail 09/18/2017
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2B. Description 09/18/2017
3A. Governance and Operations 08/16/2017
3B. Committees 08/16/2017
4A. Match 09/18/2017
4B. Funding Request 09/18/2017
5A. Attachment(s) No Input Required
5B. Certification 08/22/2017
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Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember:
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources. - Program policy questions and problems related to completing the application in e-snaps maybe directed to HUD the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS) numberand an active registration in the Central Contractor Registration (CCR)/System for AwardManagement (SAM) in order to apply for funding under the Fiscal Year (FY) 2017 Continuum ofCare (CoC) Program Competition. For more information see FY 2017 CoC ProgramCompetition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2017 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - New projects may only be submitted as either Reallocated or Permanent Supportive HousingBonus Projects. These funding methods are determined in collaboration with local CoC and it iscritical that applicants indicate the correct funding method. Project applicants mustcommunicate with their CoC to make sure that the CoC submissions reflect the same fundingmethod. - Before completing the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - HUD reserves the right to reduce or reject any new project that fails to adhere to (24 CFR part578 and application requirements set forth in FY 2017 CoC Program Competition NOFA.
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1A. SF-424 Application Type
1. Type of Submission:
2. Type of Application: New Project Application
If Revision, select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/14/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
6. Date Received by State:
7. State Application Identifier:
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1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: Stark County Mental Health & AddictionRecovery
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-6002718
c. Organizational DUNS: 795065549 PLUS 4:
d. Address
Street 1: 121 Cleveland Avenue S.W.
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702
e. Organizational Unit (optional)
Department Name: Partner Solutions
Division Name:
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Ms.
First Name: Emily
Middle Name: Kennedy
Last Name: Provance
Suffix:
Title: Manager of Resource Development
Organizational Affiliation: Stark County Mental Health & AddictionRecovery
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Telephone Number: (330) 430-3948
Extension:
Fax Number: (330) 454-2484
Email: [email protected]
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1C. SF-424 Application Details
9. Type of Applicant: B. County Government
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (state(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: Stark County Central Intake and Assessment
16. Congressional District(s):
a. Applicant: OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
17. Proposed Project
a. Start Date: 07/01/2018
b. End Date: 06/30/2019
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Mr.
First Name: John
Middle Name: Robert
Last Name: Aller
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-6644
Fax Number:(Format: 123-456-7890)
(330) 454-2484
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/14/2017
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1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: Stark County Mental Health & AddictionRecovery
Prefix: Mr.
First Name: John
Middle Name: Robert
Last Name: Aller
Suffix:
Title: Executive Director
Organizational Affiliation: Stark County Mental Health & AddictionRecovery
Telephone Number: (330) 455-6644
Extension:
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44702
2. Employer ID Number (EIN): 34-6002718
3. HUD Program: Continuum of Care Program
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4. Amount of HUD AssistanceRequested/Received:
$74,900.00
(Requested amounts will be automatically entered within applications)
5. State the name and location (street address, City and State) of theproject or activity.
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
No
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: John Aller, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/07/2017
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: Stark County Mental Health & AddictionRecovery
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
2. Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application.Refer to addresses entered into the attached project application.
I hereby certify that all the information stated X
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herein, as well as any information provided inthe accompaniment herewith, is true and
accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Mr.
First Name: John
Middle Name Robert
Last Name: Aller
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-6644
Fax Number:(Format: 123-456-7890)
(330) 454-2484
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/14/2017
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CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
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the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: Stark County Mental Health & AddictionRecovery
Name / Title of Authorized Official: John Aller, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/14/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: Stark County Mental Health & AddictionRecovery
Street 1: 121 Cleveland Avenue S.W.
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702
11. Information requested through this form is authorized by title 31U.S.C. section 1352. This disclosure of lobbying activities is a materialrepresentation of fact upon which reliance was placed by the tier above
when this transaction was made or entered into. This disclosure isrequired pursuant to 31 U.S.C. 1352. This information will be available for
public inspection. Any person who fails to file the required disclosureshall be subject to a civil penalty of not less than $10,000 and not more
than $100,000 for each such failure.
I certify that this information is true and X
Applicant: Stark County Mental Health & Addiction Recovery 361509854Project: Stark County Central Intake and Assessment 153105
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complete.
Authorized Representative
Prefix: Mr.
First Name: John
Middle Name: Robert
Last Name: Aller
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-6644
Fax Number:(Format: 123-456-7890)
(330) 454-2484
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/14/2017
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2A. Project Subrecipients
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards:Organization Type Sub-
AwardAmount
This list contains no items
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2B. Experience of Applicant, Subrecipient(s), andOther Partners
1. Describe the experience of the applicant and potential subrecipients (ifany), in effectively utilizing federal funds and performing the activitiesproposed in the application, given funding and time limitations.
Stark MHAR has been a recipient of HUD CoC funding since 2009, as the HMISLead Agency for the HCCSC of Stark County. Stark MHAR also receivesFederal ESG and CDBG funding through the City of Canton and has beententatively awarded CDBG funds through Stark County, the City of Alliance andthe City of Massillon (pending federal funding authorization), local funding fromprivate foundations and United Way. Stark MHAR has had no negative auditfindings and has expended funds in a timely manner.
2. Describe the experience of the applicant and potential subrecipients (ifany) in leveraging other Federal, State, local, and private sector funds.
StarkMHAR has extensive experience leveraging federal, state, local andprivate sector funds. This includes CDBG, ESG, and HOME federal funds;HCRP state funding; and numerous local foundation and non-profit funds.
3. Describe the basic organization and management structure of theapplicant and subrecipients (if any). Include evidence of internal andexternal coordination and an adequate financial accounting system.
In September and October of 2009, administrative responsibility for the StarkCounty Homeless Hotline and HMIS was assumed by Stark County MentalHealth & Addiction Recovery via the in-house Partner Solutions (formerlyHeartland East). Partner Solutions is a department of StarkMHAR whichdelivers information technology services to fifteen counties and providesmember enrollment and claims processing services as well as a wide array ofdatabase and reporting functions for the member boards and contractedprovider agencies.
4a. Are there any unresolved monitoring oraudit findings for any HUD grants(includingESG) operated by the applicant or potential
subrecipients (if any)?
No
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3A. Project Detail
1a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
1b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
2. Project Name: Stark County Central Intake and Assessment
3. Project Status: Standard
4. Component Type: SSO
5. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
1. Provide a description that addresses the entire scope of the proposedproject.
Coordinated entry processes help communities prioritize assistance based onvulnerability and severity of service needs to ensure that people who needassistance the most can receive it in a timely manner. Coordinated entryprocesses also provide information about service needs and gaps to helpcommunities plan their assistance and identify needed resources. TheHomeless Continuum of Care of Stark County has designated Stark MHAR’sphone-based Homeless Navigation (also known as the Homeless Hotline) toserve as the continuum’s provider of Coordinated Entry. Homeless NavigationSpecialists collect client information during the initial telephone contact utilizinga Diversion Tool which allows Specialists to pre-screen callers to ascertain ifadditional assessment is needed before diversion or referral. Specialists enterdata in HMIS for clients who have not been diverted. All clients are assessedusing SPADT or F-SPDAT and placed on the Central Prioritization List foremergency shelter and/or housing (if not immediately available). Stark CountyCentral Intake & Assessment began serving clients in Fall 2014. Additionally,HMIS staff conduct all SPDAT/FSDPAT trainings. The Central Intake &Assessment infrastructure provides for efficient use of staff time, accuracy ofdata collection and entry, effective and logical database management and SQLreporting done timely and accurately. This project is located at the Stark CountyMental Health & Addiction Recovery in Canton, serving the entire Stark Countyarea.
2. Describe the estimated schedule for the proposed activities, themanagement plan, and the method for assuring effective and timelycompletion of all work.
Project estimated to begin 7.1.18 and expend all funds within 12 months.Centralized Intake and Assessment staff: gather demographic, situational andfinancial data from clients and client families who are in need of shelter andconducting an assessment of their needs; open client records and cases in theHMIS, meeting federal requirements for data needs; provide information andreferral assistance to callers; work with bed inventory to refer clients to sheltersbased on available beds, client needs and shelter requirements; assist shelterswith data entry needs including programs and services, training andtroubleshooting access difficulties;provide customer service support to shelters,other area agencies, county and federal entities related to shelter and servicesfor homeless individuals and families. Timely completion of work is assured byproject supervisor.
* 3. Please identify the project's specific population focus.
(Select ALL that apply)Chronic Homeless
XDomestic Violence
X
Applicant: Stark County Mental Health & Addiction Recovery 361509854Project: Stark County Central Intake and Assessment 153105
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VeteransX
Substance AbuseX
Youth (under 25)X
Mental IllnessX
FamiliesX
HIV/AIDSX
Other(Click 'Save' to update)
4. Please select the type of SSO project: Coordinated Entry
4a. Will the coordinated entry process fundedin part by this grant cover the CoC’s entire
geographic area?
Yes
4b. Will the coordinated entry process fundedin part by this grant be easily accessible?
Yes
4c. Describe the advertisement strategy for the coordinated entry processand how it is designed to reach those with the highest barriers toaccessing assistance.
Centralized Intake and Assessment is well-advertised throughout the county. Inaddition to prominent positioning on the CoC website, the Homeless Hotline isalso advertised and marketed through numerous social service agencies, 211,local government, law enforcement/judicial organizations, and community-based organizations.
4d. Does the coordinated entry process use acomprehensive, standardized assessment
process?
Yes
4e. Describe the referral process and how the coordinated entry processensures that participants are directed to appropriate housing and/orservices.
All clients are assessed using SPADT or F-SPDAT and placed on the CentralPrioritization List for emergency shelter and/or housing (if not immediatelyavailable). Stark County Central Intake & Assessment began serving clients inFall 2014. Additionally, HMIS staff conduct all SPDAT/FSDPAT trainings.
4f. If the coordinated entry process includesdifferences in the access, entry, assessment,
or referral for certain populations, are thosedifferences limited only to the following fivegroups: Chronically Homeless, Individuals,
Yes
Applicant: Stark County Mental Health & Addiction Recovery 361509854Project: Stark County Central Intake and Assessment 153105
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Families, Youth, and Persons At Risk ofHomelessness?
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3C. Project Expansion Information
1. Will the project use an existing homelessfacility or incorporate activities provided by
an existing project?
No
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5D. Discharge Planning Policy
1. Has the state or local governmentdeveloped or implemented a discharge
planning policy or protocol to prevent orreduce the number of persons discharged
from publicly-funded institutions (e.g. healthcare facilities, foster care, correctional
facilities, or mental health institutions) intohomelessness or HUD McKinney-Vento
funded programs?
Yes
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6A. Funding Request
1. Will it be feasible for the project to beunder grant agreement by September 30,
2019?
Yes
2. Is the project proposing to using fundsreallocated from the CoCs annual renewal
demand OR
is the project applying for funding throughthe permanent housing bonus?
Reallocation
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Select a grant term: 1 Year
* 5. Select the costs for which funding isbeing requested:
Supportive Services X
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6F. Supportive Services Budget
Instructions: Enter the quantity and total budget request for each supportive services cost. The requestentered should be equivalent to the cost of one year of the relevant supportive service.
Eligible Costs: The system populates a list of eligible supportive services for which funds canbe requested. The costs listed are the only costs allowed under 24 CFR 578.53.
Quantity AND Description: This is a required field. A quantity AND description must beentered for each requested cost. Enter the quantity in detail (e.g. 1 FTE Case Manager Salary +benefits, or child care for 15 children) for each supportive service activity for which funding isbeing requested. Please note that simply stating “1FTE” is NOT providing “Quantity AND Detail”and limits HUD’s understanding of what is being requested. Failure to enter adequate ‘QuantityAND Detail’ may result in conditions being placed on an award and a delay of grant funding.
Annual Assistance Requested: This is a required field. For each grant year, enter the amountof funds requested for each activity. The amount entered must only be the amount that isDIRECTLY related to providing supportive services to homeless participants.
Total Annual Assistance Requested: This field is automatically calculated based on the sum ofthe annual assistance requests entered for each activity.
Grant Term: This field is populated based on the grant term selected on Screen "6A. FundingRequest" and will be read only.
Total Request for Grant Term: This field is automatically calculated based on the total amountrequested for each eligible cost multiplied by the grant term.
All total fields will be calculated once the required field has been completed and saved.
Additional Resources can be found at the HUD Exchange: https://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources
A quantity AND description must be entered for each requested cost.Eligible Costs Quantity AND Description
(max 400 characters)Annual Assistance
Requested
1. Assessment of Service Needs Staff time to conduct intakes and updates in addition to referrals. $70,000
2. Assistance with Moving Costs
3. Case Management
4. Child Care
5. Education Services
6. Employment Assistance
7. Food
8. Housing/Counseling Services
9. Legal Services
10. Life Skills
11. Mental Health Services
12. Outpatient Health Services
13. Outreach Services
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14. Substance Abuse Treatment Services
15. Transportation
16. Utility Deposits
17. Operating Costs
Total Annual Assistance Requested $70,000
Grant Term 1 Year
Total Request for Grant Term $70,000
Click the 'Save' button to automatically calculate totals.
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6I. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $18,725
Total Value of In-Kind Commitments: $0
Total Value of All Commitments: $18,725
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Match Type Source Contributor Date ofCommitment
Value ofCommitments
Yes Cash Government City of CantonESG
01/02/2017 $18,725
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Sources of Match Detail
1. Will this commitment be used towardsmatch ?
Yes
2. Type of commitment: Cash
3. Type of source: Government
4. Name the source of the commitment:(Be as specific as possible and include the
office or grant program as applicable)
City of Canton ESG
5. Date of Written Commitment: 01/02/2017
6. Value of Written Commitment: $18,725
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6J. Summary Budget
The following information summarizes the funding request for the totalterm of the project. However, administrative costs can be entered in 8.Admin field below.
Eligible Costs Annual AssistanceRequested(Applicant)
Grant Term(Applicant)
Total AssistanceRequested
for Grant Term(Applicant)
1a. Acquisition $0
1b. Rehabilitation $0
1c. New Construction $0
2a. Leased Units $0 1 Year $0
2b. Leased Structures $0 1 Year $0
3. Rental Assistance $0 1 Year $0
4. Supportive Services $70,000 1 Year $70,000
5. Operating $0 1 Year $0
6. HMIS $0 1 Year $0
7. Sub-total Costs Requested $70,000
8. Admin (Up to 10%)
$4,900
9. Total AssistancePlus Admin Requested
$74,900
10. Cash Match $18,725
11. In-Kind Match $0
12. Total Match $18,725
13. Total Budget $93,625
Click the 'Save' button to automatically calculate totals.
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachment(s) No CIA Match-ESG 1.3.17 08/14/2017
3) Other Attachment(s) No
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Attachment Details
Document Description:
Attachment Details
Document Description: CIA Match-ESG 1.3.17
Attachment Details
Document Description:
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7D. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
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It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
15-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 15 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
Where the applicant is unable to certify to any of the statements in thiscertification, such applicant shall provide an explanation.
Name of Authorized Certifying Official: John Aller
Date: 08/14/2017
Title: Executive Director
Applicant Organization: Stark County Mental Health & AddictionRecovery
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
Certification and to ensure compliance. I am
X
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aware that any false, ficticious, or fraudulentstatements or claims may subject me to
criminal, civil, or administrative penalties .(U.S. Code, Title 218, Section 1001).
Applicant: Stark County Mental Health & Addiction Recovery 361509854Project: Stark County Central Intake and Assessment 153105
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8B. Submission Summary
Applicant must click the submit button once all forms have a status ofComplete.
Page Last Updated
1A. SF-424 Application Type No Input Required
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 08/14/2017
1E. SF-424 Compliance 08/07/2017
Applicant: Stark County Mental Health & Addiction Recovery 361509854Project: Stark County Central Intake and Assessment 153105
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1F. SF-424 Declaration 08/07/2017
1G. HUD 2880 08/07/2017
1H. HUD 50070 08/07/2017
1I. Cert. Lobbying 08/07/2017
1J. SF-LLL 08/07/2017
2A. Subrecipients No Input Required
2B. Experience 08/14/2017
3A. Project Detail 08/14/2017
3B. Description 08/14/2017
3C. Expansion 08/14/2017
5D. Discharge Policy 08/14/2017
6A. Funding Request 08/07/2017
6F. Supp Srvcs Budget 08/14/2017
6I. Match 08/14/2017
6J. Summary Budget No Input Required
7A. Attachment(s) 08/14/2017
7D. Certification 08/14/2017
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Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
Applicant: Alliance for Children & Families 609962550Project: B-FIRST PSH 154848
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1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/12/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0536
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
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1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: Alliance for Children & Families
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-1590276
c. Organizational DUNS: 609962550 PLUS 4 1111
d. Address
Street 1: 624 Scranton Ave.
Street 2:
City: Alliance
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44601
e. Organizational Unit (optional)
Department Name: ACF
Division Name: Housing
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Ms.
First Name: Shirene
Middle Name: Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Executive Director
Organizational Affiliation: Alliance for Children & Families
Telephone Number: (330) 821-6332
Applicant: Alliance for Children & Families 609962550Project: B-FIRST PSH 154848
Renewal Project Application FY2017 Page 3 09/22/2017
Extension: 0000
Fax Number: (330) 821-8748
Email: [email protected]
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1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: B-FIRST PSH
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
17. Proposed Project
a. Start Date: 05/01/2017
b. End Date: 04/30/2018
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
Applicant: Alliance for Children & Families 609962550Project: B-FIRST PSH 154848
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
Applicant: Alliance for Children & Families 609962550Project: B-FIRST PSH 154848
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Ms.
First Name: Shirene
Middle Name: Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Exeuctive Director
Telephone Number:(Format: 123-456-7890)
(330) 821-6332
Fax Number:(Format: 123-456-7890)
(330) 821-8748
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/12/2017
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1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: Alliance for Children & Families
Prefix: Ms.
First Name: Shirene
Middle Name: Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Exeuctive Director
Organizational Affiliation: Alliance for Children & Families
Telephone Number: (330) 821-6332
Extension: 0
Email: [email protected]
City: Alliance
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44601
2. Employer ID Number (EIN): 34-1590276
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$106,262.00
(Requested amounts will be automatically entered within applications)
Applicant: Alliance for Children & Families 609962550Project: B-FIRST PSH 154848
Renewal Project Application FY2017 Page 9 09/22/2017
5. State the name and location (streetaddress, city and state) of the project or
activity:
B-FIRST PSH 624 Scranton Ave. Alliance Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
No
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Shirene Tapyrik, CEO/Exeuctive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 07/18/2017
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Renewal Project Application FY2017 Page 10 09/22/2017
1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: Alliance for Children & Families
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
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Renewal Project Application FY2017 Page 11 09/22/2017
accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Ms.
First Name: Shirene
Middle Name Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Exeuctive Director
Telephone Number:(Format: 123-456-7890)
(330) 821-6332
Fax Number:(Format: 123-456-7890)
(330) 821-8748
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/12/2017
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Renewal Project Application FY2017 Page 12 09/22/2017
CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
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Renewal Project Application FY2017 Page 13 09/22/2017
the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: Alliance for Children & Families
Name / Title of Authorized Official: Shirene Tapyrik, CEO/Exeuctive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/12/2017
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Renewal Project Application FY2017 Page 14 09/22/2017
1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: Alliance for Children & Families
Street 1: 624 Scranton Ave.
Street 2:
City: Alliance
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44601
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
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Authorized Representative
Prefix: Ms.
First Name: Shirene
Middle Name: Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Exeuctive Director
Telephone Number: (Format: 123-456-7890)
(330) 821-6332
Fax Number: (Format: 123-456-7890)
(330) 821-8748
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/12/2017
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Renewal Project Application FY2017 Page 16 09/22/2017
Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
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2A. Project Subrecipients
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
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2B. Recipient Performance
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
Yes
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
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3A. Project Detail
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Expiring Grant Number: OH0536(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: B-FIRST PSH
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Provide a description that addresses the entire scope of the proposedproject.
The project includes construction of a new housing facility, lease-up andimplementation of a new PSH program.
Housing Facilities: The housing includes construction of a new 10-unitapartment complex, with a 30-bed capacity. The 10-unit complex has a digitalsecurity system that includes remote monitoring. The housing includes on-sitecounseling offices; program space for on-site education and basic health carecheck-ups, and on-site laundry and playground.
Target Population: The program targets homeless families with at least onechronically homeless adult with minor child in the home. Program applicantsmust meet HUD’s definition of homeless and chronically homeless families, withthe most barriers and are viewed at the hardest to house.The target population is expected to have significant issues that have preventedsuccessful entrance into regular housing or successful maintenance ofpermanent housing, indicating a need for on-going support services. Applicantswill be referred through the CoC’s Central intake using the HUD prioritytargeting families with the highest service usage, need, mental health andcriminal barriers. The target population is expected to have the ability to engagein services, address issues that cause homelessness, and actively participate inservices agreed upon in the individualized supportive service plan,understanding that the engagement process is likely to be challenging as thefamilies are taken regardless of housing readiness. However, ACF neverrefuses or exits any participant for non-engagement. Instead, highly trained staffin a progressive engagement model continue to re-offer participants options ofservices and constantly look for services and activities that may be moretailored to the individual tenant participant, instead of having the tenant fit into aone-size-fits-all service/activity.
Program Methodology: B-FIRST uses a micro community model with a holisticapproach to provide comprehensive services in a setting that is sensitive to theneeds of homeless families and children. The program uses the Ansel-Caseyas a standardized measurement and service plans will be established within 30-days of program entry with the participant’s input based on their goals andincorporate services indicated by the Ansel-Casey scores. The program uses astrength based service plan, and behavioral techniques rewarding desiredbehaviors and self-exploration thinking to review poor choices including whatoptions would have been better, focusing on strengths.
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2. Does your project have a specificpopulation focus?
Yes
2a. Please identify the specific population focus. (Select ALL that apply)
Chronic HomelessX
Domestic ViolenceX
Veterans Substance AbuseX
Youth (under 25)X
Mental IllnessX
Families with ChildrenX
HIV/AIDS
Other(Click 'Save' to update)
Other:
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Failure to make progress on a service planX
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Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
3d. Does the project follow a "Housing First"approach?
Yes
4. Does the PH project provide PSH or RRH? PSH
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3C. Dedicated Plus
Dedicated and DedicatedPLUS
A “100% Dedicated” project is a permanent supportive housing projectthat commits 100% of its beds to chronically homeless individuals andfamilies, according to NOFA Section III.3.b.
A “DedicatedPLUS” project is a permanent supportive housing projectwhere 100% of the beds are dedicated to serve individuals with disabilitiesand families in which one adult or child has a disability, includingunaccompanied homeless youth, that at a minimum, meet ONE of thefollowing criteria according to NOFA Section III.3.d:
(1) experiencing chronic homelessness as defined in 24 CFR 578.3; (2) residing in a transitional housing project that will be eliminated and meets the definition ofchronically homeless in effect at the time in which the individual or family entered the transitionalhousing project; (3) residing in a place not meant for human habitation, emergency shelter, or safe haven; butthe individuals or families experiencing chronic homelessness as defined at 24 CFR 578.3 hadbeen admitted and enrolled in a permanent housing project within the last year and were unableto maintain a housing placement; (4) residing in transitional housing funded by a joint TH and PH-RRH component project andwho were experiencing chronic homelessness as defined at 24 CFR 578.3 prior to entering theproject; (5)residing and has resided in a place not meant for human habitation, a safe haven, oremergency shelter for at least 12 months in the last three years, but has not done so on fourseparate occasions; or (6) receiving assistance through a Department of Veterans Affairs(VA)-funded homelessassistance program and met one of the above criteria at initial intake to the VA's homelessassistance system.
A renewal project where 100 percent of the beds are dedicated in their current grant asdescribed in NOFA Section III.A.3.b. must either become DedicatedPLUS or remain 100%Dedicated. If a renewal project currently has 100 percent of its beds dedicated to chronicallyhomeless individuals and families and elects to become a DedicatedPLUS project, the projectwill be required to adhere to all fair housing requirements at 24 CFR 578.93. Any beds that theapplicant identifies in this application as being dedicated to chronically homeless individuals andfamilies in a DedicatedPLUS project must continue to operate in accordance with SectionIII.A.3.b. Beds are identified on Screen 4B.
1. Indicate whether the project is "100%Dedicated", "DedicatedPLUS", or "N/A",
according to the information provided above.
DedicatedPLUS
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4A. Supportive Services for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Applicant Quarterly
Assistance with Moving Costs Non-Partner As needed
Case Management Applicant As needed
Child Care Non-Partner As needed
Education Services Applicant Weekly
Employment Assistance and Job Training Applicant As needed
Food Non-Partner Bi-weekly
Housing Search and Counseling Services Applicant As needed
Legal Services Non-Partner As needed
Life Skills Training Applicant As needed
Mental Health Services Partner As needed
Outpatient Health Services Non-Partner As needed
Outreach Services Applicant As needed
Substance Abuse Treatment Services Partner As needed
Transportation Non-Partner As needed
Utility Deposits Non-Partner As needed
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
Yes
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are received and renewed?
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partneragency?
Yes
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
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4B. Housing Type and Location
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 10
Total Beds: 30
Total Dedicated CH Beds: 30Housing Type Units Beds
Single family homes/townhou... 10 30
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4B. Housing Type and Location Detail
1. Housing Type: Single family homes/townhouses/duplexes
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 10
b. Beds: 30
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
30
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Street 1: 300 Block Linwood Ave., SW
Street 2:
City: Canton
State: Ohio
ZIP Code: 44710
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
390066 Alliance, 390858 Canton, 393114Massillon
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5A. Project Participants - Households
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 10 0 0 10
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 8 0 8
Adults ages 18-24 4 0 4
Accompanied Children under age 18 18 0 18
Unaccompanied Children under age 18 0 0
Total Persons 30 0 0 30
Click Save to automatically calculate totals
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5B. Project Participants - Subpopulations
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 8 0 0 2 0 4 1 0 1 0
Adults ages 18-24 4 0 0 0 0 0 1 0 1 0
Children under age 18 18 0 0 0 4 0 2 0
Total Persons 30 0 0 2 0 4 6 0 4 0
Click Save to automatically calculate totals
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
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5C. Outreach for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
1% Directly from the street or other locations not meant for human habitation.
99% Directly from emergency shelters.
0% Directly from safe havens.
0% Persons fleeing domestic violence.
0% Directly from transitional housing eliminated in the FY 2017 CoC Program Competition.
Directly from the TH Portion of a Joint TH and PH-RRH Component project.
Persons receiving services through a Department of Veterans Affairs(VA)-funded homeless assistance program.
100% Total of above percentages
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6A. Funding Request
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Do any of the properties in this projecthave an active restrictive covenant?
No
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
Yes
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Leased Units
Leased Structures
Rental Assistance
Supportive Services X
Operating X
HMIS
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6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $0
Total Value of In-Kind Commitments: $26,779
Total Value of All Commitments: $26,779
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.Match Type Source Contributor Date of
CommitmentValue ofCommitments
Yes In-Kind Private PhoenixBehaviora...
08/11/2017 $6,779
Yes In-Kind Private Lattanzi &Associ...
08/11/2017 $7,000
Yes In-Kind Private Canton CitySchools
08/11/2017 $7,500
Yes In-Kind Private ACF Donations 08/11/2017 $5,500
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Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Phoenix Behavioral Healh Services
5. Date of Written Commitment: 08/11/2017
6. Value of Written Commitment: $6,779
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Lattanzi & Associates, LLC
5. Date of Written Commitment: 08/11/2017
6. Value of Written Commitment: $7,000
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
Sources of Match Detail
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1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Canton City Schools
5. Date of Written Commitment: 08/11/2017
6. Value of Written Commitment: $7,500
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
ACF Donations
5. Date of Written Commitment: 08/11/2017
6. Value of Written Commitment: $5,500
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
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6E. Summary Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $0
1b. Leased Structures $0
2. Rental Assistance $0
3. Supportive Services $24,690
4. Operating $74,553
5. HMIS $0
6. Sub-total Costs Requested $99,243
7. Admin (Up to 10%)
$7,019
8. Total Assistanceplus Admin Requested
$106,262
9. Cash Match $0
10. In-Kind Match $26,779
11. Total Match $26,779
12. Total Budget $133,041
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No
3) Other Attachment No
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Attachment Details
Document Description:
Attachment Details
Document Description:
Attachment Details
Document Description:
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7A. In-Kind Match MOU Attachment
Document Type Required? Document Description Date Attached
In-Kind Match MOU No
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Attachment Details
Document Description:
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7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
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It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Shirene Tapyrik
Date: 08/12/2017
Title: CEO/Exeuctive Director
Applicant Organization: Alliance for Children & Families
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
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Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
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Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Submit without changes
The applicant has selected “Submit without changes” to Question 2above. If the applicant has identified project information on the precedingscreens that does not match the current contract, select “Make changes”above and update the relevant project information.
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8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/11/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 08/11/2017
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1E. SF-424 Compliance 08/11/2017
1F. SF-424 Declaration 08/11/2017
1G. HUD-2880 08/11/2017
1H. HUD-50070 08/11/2017
1I. Cert. Lobbying 08/11/2017
1J. SF-LLL 08/11/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/11/2017
3A. Project Detail 08/11/2017
3B. Description 08/11/2017
3C. Dedicated Plus 08/11/2017
4A. Services 08/11/2017
4B. Housing Type 08/11/2017
5A. Households 08/11/2017
5B. Subpopulations No Input Required
5C. Outreach 08/11/2017
6A. Funding Request 08/11/2017
6D. Match 08/12/2017
6E. Summary Budget No Input Required
7A. Attachment(s) No Input Required
7A. In-Kind Match MOU Attachment No Input Required
7B. Certification 08/12/2017
Submission Without Changes 08/11/2017
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Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
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1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/15/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0571
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
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1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: ICAN Inc.
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-1575839
c. Organizational DUNS: 189042914 PLUS 4
d. Address
Street 1: 1214 Market Ave N
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44714
e. Organizational Unit (optional)
Department Name:
Division Name:
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Mrs.
First Name: Natalie
Middle Name:
Last Name: McCleskey
Suffix:
Title: Development Director
Organizational Affiliation: ICAN Inc.
Telephone Number: (330) 455-9100
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Renewal Project Application FY2017 Page 3 09/22/2017
Extension: 150
Fax Number: (330) 455-4702
Email: [email protected]
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1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: ICAN CoC Rapid Re-Housing II
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-016, OH-007
17. Proposed Project
a. Start Date: 09/01/2017
b. End Date: 08/31/2018
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-9100
Fax Number:(Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
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1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: ICAN Inc.
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Organizational Affiliation: ICAN Inc.
Telephone Number: (330) 455-9100
Extension:
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44714
2. Employer ID Number (EIN): 34-1575839
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$11,209.00
(Requested amounts will be automatically entered within applications)
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5. State the name and location (streetaddress, city and state) of the project or
activity:
ICAN CoC Rapid Re-Housing II 1214 Market AveN Canton Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
Yes
Part II Other Government Assistance Provided or Requested/ExpectedSources and Use of Funds
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance,payment, credit, or tax benefit.
Department/Local Agency Name and Address Type of Assistance AmountRequested /
Provided
Expected Uses of the Funds
Ohio Development Services Agency, 77 S. HighStreet, Columbus, OH 43215
Grant $19,851.00 Cherry Grove - Maintainance, Utilitiesand Insurance
Ohio Development Services Agency, 77 S. HighStreet, Columbus, OH 43215
Grant 37834.0 Rapid Re-Housing - Salaries andBenefits
Stark Mental Health & Addiction Recovery, 121Cleveland Ave SW, Canton, OH 44702
Grant $45,389.00 Shelter Plus Care and West Park -Supportive Services; Peer Support;Employment; Critical TimeInterventionist Salary; Benefits andTravel
Part III Interested Parties
You must disclose:1. All developers, contractors, or consultants involved in the application for the assistance or in
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the planning, development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which theassistance is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower).
Alphabetical list of all persons with areportable financial interest in the
project or activity (For individuals, give the last name
first)
Social Security No.or Employee ID No.
Type ofParticipation
Financial Interestin Project/Activity
($)
Financial Interestin Project/Activity
(%)
NA NA NA $0.00 0%
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Julie Sparks, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/14/2017
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: ICAN Inc.
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
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accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-9100
Fax Number:(Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
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CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
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the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: ICAN Inc.
Name / Title of Authorized Official: Julie Sparks, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: ICAN Inc.
Street 1: 1214 Market Ave N
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44714
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
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Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number: (Format: 123-456-7890)
(330) 455-9100
Fax Number: (Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
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Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
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2A. Project Subrecipients
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards:Organization Type Type Sub-
AwardAmount
This list contains no items
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2B. Recipient Performance
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
No
Explain why the APR for the most recently expired grant term related tothis renewal project request has not been submitted.
First time renewal and grant term has not yet expired.
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
No
Explain why the recipient has not maintained consistent QuarterlyDrawdowns for the most recent grant term related to this renewal projectrequest.
First time renewal and just received first Grant Agreement in August 2017.
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
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3A. Project Detail
1. Expiring Grant Number: OH0571(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: ICAN CoC Rapid Re-Housing II
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
1. Provide a description that addresses the entire scope of the proposedproject.
Housing Stability: ICAN Housing’s Rapid Re-Housing Coordinator will providefinancial assistance for security deposits, utility deposits and rental assistanceas needed. Households must pay 30% of the monthly adjusted income for rent.The Coordinator will provide housing search and placement assistance andhousing stability case management to help participants retain their housing,thereby reducing the number of homeless episodes. Participants will attend atleast one case management session per month. The sessions will be heldmore frequently as needed.
Assistance with Increasing Employment Income: ICAN Housing maintainslongstanding and successful collaborative relationships with providers in StarkMental Health and Addiction Recovery (SMHAR) system, homeless serviceproviders, and Stark County Department of Jobs and Family Services (DJFS).ICAN staff will provide information and referrals to clients to attend training andemployment appointments. Staff will use Motivational Interviewing to helpparticipants address ambivalence and navigate through the stage of change.
Linking to Mainstream Services: ICAN staff will provide detailed information andreferrals to clients regarding mainstream services and financial assistance, andwill follow up with clients regarding utilization via phone and in casemanagement sessions. The Agency conducts follow-ups with participants toensure mainstream benefits are received and renewed. ICAN Housingmaintains longstanding and successful collaborative relationships with StarkCounty Department of Jobs and Family Services & the Social SecurityAdministration.
ICAN provides tenants access to SSI/SSDI technical assistance through referralto a SOAR-trained case manager. Referrals for move in items, furniture andbus passes provide additional relief.
2. Does your project have a specificpopulation focus?
Yes
2a. Please identify the specific population focus. (Select ALL that apply)
Chronic Homeless Domestic Violence
Veterans Substance Abuse
Youth (under 25) Mental Illness
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Families with ChildrenX
HIV/AIDS
Other(Click 'Save' to update)
Other:
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
3d. Does the project follow a "Housing First"approach?
Yes
4. Does the PH project provide PSH or RRH? RRH
Is this an SHP Project that had been approvedby HUD to change the renewal project budget
from leasing to rental assistance?
No
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4A. Supportive Services for Participants
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Partner As needed
Assistance with Moving Costs Applicant As needed
Case Management Applicant Monthly
Child Care Non-Partner As needed
Education Services Non-Partner As needed
Employment Assistance and Job Training Partner As needed
Food Non-Partner As needed
Housing Search and Counseling Services Applicant As needed
Legal Services
Life Skills Training Non-Partner As needed
Mental Health Services Partner As needed
Outpatient Health Services Non-Partner As needed
Outreach Services Applicant As needed
Substance Abuse Treatment Services Partner As needed
Transportation Applicant As needed
Utility Deposits Applicant As needed
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
are received and renewed?
Yes
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partner
Yes
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agency?
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
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4B. Housing Type and Location
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 1
Total Beds: 3Housing Type Units Beds
Scattered-site apartments (... 1 3
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4B. Housing Type and Location Detail
1. Housing Type: Scattered-site apartments (including efficiencies)
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 1
b. Beds: 3
3. Address
Street 1: 1214 Market Ave N
Street 2:
City: Canton
State: Ohio
ZIP Code: 44714
4. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
399151 Stark County
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5A. Project Participants - Households
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 1 1
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 1 1
Adults ages 18-24 0
Accompanied Children under age 18 2 2
Unaccompanied Children under age 18 0
Total Persons 3 0 0 3
Click Save to automatically calculate totals
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5B. Project Participants - Subpopulations
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 1
Adults ages 18-24
Children under age 18 2
Total Persons 1 0 0 0 0 0 0 0 0 2
Click Save to automatically calculate totals
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
Describe the unlisted subpopulations referred to above:
Children of participants.
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5C. Outreach for Participants
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
Directly from the street or other locations not meant for human habitation.
100% Directly from emergency shelters.
Directly from safe havens.
Persons fleeing domestic violence.
Directly from transitional housing eliminated in the FY 2017 CoC Program Competition.
Directly from the TH Portion of a Joint TH and PH-RRH Component project.
Persons receiving services through a Department of Veterans Affairs(VA)-funded homeless assistance program.
100% Total of above percentages
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6A. Funding Request
1. Do any of the properties in this projecthave an active restrictive covenant?
No
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
No
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Rental Assistance X
Supportive Services
HMIS
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6C. Rental Assistance Budget
The following list summarizes the rental assistance funding request for thetotal term of the project. To add information to the list, select the icon. Toview or update information already listed, select the icon.
Total Request for Grant Term: $10,476
Total Units: 1
Type of RentalAssistance
FMR Area Total UnitsRequested
Total Request
TRA OH - Canton-Massillon, OH MSA (390199... 1 $10,476
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Rental Assistance Budget Detail
Type of Rental Assistance: TRA
Metropolitan or non-metropolitanfair market rent area:
OH - Canton-Massillon, OH MSA (3901999999)
Does the applicant request rental assistancefunding for less than the area's per unit size
fair market rents?
No
Size of Units # of Units(Applicant)
FMR Area(Applicant)
HUD PaidRent
(Applicant)
12 Months TotalRequest
(Applicant)
SRO x $317 $317 x 12 = $0
0 Bedroom x $422 $422 x 12 = $0
1 Bedroom x $516 $516 x 12 = $0
2 Bedrooms x $684 $684 x 12 = $0
3 Bedrooms 1 x $873 $873 x 12 = $10,476
4 Bedrooms x $938 $938 x 12 = $0
5 Bedrooms x $1,079 $1,079 x 12 = $0
6 Bedrooms x $1,219 $1,219 x 12 = $0
7 Bedrooms x $1,360 $1,360 x 12 = $0
8 Bedrooms x $1,501 $1,501 x 12 = $0
9 Bedrooms x $1,642 $1,642 x 12 = $0
Total Units and Annual AssistanceRequested
1 $10,476
Grant Term 1 Year
Total Request for Grant Term $10,476
Click the 'Save' button to automatically calculate totals.
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6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $2,802
Total Value of In-Kind Commitments: $0
Total Value of All Commitments: $2,802
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Match Type Source Contributor Date ofCommitment
Value ofCommitments
Yes Cash Private ICAN Inc. 08/03/2017 $2,802
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Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
ICAN Inc.
5. Date of Written Commitment: 08/03/2017
6. Value of Written Commitment: $2,802
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6E. Summary Budget
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $0
1b. Leased Structures $0
2. Rental Assistance $10,476
3. Supportive Services $0
4. Operating $0
5. HMIS $0
6. Sub-total Costs Requested $10,476
7. Admin (Up to 10%)
$733
8. Total Assistanceplus Admin Requested
$11,209
9. Cash Match $2,802
10. In-Kind Match $0
11. Total Match $2,802
12. Total Budget $14,011
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No Match Commitment ... 08/09/2017
3) Other Attachment No
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Attachment Details
Document Description:
Attachment Details
Document Description: Match Commitment Letter - RRH II
Attachment Details
Document Description:
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7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
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It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Julie Sparks
Date: 08/15/2017
Title: Executive Director
Applicant Organization: ICAN Inc.
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
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Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
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Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Make changes
3. Specify which screens require changes by clicking the checkbox next tothe name and then clicking the Save button.
Part 2- Recipient and Subrecipient Information
2A. SubrecipientsX
2B. Recipient PerformanceX
Part 3 - Project Information
3A. Project DetailX
3B. DescriptionX
Part 4 - Housing Services and HMIS
4A. ServicesX
4B. Housing TypeX
Part 5 - Participants and Outreach Information
5A. HouseholdsX
5B. SubpopulationsX
5C. OutreachX
Part 6 - Budget Information
6A. Funding RequestX
6C. Rental AssistanceX
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6D. MatchX
6E. Summary BudgetX
Part 7 - Attachment(s) & Certification
7A. Attachment(s)X
7B. CertificationX
The applicant has selected "Make Changes" to Question 2 above. Pleaseprovide a brief description of the changes that will be made to the projectinformation screens (bullets are appropriate):
* As a first time renewal we were unable to use the "Pull Forward" method andhad to enter all of the information on each screen. All responses in the FY2017Renewal Application were the same as those provided in the FY2016 NewApplication for this project other than:
3B. Slight change in project description which eliminates reference to a pilotSupported Employment program4B. Now provides Agency address for "Scattered Sites" address, per theDetailed Instructions.
The applicant has selected "Make Changes". Once this screen is saved,the applicant will be prohibited from "unchecking" any box that has been
checked regardless of whether a change to data on the correspondingscreen will be made.
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8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/07/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 08/14/2017
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1E. SF-424 Compliance 08/07/2017
1F. SF-424 Declaration 08/07/2017
1G. HUD-2880 08/07/2017
1H. HUD-50070 08/07/2017
1I. Cert. Lobbying 08/07/2017
1J. SF-LLL 08/07/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/14/2017
3A. Project Detail 08/07/2017
3B. Description 08/14/2017
4A. Services 08/07/2017
4B. Housing Type 08/10/2017
5A. Households 08/07/2017
5B. Subpopulations 08/07/2017
5C. Outreach 08/07/2017
6A. Funding Request 08/07/2017
6C. Rental Assistance 08/07/2017
6D. Match 08/10/2017
6E. Summary Budget No Input Required
7A. Attachment(s) 08/09/2017
7B. Certification 08/15/2017
Submission Without Changes 08/14/2017
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Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
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1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/14/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0241
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
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1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: Stark County Mental Health & AddictionRecovery
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-6002718
c. Organizational DUNS: 795065549 PLUS 4
d. Address
Street 1: 121 Cleveland Avenue S.W.
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702
e. Organizational Unit (optional)
Department Name: Partner Solutions
Division Name:
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Ms.
First Name: Emily
Middle Name: Kennedy
Last Name: Provance
Suffix:
Title: Manager of Resource Development
Organizational Affiliation: Stark County Mental Health & AddictionRecovery
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Telephone Number: (330) 430-3948
Extension:
Fax Number: (330) 454-2484
Email: [email protected]
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1C. SF-424 Application Details
9. Type of Applicant: B. County Government
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: Stark County HMIS System Coordination
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
17. Proposed Project
a. Start Date: 10/01/2017
b. End Date: 09/30/2018
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Mr.
First Name: John
Middle Name: Robert
Last Name: Aller
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-6644
Fax Number:(Format: 123-456-7890)
(330) 454-2484
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/14/2017
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1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: Stark County Mental Health & AddictionRecovery
Prefix: Mr.
First Name: John
Middle Name: Robert
Last Name: Aller
Suffix:
Title: Executive Director
Organizational Affiliation: Stark County Mental Health & AddictionRecovery
Telephone Number: (330) 455-6644
Extension:
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44702
2. Employer ID Number (EIN): 34-6002718
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$107,446.00
(Requested amounts will be automatically entered within applications)
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5. State the name and location (streetaddress, city and state) of the project or
activity:
Stark County HMIS System Coordination 121Cleveland Avenue S.W. Canton Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
No
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: John Aller, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/07/2017
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: Stark County Mental Health & AddictionRecovery
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
X
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the accompaniment herewith, is true andaccurate.
Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Mr.
First Name: John
Middle Name Robert
Last Name: Aller
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-6644
Fax Number:(Format: 123-456-7890)
(330) 454-2484
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/14/2017
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CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
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the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: Stark County Mental Health & AddictionRecovery
Name / Title of Authorized Official: John Aller, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/14/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: Stark County Mental Health & AddictionRecovery
Street 1: 121 Cleveland Avenue S.W.
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true and X
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complete.
Authorized Representative
Prefix: Mr.
First Name: John
Middle Name: Robert
Last Name: Aller
Suffix:
Title: Executive Director
Telephone Number: (Format: 123-456-7890)
(330) 455-6644
Fax Number: (Format: 123-456-7890)
(330) 454-2484
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/14/2017
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Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
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2A. Project Subrecipients
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
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2B. Recipient Performance
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
Yes
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
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3A. Project Detail
1. Expiring Grant Number: OH0241(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: Stark County HMIS System Coordination
4. Project Status: Standard
5. Component Type: HMIS
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
1. Provide a description that addresses the entire scope of the proposedproject.
The Stark County HMIS system tracks data for the Stark County HomelessContinuum of Care (CoC) in Applied Enginuity System (AES), a relationaldatabase developed and maintained by Adsystech, Inc. Homeless NavigationSpecialists enter initial data for clients who have not been diverted from thehomeless system. Projects verify initial information and gather additional datathat they enter into the software, especially project information, services andoutcomes. HMIS monitors completeness and accuracy of data, self-reportingomissions and errors, and reports to projects, the CoC Board and various CoCCommittees. HMIS also is responsible for entering System Performance data,Data Quality reports, AHAR data, the ESG CAPER, Point-in-Time data (forsheltered and street counts), and for data collection and reporting for the AnnualProject Homeless Connect event, as well as numerous other federal, state localand special project reports on behalf of the Continuum. Additionally, HMIS staffconduct all HMIS Privacy & Security, HMIS 101, HMIS Local Administrator,HMIS by Project Type, Tips and Tricks, and HMIS Agency trainings. The HMISinfrastructure provides for efficient use of staff time, accuracy of data collectionand entry, effective and logical database management and SQL reporting donetimely and accurately. This project is located at the Stark County Mental Health& Addiction Recovery in Canton, serving the entire Stark County area.
2. Does your project have a specificpopulation focus?
No
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4A. HMIS Standards
1a. Is the HMIS currently programmed tocollect all Universal Data Elements (UDE’s) as
set forth in the HMIS Data Standard Notice?
Yes
1b. If no, explain why and the planned steps for compliance. Max. 500 characters
2a. Is the HMIS currently able to produce allHUD-required reports and provide data as
needed for HUD reporting? (i.e., AnnualPerformance Reports, Annual Homeless
Assessment table shells, and data forCAPER/ESG reporting, etc).
Yes
2b. If no, explain why and the planned steps for compliance. Max. 500 characters
3. Can the HMIS currently provide the CoCwith an unduplicated count of clients
receiving services in the CoC?
Yes
4. Does your HMIS implementation have astaff person responsible for insuring the
implementation meets all security standardsas required by HUD and the federal partners?
Yes
5. Does your organization conduct abackground check on all employees who
access HMIS or view HMIS data?
Yes
6. Does the HMIS Lead conduct SecurityTraining and follow up on security standards
on a regular basis?
Yes
7. Do you have a process in place to removecommunity members who no longer needaccess to HMIS (e.g. leave their job, fired,
etc.)
Yes
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a. How long does it take to remove accessrights to former HMIS users?
Within 24 hours
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6A. Funding Request
1. Do any of the properties in this projecthave an active restrictive covenant?
No
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
No
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
HMIS X
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6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $26,862
Total Value of In-Kind Commitments: $0
Total Value of All Commitments: $26,862
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Match Type Source Contributor Date ofCommitment
Value ofCommitments
Yes Cash Government Stark CountyMent...
08/10/2017 $26,862
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Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Government
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Stark County Mental Health and AddictionRecovery
5. Date of Written Commitment: 08/10/2017
6. Value of Written Commitment: $26,862
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6E. Summary Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $0
1b. Leased Structures $0
2. Rental Assistance $0
3. Supportive Services $0
4. Operating $0
5. HMIS $100,417
6. Sub-total Costs Requested $100,417
7. Admin (Up to 10%)
$7,029
8. Total Assistanceplus Admin Requested
$107,446
9. Cash Match $26,862
10. In-Kind Match $0
11. Total Match $26,862
12. Total Budget $134,308
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No HMIS Match 10.1.1... 08/14/2017
3) Other Attachment No
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Attachment Details
Document Description:
Attachment Details
Document Description: HMIS Match 10.1.17 to 9.30.18
Attachment Details
Document Description:
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7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
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It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official John Aller
Date: 08/14/2017
Title: Executive Director
Applicant Organization: Stark County Mental Health & AddictionRecovery
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized by X
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the applicant to submit this ApplicantCertification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
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Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Make changes
3. Specify which screens require changes by clicking the checkbox next tothe name and then clicking the Save button.
Part 2- Recipient and Subrecipient Information
2A. Subrecipients
2B. Recipient Performance
Part 3 - Project Information
3A. Project DetailX
3B. DescriptionX
Part 4 - Housing Services and HMIS
4A. HMIS StandardsX
Part 5 - Participants and Outreach Information
Part 6 - Budget Information
6A. Funding RequestX
6D. MatchX
6E. Summary Budget
Part 7 - Attachment(s) & Certification
7A. Attachment(s)X
7B. CertificationX
The applicant has selected "Make Changes" to Question 2 above. Pleaseprovide a brief description of the changes that will be made to the project
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information screens (bullets are appropriate):
Changes include an update to project description and verification for accuracy.
The applicant has selected "Make Changes". Once this screen is saved,the applicant will be prohibited from "unchecking" any box that has been
checked regardless of whether a change to data on the correspondingscreen will be made.
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8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/07/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 08/14/2017
1E. SF-424 Compliance 08/07/2017
1F. SF-424 Declaration 08/07/2017
1G. HUD-2880 08/07/2017
1H. HUD-50070 08/07/2017
1I. Cert. Lobbying 08/07/2017
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1J. SF-LLL 08/07/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/07/2017
3A. Project Detail 08/07/2017
3B. Description 08/14/2017
4A. HMIS Standards 08/07/2017
6A. Funding Request 08/07/2017
6D. Match 08/14/2017
6E. Summary Budget No Input Required
7A. Attachment(s) 08/14/2017
7B. Certification 08/07/2017
Submission Without Changes 08/14/2017
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Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
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1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/17/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0569
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
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1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: ICAN Inc.
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-1575839
c. Organizational DUNS: 189042914 PLUS 4
d. Address
Street 1: 1214 Market Ave N
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44714
e. Organizational Unit (optional)
Department Name:
Division Name:
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Mrs.
First Name: Natalie
Middle Name:
Last Name: McCleskey
Suffix:
Title: Development Director
Organizational Affiliation: ICAN Inc.
Telephone Number: (330) 455-9100
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Extension: 150
Fax Number: (330) 455-4702
Email: [email protected]
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1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: ICAN CoC Rapid Re-Housing I
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
17. Proposed Project
a. Start Date: 09/01/2017
b. End Date: 08/31/2018
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-9100
Fax Number:(Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/17/2017
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1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: ICAN Inc.
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Organizational Affiliation: ICAN Inc.
Telephone Number: (330) 455-9100
Extension:
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44714
2. Employer ID Number (EIN): 34-1575839
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$85,000.00
(Requested amounts will be automatically entered within applications)
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5. State the name and location (streetaddress, city and state) of the project or
activity:
ICAN CoC Rapid Re-Housing I 1214 Market AveN Canton Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
Yes
Part II Other Government Assistance Provided or Requested/ExpectedSources and Use of Funds
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance,payment, credit, or tax benefit.
Department/Local Agency Name and Address Type of Assistance AmountRequested /
Provided
Expected Uses of the Funds
Ohio Development Services Agency, 77 S. HighStreet, Columbus, OH 43215
Grant $19,851.00 Cherry Grove - Maintainance, Utilitiesand Insurance
Ohio Development Services Agency, 77 S. HighStreet, Columbus, OH 43215
Grant 37834.0 Rapid Re-Housing - Salaries andBenefits
Stark Mental Health & Addiction Recovery, 121Cleveland Ave SW, Canton, OH 44702
Grant $45,389.00 Shelter Plus Care and West Park -Supportive Services; Peer Support;Employment; Critical TimeInterventionist Salary; Benefits andTravel
Part III Interested Parties
You must disclose:1. All developers, contractors, or consultants involved in the application for the assistance or in
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the planning, development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which theassistance is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower).
Alphabetical list of all persons with areportable financial interest in the
project or activity (For individuals, give the last name
first)
Social Security No.or Employee ID No.
Type ofParticipation
Financial Interestin Project/Activity
($)
Financial Interestin Project/Activity
(%)
NA NA NA $0.00 0%
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Julie Sparks, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/14/2017
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: ICAN Inc.
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
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accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-9100
Fax Number:(Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/17/2017
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CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
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Renewal Project Application FY2017 Page 14 09/22/2017
the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: ICAN Inc.
Name / Title of Authorized Official: Julie Sparks, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/17/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: ICAN Inc.
Street 1: 1214 Market Ave N
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44714
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
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Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number: (Format: 123-456-7890)
(330) 455-9100
Fax Number: (Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/17/2017
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Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
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2A. Project Subrecipients
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
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2B. Recipient Performance
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
No
Explain why the APR for the most recently expired grant term related tothis renewal project request has not been submitted.
First time renewal and grant term has not yet expired.
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
No
Explain why the recipient has not maintained consistent QuarterlyDrawdowns for the most recent grant term related to this renewal projectrequest.
First time renewal and just received first Grant Agreement in August 2017.
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
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3A. Project Detail
1. Expiring Grant Number: OH0569(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: ICAN CoC Rapid Re-Housing I
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
1. Provide a description that addresses the entire scope of the proposedproject.
Housing Stability: ICAN Housing’s Rapid Re-Housing Coordinator will providefinancial assistance for security deposits, utility deposits and rental assistanceas needed. Households must pay 30% of the monthly adjusted income for rent.The Coordinator will provide housing search and placement assistance andhousing stability case management to help participants retain their housing,thereby reducing the number of homeless episodes. Participants will attend atleast one case management session per month. The sessions will be heldmore frequently as needed.
Assistance with Increasing Employment Income: ICAN Housing maintainslongstanding and successful collaborative relationships with providers in StarkMental Health and Addiction Recovery (SMHAR) system, homeless serviceproviders, and Stark County Department of Jobs and Family Services (DJFS).ICAN staff will provide information and referrals to clients to attend training andemployment appointments. Staff will use Motivational Interviewing to helpparticipants address ambivalence and navigate through the stage of change.
Linking to Mainstream Services: ICAN staff will provide detailed information andreferrals to clients regarding mainstream services and financial assistance, andwill follow up with clients regarding utilization via phone and in casemanagement sessions. The Agency conducts follow-ups with participants toensure mainstream benefits are received and renewed. ICAN Housingmaintains longstanding and successful collaborative relationships with StarkCounty Department of Jobs and Family Services & the Social SecurityAdministration.
ICAN provides tenants access to SSI/SSDI technical assistance through referralto a SOAR-trained case manager. Referrals for move in items, furniture andbus passes provide additional relief.
2. Does your project have a specificpopulation focus?
Yes
2a. Please identify the specific population focus. (Select ALL that apply)
Chronic Homeless Domestic Violence
Veterans Substance Abuse
Youth (under 25) Mental IllnessX
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Families with ChildrenX
HIV/AIDS
Other(Click 'Save' to update)
Other:
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
3d. Does the project follow a "Housing First"approach?
Yes
4. Does the PH project provide PSH or RRH? RRH
Is this an SHP Project that had been approvedby HUD to change the renewal project budget
from leasing to rental assistance?
No
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4A. Supportive Services for Participants
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Partner As needed
Assistance with Moving Costs Applicant As needed
Case Management Applicant Monthly
Child Care Non-Partner As needed
Education Services Non-Partner As needed
Employment Assistance and Job Training Partner As needed
Food Non-Partner As needed
Housing Search and Counseling Services Applicant As needed
Legal Services
Life Skills Training Non-Partner As needed
Mental Health Services Partner As needed
Outpatient Health Services Non-Partner As needed
Outreach Services Applicant As needed
Substance Abuse Treatment Services Partner As needed
Transportation Applicant As needed
Utility Deposits Applicant As needed
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
are received and renewed?
Yes
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partner
Yes
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agency?
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
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4B. Housing Type and Location
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 9
Total Beds: 22Housing Type Units Beds
Scattered-site apartments (... 9 22
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4B. Housing Type and Location Detail
1. Housing Type: Scattered-site apartments (including efficiencies)
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 9
b. Beds: 22
3. Address
Street 1: 1214 Market Ave N
Street 2:
City: Canton
State: Ohio
ZIP Code: 44714
4. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
399151 Stark County
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5A. Project Participants - Households
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 9 9
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 9 9
Adults ages 18-24 0
Accompanied Children under age 18 13 13
Unaccompanied Children under age 18 0
Total Persons 22 0 0 22
Click Save to automatically calculate totals
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5B. Project Participants - Subpopulations
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 2 2 1 1 5 1
Adults ages 18-24
Children under age 18 13
Total Persons 2 2 1 1 0 5 1 0 0 13
Click Save to automatically calculate totals
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
Describe the unlisted subpopulations referred to above:
Children of participants.
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5C. Outreach for Participants
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
30% Directly from the street or other locations not meant for human habitation.
70% Directly from emergency shelters.
Directly from safe havens.
Persons fleeing domestic violence.
Directly from transitional housing eliminated in the FY 2017 CoC Program Competition.
Directly from the TH Portion of a Joint TH and PH-RRH Component project.
Persons receiving services through a Department of Veterans Affairs(VA)-funded homeless assistance program.
100% Total of above percentages
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6A. Funding Request
1. Do any of the properties in this projecthave an active restrictive covenant?
No
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
No
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Rental Assistance X
Supportive Services
HMIS
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6C. Rental Assistance Budget
The following list summarizes the rental assistance funding request for thetotal term of the project. To add information to the list, select the icon. Toview or update information already listed, select the icon.
Total Request for Grant Term: $82,944
Total Units: 9
Type of RentalAssistance
FMR Area Total UnitsRequested
Total Request
TRA OH - Canton-Massillon, OH MSA (390199... 9 $82,944
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Rental Assistance Budget Detail
Type of Rental Assistance: TRA
Metropolitan or non-metropolitanfair market rent area:
OH - Canton-Massillon, OH MSA (3901999999)
Does the applicant request rental assistancefunding for less than the area's per unit size
fair market rents?
No
Size of Units # of Units(Applicant)
FMR Area(Applicant)
HUD PaidRent
(Applicant)
12 Months TotalRequest
(Applicant)
SRO x $317 $317 x 12 = $0
0 Bedroom x $422 $422 x 12 = $0
1 Bedroom x $516 $516 x 12 = $0
2 Bedrooms 5 x $684 $684 x 12 = $41,040
3 Bedrooms 4 x $873 $873 x 12 = $41,904
4 Bedrooms x $938 $938 x 12 = $0
5 Bedrooms x $1,079 $1,079 x 12 = $0
6 Bedrooms x $1,219 $1,219 x 12 = $0
7 Bedrooms x $1,360 $1,360 x 12 = $0
8 Bedrooms x $1,501 $1,501 x 12 = $0
9 Bedrooms x $1,642 $1,642 x 12 = $0
Total Units and Annual AssistanceRequested
9 $82,944
Grant Term 1 Year
Total Request for Grant Term $82,944
Click the 'Save' button to automatically calculate totals.
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6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $21,250
Total Value of In-Kind Commitments: $0
Total Value of All Commitments: $21,250
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Match Type Source Contributor Date ofCommitment
Value ofCommitments
Yes Cash Private ICAN Inc. 08/03/2017 $21,250
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Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
ICAN Inc.
5. Date of Written Commitment: 08/03/2017
6. Value of Written Commitment: $21,250
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6E. Summary Budget
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $0
1b. Leased Structures $0
2. Rental Assistance $82,944
3. Supportive Services $0
4. Operating $0
5. HMIS $0
6. Sub-total Costs Requested $82,944
7. Admin (Up to 10%)
$2,056
8. Total Assistanceplus Admin Requested
$85,000
9. Cash Match $21,250
10. In-Kind Match $0
11. Total Match $21,250
12. Total Budget $106,250
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No Match Commitment ... 08/09/2017
3) Other Attachment No
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Attachment Details
Document Description:
Attachment Details
Document Description: Match Commitment Letter - RRH I
Attachment Details
Document Description:
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7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
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It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Julie Sparks
Date: 08/17/2017
Title: Executive Director
Applicant Organization: ICAN Inc.
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
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Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
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Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Make changes
3. Specify which screens require changes by clicking the checkbox next tothe name and then clicking the Save button.
Part 2- Recipient and Subrecipient Information
2A. SubrecipientsX
2B. Recipient PerformanceX
Part 3 - Project Information
3A. Project DetailX
3B. DescriptionX
Part 4 - Housing Services and HMIS
4A. ServicesX
4B. Housing TypeX
Part 5 - Participants and Outreach Information
5A. HouseholdsX
5B. SubpopulationsX
5C. OutreachX
Part 6 - Budget Information
6A. Funding RequestX
6C. Rental AssistanceX
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6D. MatchX
6E. Summary BudgetX
Part 7 - Attachment(s) & Certification
7A. Attachment(s)X
7B. CertificationX
The applicant has selected "Make Changes" to Question 2 above. Pleaseprovide a brief description of the changes that will be made to the projectinformation screens (bullets are appropriate):
This is a first time renewal. Therefore we were unable to use the "Pull Forward"method and had to input information on each screen. There were no changesmade from the FY'16 Application other than:* 3B. Slight change in project description eliminating reference to a pilotsupported employment program* 4B. Now provides Agency address for "Scattered Sites" address, per theDetailed Instructions
The applicant has selected "Make Changes". Once this screen is saved,the applicant will be prohibited from "unchecking" any box that has been
checked regardless of whether a change to data on the correspondingscreen will be made.
Applicant: ICAN Inc. 189042914Project: ICAN CoC Rapid Re-Housing I 152350
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8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/17/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 08/17/2017
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Renewal Project Application FY2017 Page 44 09/22/2017
1E. SF-424 Compliance 08/17/2017
1F. SF-424 Declaration 08/17/2017
1G. HUD-2880 08/17/2017
1H. HUD-50070 08/17/2017
1I. Cert. Lobbying 08/17/2017
1J. SF-LLL 08/17/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/17/2017
3A. Project Detail 08/17/2017
3B. Description 08/17/2017
4A. Services 08/17/2017
4B. Housing Type 08/17/2017
5A. Households 08/17/2017
5B. Subpopulations 08/17/2017
5C. Outreach 08/17/2017
6A. Funding Request 08/17/2017
6C. Rental Assistance 08/17/2017
6D. Match 08/17/2017
6E. Summary Budget No Input Required
7A. Attachment(s) 08/17/2017
7B. Certification 08/17/2017
Submission Without Changes 08/17/2017
Applicant: ICAN Inc. 189042914Project: ICAN CoC Rapid Re-Housing I 152350
Renewal Project Application FY2017 Page 45 09/22/2017
Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
Applicant: Alliance for Children & Families 609962550Project: SOHO BONUS 154850
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1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/12/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0534
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
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1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: Alliance for Children & Families
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-1590276
c. Organizational DUNS: 609962550 PLUS 4 1111
d. Address
Street 1: 624 Scranton Ave.
Street 2:
City: Alliance
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44601
e. Organizational Unit (optional)
Department Name: ACF
Division Name: Housing
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Ms.
First Name: Shirene
Middle Name: Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Executive Director
Organizational Affiliation: Alliance for Children & Families
Telephone Number: (330) 821-6332
Applicant: Alliance for Children & Families 609962550Project: SOHO BONUS 154850
Renewal Project Application FY2017 Page 3 09/22/2017
Extension: 0000
Fax Number: (330) 821-8748
Email: [email protected]
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1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: SOHO BONUS
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
17. Proposed Project
a. Start Date: 08/01/2017
b. End Date: 07/31/2018
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Ms.
First Name: Shirene
Middle Name: Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Exeuctive Director
Telephone Number:(Format: 123-456-7890)
(330) 821-6332
Fax Number:(Format: 123-456-7890)
(330) 821-8748
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/12/2017
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1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: Alliance for Children & Families
Prefix: Ms.
First Name: Shirene
Middle Name: Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Exeuctive Director
Organizational Affiliation: Alliance for Children & Families
Telephone Number: (330) 821-6332
Extension: 0
Email: [email protected]
City: Alliance
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44601
2. Employer ID Number (EIN): 34-1590276
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$175,310.00
(Requested amounts will be automatically entered within applications)
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Renewal Project Application FY2017 Page 9 09/22/2017
5. State the name and location (streetaddress, city and state) of the project or
activity:
SOHO BONUS 624 Scranton Ave. Alliance Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
No
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Shirene Tapyrik, CEO/Exeuctive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 07/18/2017
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: Alliance for Children & Families
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
Applicant: Alliance for Children & Families 609962550Project: SOHO BONUS 154850
Renewal Project Application FY2017 Page 11 09/22/2017
accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Ms.
First Name: Shirene
Middle Name Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Exeuctive Director
Telephone Number:(Format: 123-456-7890)
(330) 821-6332
Fax Number:(Format: 123-456-7890)
(330) 821-8748
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/12/2017
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Renewal Project Application FY2017 Page 12 09/22/2017
CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
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Renewal Project Application FY2017 Page 13 09/22/2017
the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: Alliance for Children & Families
Name / Title of Authorized Official: Shirene Tapyrik, CEO/Exeuctive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/12/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: Alliance for Children & Families
Street 1: 624 Scranton Ave.
Street 2:
City: Alliance
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44601
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
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Authorized Representative
Prefix: Ms.
First Name: Shirene
Middle Name: Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Exeuctive Director
Telephone Number: (Format: 123-456-7890)
(330) 821-6332
Fax Number: (Format: 123-456-7890)
(330) 821-8748
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/12/2017
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Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
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2A. Project Subrecipients
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
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2B. Recipient Performance
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
Yes
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
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3A. Project Detail
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Expiring Grant Number: OH0534(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: SOHO BONUS
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Provide a description that addresses the entire scope of the proposedproject.
Housing Facilities: The housing will be existing, scattered site 0-bedroom and 1-bedroom rental units.
Program Methodology: SOHO will use the Ansel-Casey and/or SPDAT as astandardized measurement and services plans will be established within 30days of program entry with the participant's input based on their goals andincorporate services indicated by the Ansel-Casey and/or SPDAT scores. Theprogram uses a strength based service plan, and behavioral techniquesrewarding desired behaviors and self-exploration thinking to review poorchoices including what options would have been better, focusing on strengths.
Number of Persons to be Served: The program is designed for 15 beds in 15units, for an annual population of 15 of the most chronic, most vulnerable, andhighest priority homeless individuals in Stark County, according to the StarkCounty Homeless Hotline, as they are the agency responsible for referrals andcentral intake and assessment. The number served would also appear higherin years when participant(s) move out into permanent housing, uponsuccessful exit(s).
Target Populations: The program will target the most chronically homelessindividuals. The target population are traditionally among the most vulnerableand difficult to house due to external and internal barriers. Program applicantsmust meet HUD's definition of homeless and include chronically homelesswith the highest vulnerability, as determined by the central intake andassessment process of the Stark County Homeless Hotline. The targetpopulation is expected to have significant issues that have prevented successfulentrance into regular housing or successful maintenance of permanent housing
2. Does your project have a specificpopulation focus?
Yes
2a. Please identify the specific population focus. (Select ALL that apply)
Chronic HomelessX
Domestic ViolenceX
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Veterans Substance AbuseX
Youth (under 25)X
Mental IllnessX
Families with Children HIV/AIDS
Other(Click 'Save' to update) X
Other: criminal history that is a barrier to housing
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
3d. Does the project follow a "Housing First"approach?
Yes
4. Does the PH project provide PSH or RRH? PSH
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3C. Dedicated Plus
Dedicated and DedicatedPLUS
A “100% Dedicated” project is a permanent supportive housing projectthat commits 100% of its beds to chronically homeless individuals andfamilies, according to NOFA Section III.3.b.
A “DedicatedPLUS” project is a permanent supportive housing projectwhere 100% of the beds are dedicated to serve individuals with disabilitiesand families in which one adult or child has a disability, includingunaccompanied homeless youth, that at a minimum, meet ONE of thefollowing criteria according to NOFA Section III.3.d:
(1) experiencing chronic homelessness as defined in 24 CFR 578.3; (2) residing in a transitional housing project that will be eliminated and meets the definition ofchronically homeless in effect at the time in which the individual or family entered the transitionalhousing project; (3) residing in a place not meant for human habitation, emergency shelter, or safe haven; butthe individuals or families experiencing chronic homelessness as defined at 24 CFR 578.3 hadbeen admitted and enrolled in a permanent housing project within the last year and were unableto maintain a housing placement; (4) residing in transitional housing funded by a joint TH and PH-RRH component project andwho were experiencing chronic homelessness as defined at 24 CFR 578.3 prior to entering theproject; (5)residing and has resided in a place not meant for human habitation, a safe haven, oremergency shelter for at least 12 months in the last three years, but has not done so on fourseparate occasions; or (6) receiving assistance through a Department of Veterans Affairs(VA)-funded homelessassistance program and met one of the above criteria at initial intake to the VA's homelessassistance system.
A renewal project where 100 percent of the beds are dedicated in their current grant asdescribed in NOFA Section III.A.3.b. must either become DedicatedPLUS or remain 100%Dedicated. If a renewal project currently has 100 percent of its beds dedicated to chronicallyhomeless individuals and families and elects to become a DedicatedPLUS project, the projectwill be required to adhere to all fair housing requirements at 24 CFR 578.93. Any beds that theapplicant identifies in this application as being dedicated to chronically homeless individuals andfamilies in a DedicatedPLUS project must continue to operate in accordance with SectionIII.A.3.b. Beds are identified on Screen 4B.
1. Indicate whether the project is "100%Dedicated", "DedicatedPLUS", or "N/A",
according to the information provided above.
DedicatedPLUS
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4A. Supportive Services for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Applicant Quarterly
Assistance with Moving Costs Non-Partner As needed
Case Management Applicant As needed
Child Care Non-Partner As needed
Education Services Non-Partner Weekly
Employment Assistance and Job Training Non-Partner As needed
Food Non-Partner Bi-weekly
Housing Search and Counseling Services Non-Partner As needed
Legal Services Non-Partner As needed
Life Skills Training Non-Partner As needed
Mental Health Services Partner As needed
Outpatient Health Services Non-Partner As needed
Outreach Services Non-Partner As needed
Substance Abuse Treatment Services Partner As needed
Transportation Applicant As needed
Utility Deposits Non-Partner As needed
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
Yes
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are received and renewed?
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partneragency?
Yes
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
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4B. Housing Type and Location
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 15
Total Beds: 15
Total Dedicated CH Beds: 15Housing Type Units Beds
Single family homes/townhou... 15 15
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4B. Housing Type and Location Detail
1. Housing Type: Single family homes/townhouses/duplexes
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 15
b. Beds: 15
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
15
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Street 1: Scattered site
Street 2:
City: Alliance, Canton, Massillon
State: Ohio
ZIP Code: 44601
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
390066 Alliance, 390858 Canton, 393114Massillon
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5A. Project Participants - Households
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 0 15 0 15
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 0 10 10
Adults ages 18-24 0 5 5
Accompanied Children under age 18 0 0 0
Unaccompanied Children under age 18 0 0
Total Persons 0 15 0 15
Click Save to automatically calculate totals
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5B. Project Participants - Subpopulations
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Children under age 18
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 10 2 5 2 1 2 0
Adults ages 18-24 5 1 2 3 0 1 0
Total Persons 15 0 0 3 0 7 5 1 3 0
Click Save to automatically calculate totals
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
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5C. Outreach for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
1% Directly from the street or other locations not meant for human habitation.
99% Directly from emergency shelters.
0% Directly from safe havens.
0% Persons fleeing domestic violence.
0% Directly from transitional housing eliminated in the FY 2017 CoC Program Competition.
Directly from the TH Portion of a Joint TH and PH-RRH Component project.
Persons receiving services through a Department of Veterans Affairs(VA)-funded homeless assistance program.
100% Total of above percentages
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6A. Funding Request
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Do any of the properties in this projecthave an active restrictive covenant?
No
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
Yes
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Leased Units X
Leased Structures
Rental Assistance
Supportive Services X
Operating X
HMIS
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6B. Leased Units Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes the funds being requested for one or moreunits leased for operating the projects. To add information to the list,select the icon. To view or update information already listed, select theicon.
Total Annual Assistance Requested: $94,354
Grant Term: 1 Year
Total Request for Grant Term: $94,354
Total Units: 15
FMR Area Total Units Requested Total Annual BudgetRequested
Total Budget Requested
OH - Canton-Massi... 15 $94,354 $94,354
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Leased Units Budget Detail
Enter the appropriate values in the "Number of Units" AND "TotalRequest" fields.
Metropolitan or non-metropolitanfair market rent area:
OH - Canton-Massillon, OH MSA (3901999999)
Leased Units Annual BudgetSize of Units # of Units
(Applicant)Total
Request(Applicant)
SRO
0 Bedroom
1 Bedroom 15
2 Bedroom
3 Bedroom
4 Bedroom
5 Bedroom
6 Bedroom
7 Bedroom
8 Bedroom
9 Bedroom
Total Units and AnnualAssistance Requested
15 $94,354
Grant Term 1 Year
Total Request for Grant Term $94,354
Click the 'Save' button to automatically calculate totals.
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6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $5,225
Total Value of In-Kind Commitments: $15,700
Total Value of All Commitments: $20,925
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.Match Type Source Contributor Date of
CommitmentValue ofCommitments
Yes In-Kind Private Lattanzi &Associ...
08/11/2017 $8,750
Yes In-Kind Private Phoenix RisingBe...
08/11/2017 $6,950
Yes Cash Private Alliance for Chil... 08/11/2017 $5,225
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Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Lattanzi & Associates, LLC
5. Date of Written Commitment: 08/11/2017
6. Value of Written Commitment: $8,750
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Phoenix Rising Behavioral Health
5. Date of Written Commitment: 08/11/2017
6. Value of Written Commitment: $6,950
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
Sources of Match Detail
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1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Alliance for Children and Families, Inc.
5. Date of Written Commitment: 08/11/2017
6. Value of Written Commitment: $5,225
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6E. Summary Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $94,354
1b. Leased Structures $0
2. Rental Assistance $0
3. Supportive Services $40,800
4. Operating $28,767
5. HMIS $0
6. Sub-total Costs Requested $163,921
7. Admin (Up to 10%)
$11,389
8. Total Assistanceplus Admin Requested
$175,310
9. Cash Match $5,225
10. In-Kind Match $15,700
11. Total Match $20,925
12. Total Budget $196,235
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No
3) Other Attachment No
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Attachment Details
Document Description:
Attachment Details
Document Description:
Attachment Details
Document Description:
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7A. In-Kind Match MOU Attachment
Document Type Required? Document Description Date Attached
In-Kind Match MOU No
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Attachment Details
Document Description:
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7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
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It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Shirene Tapyrik
Date: 08/12/2017
Title: CEO/Exeuctive Director
Applicant Organization: Alliance for Children & Families
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
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Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
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Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Submit without changes
The applicant has selected “Submit without changes” to Question 2above. If the applicant has identified project information on the precedingscreens that does not match the current contract, select “Make changes”above and update the relevant project information.
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8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/11/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
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1D. SF-424 Congressional District(s) 08/11/2017
1E. SF-424 Compliance 08/11/2017
1F. SF-424 Declaration 08/11/2017
1G. HUD-2880 08/11/2017
1H. HUD-50070 08/11/2017
1I. Cert. Lobbying 08/11/2017
1J. SF-LLL 08/11/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/11/2017
3A. Project Detail 08/11/2017
3B. Description 08/11/2017
3C. Dedicated Plus 08/12/2017
4A. Services 08/11/2017
4B. Housing Type 08/11/2017
5A. Households 08/11/2017
5B. Subpopulations No Input Required
5C. Outreach 08/11/2017
6A. Funding Request 08/11/2017
6B. Leased Units 08/11/2017
6D. Match 08/12/2017
6E. Summary Budget No Input Required
7A. Attachment(s) No Input Required
7A. In-Kind Match MOU Attachment No Input Required
7B. Certification 08/12/2017
Submission Without Changes 08/11/2017
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Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
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1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/12/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0515
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
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1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: Alliance for Children & Families
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-1590276
c. Organizational DUNS: 609962550 PLUS 4 1111
d. Address
Street 1: 624 Scranton Ave.
Street 2:
City: Alliance
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44601
e. Organizational Unit (optional)
Department Name: ACF
Division Name: Housing
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Ms.
First Name: Shirene
Middle Name: Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Executive Director
Organizational Affiliation: Alliance for Children & Families
Telephone Number: (330) 821-6332
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Extension: 0000
Fax Number: (330) 821-8748
Email: [email protected]
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1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: SOHO PSH 2015
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
17. Proposed Project
a. Start Date: 07/01/2017
b. End Date: 06/30/2018
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Ms.
First Name: Shirene
Middle Name: Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Exeuctive Director
Telephone Number:(Format: 123-456-7890)
(330) 821-6332
Fax Number:(Format: 123-456-7890)
(330) 821-8748
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/12/2017
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1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: Alliance for Children & Families
Prefix: Ms.
First Name: Shirene
Middle Name: Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Exeuctive Director
Organizational Affiliation: Alliance for Children & Families
Telephone Number: (330) 821-6332
Extension: 0
Email: [email protected]
City: Alliance
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44601
2. Employer ID Number (EIN): 34-1590276
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$129,117.00
(Requested amounts will be automatically entered within applications)
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5. State the name and location (streetaddress, city and state) of the project or
activity:
SOHO PSH 2015 624 Scranton Ave. AllianceOhio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
No
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Shirene Tapyrik, CEO/Exeuctive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 07/18/2017
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: Alliance for Children & Families
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
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accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Ms.
First Name: Shirene
Middle Name Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Exeuctive Director
Telephone Number:(Format: 123-456-7890)
(330) 821-6332
Fax Number:(Format: 123-456-7890)
(330) 821-8748
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/12/2017
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CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
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the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: Alliance for Children & Families
Name / Title of Authorized Official: Shirene Tapyrik, CEO/Exeuctive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/12/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: Alliance for Children & Families
Street 1: 624 Scranton Ave.
Street 2:
City: Alliance
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44601
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
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Authorized Representative
Prefix: Ms.
First Name: Shirene
Middle Name: Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Exeuctive Director
Telephone Number: (Format: 123-456-7890)
(330) 821-6332
Fax Number: (Format: 123-456-7890)
(330) 821-8748
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/12/2017
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Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
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2A. Project Subrecipients
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
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2B. Recipient Performance
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
Yes
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
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3A. Project Detail
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Expiring Grant Number: OH0515(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: SOHO PSH 2015
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Provide a description that addresses the entire scope of the proposedproject.
Housing Facilities: The housing will be existing, scattered site one-bedroom andtwo-bedroom rental units.
Number of Persons to be Served: The program is designed for 14-beds in 14-units, for an annual population of 14 chronically homeless individuals (so longas this need continues to exist). The number served would also appear higherin years when participant(s) move out into together permanent housing, uponsuccessful exit(s).
Target Populations: The program will target chronically homeless individuals,comprised of the most vulnerable and/or highest priority homeless individuals inStark County, according to the Stark County Homeless Hotline. The Hotline isthe agency responsible for referrals and central intake and assessment. Thetarget population is traditionally among the most vulnerable and difficult tohouse due to external and internal barriers. Program applicants must meetHUD's definition of homeless and include chronically homeless with the highestvulnerability, as determined by the central intake and assessment process ofthe Stark County Homeless Hotline. The target population is expected to havesignificant issues that have prevented successful entrance into regular housingor successful maintenance of permanent housing, indicating a need for ongoingsupport services. The target population is expected to actively engage inservices as necessary to maintain housing to address issues that are placinghousing in jeopardy that would result in eviction if not addressed. Engagementin services is not a pre-requisite to housing or to keep housing. ACF utilizes amodel of progressive engagement, offering tailored fits of services to individualparticipants instead of a one-size-fits-all approach. ACF has had 98%successful outcomes in HUD programs with participants engaging in servicesand activities.
Program Methodology: SOHO will use the Ansel-Casey and/or SPDAT as astandardized measurement and services plans will be established within 30-days of program entry with the participant's input based on their goals andincorporate services indicated by the Ansel-Casey and/or SPDAT scores. Theprogram uses a strength based service plan, and behavioral techniquesrewarding desired behaviors and self-exploration thinking to review poorchoices including what options would have been better, focusing on strengths.
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2. Does your project have a specificpopulation focus?
Yes
2a. Please identify the specific population focus. (Select ALL that apply)
Chronic HomelessX
Domestic ViolenceX
Veterans Substance AbuseX
Youth (under 25)X
Mental IllnessX
Families with Children HIV/AIDS
Other(Click 'Save' to update)
Other:
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
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Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
3d. Does the project follow a "Housing First"approach?
Yes
4. Does the PH project provide PSH or RRH? PSH
Is this an SHP Project that had been approvedby HUD to change the renewal project budget
from leasing to rental assistance?
Yes
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3C. Dedicated Plus
Dedicated and DedicatedPLUS
A “100% Dedicated” project is a permanent supportive housing projectthat commits 100% of its beds to chronically homeless individuals andfamilies, according to NOFA Section III.3.b.
A “DedicatedPLUS” project is a permanent supportive housing projectwhere 100% of the beds are dedicated to serve individuals with disabilitiesand families in which one adult or child has a disability, includingunaccompanied homeless youth, that at a minimum, meet ONE of thefollowing criteria according to NOFA Section III.3.d:
(1) experiencing chronic homelessness as defined in 24 CFR 578.3; (2) residing in a transitional housing project that will be eliminated and meets the definition ofchronically homeless in effect at the time in which the individual or family entered the transitionalhousing project; (3) residing in a place not meant for human habitation, emergency shelter, or safe haven; butthe individuals or families experiencing chronic homelessness as defined at 24 CFR 578.3 hadbeen admitted and enrolled in a permanent housing project within the last year and were unableto maintain a housing placement; (4) residing in transitional housing funded by a joint TH and PH-RRH component project andwho were experiencing chronic homelessness as defined at 24 CFR 578.3 prior to entering theproject; (5)residing and has resided in a place not meant for human habitation, a safe haven, oremergency shelter for at least 12 months in the last three years, but has not done so on fourseparate occasions; or (6) receiving assistance through a Department of Veterans Affairs(VA)-funded homelessassistance program and met one of the above criteria at initial intake to the VA's homelessassistance system.
A renewal project where 100 percent of the beds are dedicated in their current grant asdescribed in NOFA Section III.A.3.b. must either become DedicatedPLUS or remain 100%Dedicated. If a renewal project currently has 100 percent of its beds dedicated to chronicallyhomeless individuals and families and elects to become a DedicatedPLUS project, the projectwill be required to adhere to all fair housing requirements at 24 CFR 578.93. Any beds that theapplicant identifies in this application as being dedicated to chronically homeless individuals andfamilies in a DedicatedPLUS project must continue to operate in accordance with SectionIII.A.3.b. Beds are identified on Screen 4B.
1. Indicate whether the project is "100%Dedicated", "DedicatedPLUS", or "N/A",
according to the information provided above.
DedicatedPLUS
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4A. Supportive Services for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Applicant Quarterly
Assistance with Moving Costs Non-Partner As needed
Case Management Applicant As needed
Child Care Non-Partner As needed
Education Services Applicant Weekly
Employment Assistance and Job Training Applicant As needed
Food Non-Partner Bi-weekly
Housing Search and Counseling Services Applicant As needed
Legal Services Non-Partner As needed
Life Skills Training Applicant As needed
Mental Health Services Partner As needed
Outpatient Health Services Non-Partner As needed
Outreach Services Applicant As needed
Substance Abuse Treatment Services Partner As needed
Transportation Applicant As needed
Utility Deposits Non-Partner As needed
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
Yes
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are received and renewed?
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partneragency?
Yes
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
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4B. Housing Type and Location
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 14
Total Beds: 14
Total Dedicated CH Beds: 14Housing Type Units Beds
Scattered-site apartments (... 14 14
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4B. Housing Type and Location Detail
1. Housing Type: Scattered-site apartments (including efficiencies)
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 14
b. Beds: 14
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
14
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Street 1: Scattered Site
Street 2:
City: Alliance
State: Ohio
ZIP Code: 44601
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
390066 Alliance, 390858 Canton, 393114Massillon
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5A. Project Participants - Households
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 0 14 0 14
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 0 10 10
Adults ages 18-24 0 4 4
Accompanied Children under age 18 0 0 0
Unaccompanied Children under age 18 0 0
Total Persons 0 14 0 14
Click Save to automatically calculate totals
Applicant: Alliance for Children & Families 609962550Project: SOHO PSH 2015 154849
Renewal Project Application FY2017 Page 29 09/22/2017
5B. Project Participants - Subpopulations
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Children under age 18
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 10 0 0 2 0 5 2 1 1 0
Adults ages 18-24 4 0 0 1 0 1 3 0 0 0
Total Persons 14 0 0 3 0 6 5 1 1 0
Click Save to automatically calculate totals
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
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5C. Outreach for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
1% Directly from the street or other locations not meant for human habitation.
99% Directly from emergency shelters.
0% Directly from safe havens.
0% Persons fleeing domestic violence.
0% Directly from transitional housing eliminated in the FY 2017 CoC Program Competition.
Directly from the TH Portion of a Joint TH and PH-RRH Component project.
Persons receiving services through a Department of Veterans Affairs(VA)-funded homeless assistance program.
100% Total of above percentages
Applicant: Alliance for Children & Families 609962550Project: SOHO PSH 2015 154849
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6A. Funding Request
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Do any of the properties in this projecthave an active restrictive covenant?
No
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
No
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Leased Units
Leased Structures
Rental Assistance X
Supportive Services X
Operating
HMIS
Applicant: Alliance for Children & Families 609962550Project: SOHO PSH 2015 154849
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6C. Rental Assistance Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes the rental assistance funding request for thetotal term of the project. To add information to the list, select the icon. Toview or update information already listed, select the icon.
Total Request for Grant Term: $83,304
Total Units: 14
Type of RentalAssistance
FMR Area Total UnitsRequested
Total Request
TRA OH - Canton-Massillon, OH MSA (390199... 14 $83,304
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Rental Assistance Budget Detail
Type of Rental Assistance: TRA
Metropolitan or non-metropolitanfair market rent area:
OH - Canton-Massillon, OH MSA (3901999999)
Does the applicant request rental assistancefunding for less than the area's per unit size
fair market rents?
No
Size of Units # of Units(Applicant)
FMR Area(Applicant)
HUD PaidRent
(Applicant)
12 Months TotalRequest
(Applicant)
SRO x $317 $317 x = $0
0 Bedroom 3 x $422 $422 x = $15,192
1 Bedroom 11 x $516 $516 x = $68,112
2 Bedrooms x $684 $684 x = $0
3 Bedrooms x $873 $873 x = $0
4 Bedrooms x $938 $938 x = $0
5 Bedrooms x $1,079 $1,079 x = $0
6 Bedrooms x $1,219 $1,219 x = $0
7 Bedrooms x $1,360 $1,360 x = $0
8 Bedrooms x $1,501 $1,501 x = $0
9 Bedrooms x $1,642 $1,642 x = $0
Total Units and Annual AssistanceRequested
14 $83,304
Grant Term 1 Year
Total Request for Grant Term $83,304
Click the 'Save' button to automatically calculate totals.
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6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $5,500
Total Value of In-Kind Commitments: $26,800
Total Value of All Commitments: $32,300
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.Match Type Source Contributor Date of
CommitmentValue ofCommitments
Yes In-Kind Private ACF - HQSInspect...
08/11/2017 $5,100
Yes Cash Private ACF 08/11/2017 $5,500
Yes In-Kind Private PhoenixBehaviora...
08/11/2017 $6,950
Yes In-Kind Private Lattanzi &Associ...
08/11/2017 $8,750
Yes In-Kind Private University ofMou...
08/11/2017 $6,000
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Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
ACF - HQS Inspections
5. Date of Written Commitment: 08/11/2017
6. Value of Written Commitment: $5,100
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
ACF
5. Date of Written Commitment: 08/11/2017
6. Value of Written Commitment: $5,500
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
Applicant: Alliance for Children & Families 609962550Project: SOHO PSH 2015 154849
Renewal Project Application FY2017 Page 36 09/22/2017
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Phoenix Behavioral Health Services
5. Date of Written Commitment: 08/11/2017
6. Value of Written Commitment: $6,950
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Lattanzi & Associates, LLC
5. Date of Written Commitment: 08/11/2017
6. Value of Written Commitment: $8,750
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
University of Mount Union
5. Date of Written Commitment: 08/11/2017
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6. Value of Written Commitment: $6,000
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
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6E. Summary Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $0
1b. Leased Structures $0
2. Rental Assistance $83,304
3. Supportive Services $37,360
4. Operating $0
5. HMIS $0
6. Sub-total Costs Requested $120,664
7. Admin (Up to 10%)
$8,453
8. Total Assistanceplus Admin Requested
$129,117
9. Cash Match $5,500
10. In-Kind Match $26,800
11. Total Match $32,300
12. Total Budget $161,417
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No
3) Other Attachment No
Applicant: Alliance for Children & Families 609962550Project: SOHO PSH 2015 154849
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Attachment Details
Document Description:
Attachment Details
Document Description:
Attachment Details
Document Description:
Applicant: Alliance for Children & Families 609962550Project: SOHO PSH 2015 154849
Renewal Project Application FY2017 Page 41 09/22/2017
7A. In-Kind Match MOU Attachment
Document Type Required? Document Description Date Attached
In-Kind Match MOU No
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Attachment Details
Document Description:
Applicant: Alliance for Children & Families 609962550Project: SOHO PSH 2015 154849
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7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
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It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Shirene Tapyrik
Date: 08/12/2017
Title: CEO/Exeuctive Director
Applicant Organization: Alliance for Children & Families
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
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Renewal Project Application FY2017 Page 45 09/22/2017
Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
Applicant: Alliance for Children & Families 609962550Project: SOHO PSH 2015 154849
Renewal Project Application FY2017 Page 46 09/22/2017
Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Submit without changes
The applicant has selected “Submit without changes” to Question 2above. If the applicant has identified project information on the precedingscreens that does not match the current contract, select “Make changes”above and update the relevant project information.
Applicant: Alliance for Children & Families 609962550Project: SOHO PSH 2015 154849
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8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/11/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
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Renewal Project Application FY2017 Page 48 09/22/2017
1D. SF-424 Congressional District(s) 08/11/2017
1E. SF-424 Compliance 08/11/2017
1F. SF-424 Declaration 08/11/2017
1G. HUD-2880 08/11/2017
1H. HUD-50070 08/11/2017
1I. Cert. Lobbying 08/11/2017
1J. SF-LLL 08/11/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/11/2017
3A. Project Detail 08/11/2017
3B. Description 08/11/2017
3C. Dedicated Plus 08/12/2017
4A. Services 08/11/2017
4B. Housing Type 08/11/2017
5A. Households 08/11/2017
5B. Subpopulations No Input Required
5C. Outreach 08/11/2017
6A. Funding Request 08/11/2017
6C. Rental Assistance 08/11/2017
6D. Match 08/12/2017
6E. Summary Budget No Input Required
7A. Attachment(s) No Input Required
7A. In-Kind Match MOU Attachment No Input Required
7B. Certification 08/12/2017
Submission Without Changes 08/11/2017
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Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
Renewal Project Application FY2017 Page 1 09/22/2017
1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/15/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0300
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
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Renewal Project Application FY2017 Page 2 09/22/2017
1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: ICAN Inc.
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-1575839
c. Organizational DUNS: 189042914 PLUS 4
d. Address
Street 1: 1214 Market Ave N
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44714
e. Organizational Unit (optional)
Department Name:
Division Name:
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Mrs.
First Name: Natalie
Middle Name:
Last Name: McCleskey
Suffix:
Title: Development Director
Organizational Affiliation: ICAN Inc.
Telephone Number: (330) 455-9100
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
Renewal Project Application FY2017 Page 3 09/22/2017
Extension: 150
Fax Number: (330) 455-4702
Email: [email protected]
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Renewal Project Application FY2017 Page 4 09/22/2017
1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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Renewal Project Application FY2017 Page 5 09/22/2017
1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: West Park Apartments
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-007
17. Proposed Project
a. Start Date: 01/01/2018
b. End Date: 12/31/2018
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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Renewal Project Application FY2017 Page 6 09/22/2017
1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
Renewal Project Application FY2017 Page 7 09/22/2017
1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-9100
Fax Number:(Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
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Renewal Project Application FY2017 Page 8 09/22/2017
1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: ICAN Inc.
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Organizational Affiliation: ICAN Inc.
Telephone Number: (330) 455-9100
Extension:
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44714
2. Employer ID Number (EIN): 34-1575839
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$83,326.00
(Requested amounts will be automatically entered within applications)
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
Renewal Project Application FY2017 Page 9 09/22/2017
5. State the name and location (streetaddress, city and state) of the project or
activity:
West Park Apartments 1214 Market Ave NCanton Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
Yes
Part II Other Government Assistance Provided or Requested/ExpectedSources and Use of Funds
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance,payment, credit, or tax benefit.
Department/Local Agency Name and Address Type of Assistance AmountRequested /
Provided
Expected Uses of the Funds
Ohio Development Services Agency, 77 S. HighStreet, Columbus, OH 43215
Grant $19,851.00 Cherry Grove - Maintainance, Utilitiesand Insurance
Ohio Development Services Agency, 77 S. HighStreet, Columbus, OH 43215
Grant 37834.0 Rapid Re-Housing - Salaries andBenefits
Stark Mental Health & Addiction Recovery, 121Cleveland Ave SW, Canton, OH 44702
Grant $45,389.00 Shelter Plus Care and West Park -Supportive Services; Peer Support;Employment; Critical TimeInterventionist Salary; Benefits andTravel
Part III Interested Parties
You must disclose:1. All developers, contractors, or consultants involved in the application for the assistance or in
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
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the planning, development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which theassistance is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower).
Alphabetical list of all persons with areportable financial interest in the
project or activity (For individuals, give the last name
first)
Social Security No.or Employee ID No.
Type ofParticipation
Financial Interestin Project/Activity
($)
Financial Interestin Project/Activity
(%)
NA NA NA $0.00 0%
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Julie Sparks, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/14/2017
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: ICAN Inc.
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
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accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-9100
Fax Number:(Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
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CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
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the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: ICAN Inc.
Name / Title of Authorized Official: Julie Sparks, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: ICAN Inc.
Street 1: 1214 Market Ave N
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44714
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
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Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number: (Format: 123-456-7890)
(330) 455-9100
Fax Number: (Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
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Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
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2A. Project Subrecipients
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
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2B. Recipient Performance
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
Yes
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
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3A. Project Detail
1. Expiring Grant Number: OH0300(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: West Park Apartments
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Provide a description that addresses the entire scope of the proposedproject.
West Park serves 16 residents at 3 locations. Two of the buildings, located at1313 and 1323 12th St. NW, Canton, have six units each. These buildingsserve single adults. The third building, located at 2720 Mahoning Rd. NE,Canton, has four two-bedroom units that can serve families. ICAN’s HousingSupport Specialist works with each tenant to develop goals for a permanenthousing outcome and increased income. ICAN Housing refers clients toColeman Professional Services (CPS) for help in accessing mainstreamservices and benefits through a partnership with the Stark Mental Health &Addiction Recovery (SMHAR) Board. Clients use existing services within themental health system. ICAN Housing requires CoC funding to pay for utilities,maintenance and insurance costs. Participants pay an occupancy charge whichmay not exceed the highest of: a) 30 percent of the family’s monthly adjustedincome; or b) 10% of the family’s monthly gross income.
2. Does your project have a specificpopulation focus?
Yes
2a. Please identify the specific population focus. (Select ALL that apply)
Chronic Homeless Domestic Violence
Veterans Substance Abuse
Youth (under 25) Mental IllnessX
Families with Children HIV/AIDS
Other(Click 'Save' to update)
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Other:
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
3d. Does the project follow a "Housing First"approach?
Yes
4. Does the PH project provide PSH or RRH? PSH
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3C. Dedicated Plus
Dedicated and DedicatedPLUS
A “100% Dedicated” project is a permanent supportive housing projectthat commits 100% of its beds to chronically homeless individuals andfamilies, according to NOFA Section III.3.b.
A “DedicatedPLUS” project is a permanent supportive housing projectwhere 100% of the beds are dedicated to serve individuals with disabilitiesand families in which one adult or child has a disability, includingunaccompanied homeless youth, that at a minimum, meet ONE of thefollowing criteria according to NOFA Section III.3.d:
(1) experiencing chronic homelessness as defined in 24 CFR 578.3; (2) residing in a transitional housing project that will be eliminated and meets the definition ofchronically homeless in effect at the time in which the individual or family entered the transitionalhousing project; (3) residing in a place not meant for human habitation, emergency shelter, or safe haven; butthe individuals or families experiencing chronic homelessness as defined at 24 CFR 578.3 hadbeen admitted and enrolled in a permanent housing project within the last year and were unableto maintain a housing placement; (4) residing in transitional housing funded by a joint TH and PH-RRH component project andwho were experiencing chronic homelessness as defined at 24 CFR 578.3 prior to entering theproject; (5)residing and has resided in a place not meant for human habitation, a safe haven, oremergency shelter for at least 12 months in the last three years, but has not done so on fourseparate occasions; or (6) receiving assistance through a Department of Veterans Affairs(VA)-funded homelessassistance program and met one of the above criteria at initial intake to the VA's homelessassistance system.
A renewal project where 100 percent of the beds are dedicated in their current grant asdescribed in NOFA Section III.A.3.b. must either become DedicatedPLUS or remain 100%Dedicated. If a renewal project currently has 100 percent of its beds dedicated to chronicallyhomeless individuals and families and elects to become a DedicatedPLUS project, the projectwill be required to adhere to all fair housing requirements at 24 CFR 578.93. Any beds that theapplicant identifies in this application as being dedicated to chronically homeless individuals andfamilies in a DedicatedPLUS project must continue to operate in accordance with SectionIII.A.3.b. Beds are identified on Screen 4B.
1. Indicate whether the project is "100%Dedicated", "DedicatedPLUS", or "N/A",
according to the information provided above.
N/A
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4A. Supportive Services for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Applicant Annually
Assistance with Moving Costs
Case Management Partner Monthly
Child Care
Education Services Non-Partner As needed
Employment Assistance and Job Training Non-Partner As needed
Food Non-Partner As needed
Housing Search and Counseling Services Applicant Monthly
Legal Services
Life Skills Training Applicant Monthly
Mental Health Services Partner Monthly
Outpatient Health Services Non-Partner As needed
Outreach Services Applicant As needed
Substance Abuse Treatment Services Partner Monthly
Transportation Applicant As needed
Utility Deposits
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
Yes
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are received and renewed?
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partneragency?
Yes
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
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4B. Housing Type and Location
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 16
Total Beds: 16
Total Dedicated CH Beds: 0Housing Type Units Beds
Clustered apartments 6 6
Clustered apartments 6 6
Clustered apartments 4 4
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4B. Housing Type and Location Detail
1. Housing Type: Clustered apartments
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 6
b. Beds: 6
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
0
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Street 1: 1313 12th St. NW
Street 2:
City: Canton
State: Ohio
ZIP Code: 44703
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
390858 Canton, 399151 Stark County
4B. Housing Type and Location Detail
1. Housing Type: Clustered apartments
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 6
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b. Beds: 6
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
0
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Street 1: 1323 12th St. N.W.
Street 2:
City: Canton
State: Ohio
ZIP Code: 44703
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
390858 Canton, 399151 Stark County
4B. Housing Type and Location Detail
1. Housing Type: Clustered apartments
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 4
b. Beds: 4
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
0
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
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Street 1: 2720 Mahoning Rd. N.E.
Street 2:
City: Canton
State: Ohio
ZIP Code: 44705
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
390858 Canton, 399151 Stark County
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5A. Project Participants - Households
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 0 16 0 16
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 0 15 15
Adults ages 18-24 0 1 1
Accompanied Children under age 18 0 0 0
Unaccompanied Children under age 18 0 0
Total Persons 0 16 0 16
Click Save to automatically calculate totals
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5B. Project Participants - Subpopulations
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Children under age 18
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 11 0 1 1 0 15 0 0 0 0
Adults ages 18-24 1 0 0 0 0 1 0 0 0 0
Total Persons 12 0 1 1 0 16 0 0 0 0
Click Save to automatically calculate totals
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
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Renewal Project Application FY2017 Page 32 09/22/2017
5C. Outreach for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
50% Directly from the street or other locations not meant for human habitation.
50% Directly from emergency shelters.
0% Directly from safe havens.
0% Persons fleeing domestic violence.
0% Directly from transitional housing.
Directly from the TH Portion of a Joint TH and PH-RRH Component project.
Persons receiving services through a Department of Veterans Affairs(VA)-funded homeless assistance program.
100% Total of above percentages
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
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6A. Funding Request
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Do any of the properties in this projecthave an active restrictive covenant?
Yes
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
No
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Leased Units
Leased Structures
Rental Assistance
Supportive Services
Operating X
HMIS
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
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6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $20,832
Total Value of In-Kind Commitments: $0
Total Value of All Commitments: $20,832
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
Yes
1a. Briefly describe the source of the program income:
Program Income will be generated from occupancy charges paid to ICAN Inc.by the participants that does not exceed the highest of: a) 30% of the family'smonthly adjusted income; or b) 10% of the family's monthly gross income.
1b. Estimate the amount of program income that will be used as Match for this project:
$20,832
Match Type Source Contributor Date ofCommitment
Value ofCommitments
Yes Cash Private ICAN, Inc. rental... 08/12/2017 $20,832
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
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Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
ICAN, Inc. rental payment income.
5. Date of Written Commitment: 08/12/2017
6. Value of Written Commitment: $20,832
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
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6E. Summary Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $0
1b. Leased Structures $0
2. Rental Assistance $0
3. Supportive Services $0
4. Operating $78,169
5. HMIS $0
6. Sub-total Costs Requested $78,169
7. Admin (Up to 10%)
$5,157
8. Total Assistanceplus Admin Requested
$83,326
9. Cash Match $20,832
10. In-Kind Match $0
11. Total Match $20,832
12. Total Budget $104,158
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No Match Commitment ... 08/09/2017
3) Other Attachment No
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
Renewal Project Application FY2017 Page 38 09/22/2017
Attachment Details
Document Description:
Attachment Details
Document Description: Match Commitment Letter - West ParkApartments
Attachment Details
Document Description:
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
Renewal Project Application FY2017 Page 39 09/22/2017
7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
Renewal Project Application FY2017 Page 40 09/22/2017
It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Julie Sparks
Date: 08/15/2017
Title: Executive Director
Applicant Organization: ICAN Inc.
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
Renewal Project Application FY2017 Page 41 09/22/2017
Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
Renewal Project Application FY2017 Page 42 09/22/2017
Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Make changes
3. Specify which screens require changes by clicking the checkbox next tothe name and then clicking the Save button.
Part 2- Recipient and Subrecipient Information
2A. Subrecipients
2B. Recipient Performance
Part 3 - Project Information
3A. Project DetailX
3B. Description
3C. Dedicated PlusX
Part 4 - Housing Services and HMIS
4A. Services
4B. Housing Type
Part 5 - Participants and Outreach Information
5A. Households
5B. Subpopulations
5C. Outreach
Part 6 - Budget Information
6A. Funding Request
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
Renewal Project Application FY2017 Page 43 09/22/2017
6D. MatchX
6E. Summary Budget
Part 7 - Attachment(s) & Certification
7A. Attachment(s)X
7B. CertificationX
The applicant has selected "Make Changes" to Question 2 above. Pleaseprovide a brief description of the changes that will be made to the projectinformation screens (bullets are appropriate):
* 3B. Project Description - Removing final paragraph in the narrative section,that previously provided annual APR outcomes, in order to align with HUD'sInstructional Guidance regarding to desire for Applicants to avoid the need tomake annual updates in renewal project applications.* 5C. Outreach - Our local Continuum no longer has a Safe Haven as itconverted to PSH, therefore no persons will be entering the project from a SafeHaven. Percentages were adjusted accordingly.
The applicant has selected "Make Changes". Once this screen is saved,the applicant will be prohibited from "unchecking" any box that has been
checked regardless of whether a change to data on the correspondingscreen will be made.
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
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8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/01/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 08/02/2017
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Renewal Project Application FY2017 Page 45 09/22/2017
1E. SF-424 Compliance 08/01/2017
1F. SF-424 Declaration 08/02/2017
1G. HUD-2880 08/02/2017
1H. HUD-50070 08/02/2017
1I. Cert. Lobbying 08/02/2017
1J. SF-LLL 08/02/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/01/2017
3A. Project Detail 08/02/2017
3B. Description 08/03/2017
3C. Dedicated Plus 08/02/2017
4A. Services 08/01/2017
4B. Housing Type 08/01/2017
5A. Households 08/01/2017
5B. Subpopulations No Input Required
5C. Outreach 08/03/2017
6A. Funding Request 08/01/2017
6D. Match 08/09/2017
6E. Summary Budget No Input Required
7A. Attachment(s) 08/09/2017
7B. Certification 08/15/2017
Submission Without Changes 08/03/2017
Applicant: ICAN Inc. 189042914Project: West Park Apartments 150747
Renewal Project Application FY2017 Page 46 09/22/2017
Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
Applicant: Alliance for Children & Families 609962550Project: A-FIRST PSH 154847
Renewal Project Application FY2017 Page 1 09/22/2017
1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/12/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0385
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
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1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: Alliance for Children & Families
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-1590276
c. Organizational DUNS: 609962550 PLUS 4 1111
d. Address
Street 1: 624 Scranton Ave.
Street 2:
City: Alliance
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44601
e. Organizational Unit (optional)
Department Name: ACF
Division Name: Housing
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Ms.
First Name: Shirene
Middle Name: Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Executive Director
Organizational Affiliation: Alliance for Children & Families
Telephone Number: (330) 821-6332
Applicant: Alliance for Children & Families 609962550Project: A-FIRST PSH 154847
Renewal Project Application FY2017 Page 3 09/22/2017
Extension: 0000
Fax Number: (330) 821-8748
Email: [email protected]
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1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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Renewal Project Application FY2017 Page 5 09/22/2017
1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: A-FIRST PSH
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
17. Proposed Project
a. Start Date: 12/01/2017
b. End Date: 11/30/2018
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Ms.
First Name: Shirene
Middle Name: Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Exeuctive Director
Telephone Number:(Format: 123-456-7890)
(330) 821-6332
Fax Number:(Format: 123-456-7890)
(330) 821-8748
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/12/2017
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1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: Alliance for Children & Families
Prefix: Ms.
First Name: Shirene
Middle Name: Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Exeuctive Director
Organizational Affiliation: Alliance for Children & Families
Telephone Number: (330) 821-6332
Extension: 0
Email: [email protected]
City: Alliance
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44601
2. Employer ID Number (EIN): 34-1590276
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$108,173.00
(Requested amounts will be automatically entered within applications)
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Renewal Project Application FY2017 Page 9 09/22/2017
5. State the name and location (streetaddress, city and state) of the project or
activity:
A-FIRST PSH 624 Scranton Ave. Alliance Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
No
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Shirene Tapyrik, CEO/Exeuctive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 07/18/2017
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: Alliance for Children & Families
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
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Renewal Project Application FY2017 Page 11 09/22/2017
accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Ms.
First Name: Shirene
Middle Name Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Exeuctive Director
Telephone Number:(Format: 123-456-7890)
(330) 821-6332
Fax Number:(Format: 123-456-7890)
(330) 821-8748
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/12/2017
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CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
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Renewal Project Application FY2017 Page 13 09/22/2017
the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: Alliance for Children & Families
Name / Title of Authorized Official: Shirene Tapyrik, CEO/Exeuctive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/12/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: Alliance for Children & Families
Street 1: 624 Scranton Ave.
Street 2:
City: Alliance
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44601
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
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Authorized Representative
Prefix: Ms.
First Name: Shirene
Middle Name: Starn
Last Name: Tapyrik
Suffix:
Title: CEO/Exeuctive Director
Telephone Number: (Format: 123-456-7890)
(330) 821-6332
Fax Number: (Format: 123-456-7890)
(330) 821-8748
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/12/2017
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Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
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2A. Project Subrecipients
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
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2B. Recipient Performance
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
Yes
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
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3A. Project Detail
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Expiring Grant Number: OH0385(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: A-FIRST PSH
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Provide a description that addresses the entire scope of the proposedproject.
Target Population: The program targets homeless families with at least onedisabled adult. Program applicants must meet HUD's definition ofhomelessness and may include chronically homeless families, giving priority tothe most vulnerable, hardest to house chronically homeless families on the CoCcentral prioritization list. The target population is expected to have significantissues that have prevented successful entrance into regular housing orsuccessful maintenance of permanent housing, indicating a need for on-goingsupport services. The target population is actively encouraged to engage inservices through a Housing First Model of progressive engagement, to addressissues that cause homelessness, and actively participate in services agreedupon in the individualized supportive service plan to successfully maintainhousing stability. However, no participant is denied housing for refusing toparticipate in services. ACF offers a wide variety of service options to find thebest service fit for even the most challenging of tenants. ACF staff continuallyoffer dynamic programs again until the client engages.
Housing: The housing includes a new 10-unit new apartment complex and 2units, in immediate proximity, that were rehabbed (A-FIRST Phase II), providing12 total PSH units with a 36-bed capacity. The 10-unit complex has a digitalsecurity system that includes remote monitoring. The housing includes on-sitecounseling offices; program space for on-site education and basic health carecheck-ups, an on-site laundry and playground.
Program Methodology: A-FIRST uses a micro community model with a holisticapproach to provide comprehensive services in a setting that is sensitive to theneeds of homeless families and children. The program will use the Ansel-Caseyas a standardized measurement and service plan design tool. Individualizedservice plans will be established within 30 days of program entry with theparticipant's input based on their goals and incorporate services indicated bythe Ansel-Casey scores. The program uses behavioral techniques rewardingdesired behavior and self-exploration thinking to review poor choices includingwhat options would have been better.
Support Services: Support services include assessment, case plans, casemanagement, and wrap around services including: life skills, non-emergencymedical services, prescription assistance, substance abuse counseling, mentalhealth counseling, tutoring, educational instruction and job skills training.Community service partners include: Alliance Health Department, Phoenix
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Rising Behavioral Health, Alliance Family Health Center, Quest RecoveryServices, Alliance Career Center, Alliance City Schools, and the University ofMount Union, Child and Adolescent Service Center, and Canton Schools.
2. Does your project have a specificpopulation focus?
Yes
2a. Please identify the specific population focus. (Select ALL that apply)
Chronic HomelessX
Domestic ViolenceX
Veterans Substance AbuseX
Youth (under 25)X
Mental IllnessX
Families with ChildrenX
HIV/AIDS
Other(Click 'Save' to update)
Other:
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
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Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
3d. Does the project follow a "Housing First"approach?
Yes
4. Does the PH project provide PSH or RRH? PSH
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3C. Dedicated Plus
Dedicated and DedicatedPLUS
A “100% Dedicated” project is a permanent supportive housing projectthat commits 100% of its beds to chronically homeless individuals andfamilies, according to NOFA Section III.3.b.
A “DedicatedPLUS” project is a permanent supportive housing projectwhere 100% of the beds are dedicated to serve individuals with disabilitiesand families in which one adult or child has a disability, includingunaccompanied homeless youth, that at a minimum, meet ONE of thefollowing criteria according to NOFA Section III.3.d:
(1) experiencing chronic homelessness as defined in 24 CFR 578.3; (2) residing in a transitional housing project that will be eliminated and meets the definition ofchronically homeless in effect at the time in which the individual or family entered the transitionalhousing project; (3) residing in a place not meant for human habitation, emergency shelter, or safe haven; butthe individuals or families experiencing chronic homelessness as defined at 24 CFR 578.3 hadbeen admitted and enrolled in a permanent housing project within the last year and were unableto maintain a housing placement; (4) residing in transitional housing funded by a joint TH and PH-RRH component project andwho were experiencing chronic homelessness as defined at 24 CFR 578.3 prior to entering theproject; (5)residing and has resided in a place not meant for human habitation, a safe haven, oremergency shelter for at least 12 months in the last three years, but has not done so on fourseparate occasions; or (6) receiving assistance through a Department of Veterans Affairs(VA)-funded homelessassistance program and met one of the above criteria at initial intake to the VA's homelessassistance system.
A renewal project where 100 percent of the beds are dedicated in their current grant asdescribed in NOFA Section III.A.3.b. must either become DedicatedPLUS or remain 100%Dedicated. If a renewal project currently has 100 percent of its beds dedicated to chronicallyhomeless individuals and families and elects to become a DedicatedPLUS project, the projectwill be required to adhere to all fair housing requirements at 24 CFR 578.93. Any beds that theapplicant identifies in this application as being dedicated to chronically homeless individuals andfamilies in a DedicatedPLUS project must continue to operate in accordance with SectionIII.A.3.b. Beds are identified on Screen 4B.
1. Indicate whether the project is "100%Dedicated", "DedicatedPLUS", or "N/A",
according to the information provided above.
DedicatedPLUS
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4A. Supportive Services for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Applicant Quarterly
Assistance with Moving Costs Non-Partner As needed
Case Management Applicant As needed
Child Care Non-Partner As needed
Education Services Applicant Weekly
Employment Assistance and Job Training Applicant As needed
Food Non-Partner Bi-weekly
Housing Search and Counseling Services Applicant As needed
Legal Services Non-Partner As needed
Life Skills Training Applicant As needed
Mental Health Services Partner As needed
Outpatient Health Services Non-Partner As needed
Outreach Services Applicant As needed
Substance Abuse Treatment Services Partner As needed
Transportation Non-Partner As needed
Utility Deposits Applicant As needed
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
Yes
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are received and renewed?
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partneragency?
Yes
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
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4B. Housing Type and Location
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 12
Total Beds: 36
Total Dedicated CH Beds: 30Housing Type Units Beds
Single family homes/townhou... 12 36
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4B. Housing Type and Location Detail
1. Housing Type: Single family homes/townhouses/duplexes
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 12
b. Beds: 36
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
30
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Street 1: 110 West Cambridge Street
Street 2:
City: Alliance
State: Ohio
ZIP Code: 44601
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
390066 Alliance, 390858 Canton, 393114Massillon
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5A. Project Participants - Households
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 12 0 0 12
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 14 0 14
Adults ages 18-24 2 0 2
Accompanied Children under age 18 20 0 20
Unaccompanied Children under age 18 0 0
Total Persons 36 0 0 36
Click Save to automatically calculate totals
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5B. Project Participants - Subpopulations
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 2 0 0 3 0 7 2 0 0 0
Adults ages 18-24 0 0 0 0 0 0 0 0 0 2
Children under age 18 0 0 0 0 2 0 2 16
Total Persons 2 0 0 3 0 7 4 0 2 18
Click Save to automatically calculate totals
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
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Describe the unlisted subpopulations referred to above:
Unlisted sub populations include children in families, and additional adults infamilies who are not disabled. It also includes additional adults and children whoare low functioning but do not score low enough to meet the anddevelopmentally disabled criteria. There is a class of persons who are notcategorized as DD but who are very low functioning and cannot maintainindependent housing without support services. This group is a very vulnerablepopulation that is often the target of predatory behaviors by those seeking totake money out of the hands of the vulnerable. Between money issues and aninability to maintain a home, understand lease requirements, and who struggleto maintain employment, this population enters and consistently returns tohomelessness without supportive housing.
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5C. Outreach for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
5% Directly from the street or other locations not meant for human habitation.
90% Directly from emergency shelters.
5% Directly from safe havens.
0% Persons fleeing domestic violence.
0% Directly from transitional housing eliminated in the FY 2017 CoC Program Competition.
Directly from the TH Portion of a Joint TH and PH-RRH Component project.
Persons receiving services through a Department of Veterans Affairs(VA)-funded homeless assistance program.
100% Total of above percentages
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6A. Funding Request
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Do any of the properties in this projecthave an active restrictive covenant?
No
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
No
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Leased Units
Leased Structures
Rental Assistance
Supportive Services X
Operating X
HMIS
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6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $5,700
Total Value of In-Kind Commitments: $22,800
Total Value of All Commitments: $28,500
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.Match Type Source Contributor Date of
CommitmentValue ofCommitments
Yes Cash Private ACF - Donations 08/11/2017 $5,700
Yes In-Kind Private Phenix RisingBeh...
08/11/2017 $5,300
Yes In-Kind Private Canton CitySchools
08/11/2017 $7,500
Yes In-Kind Private University ofMou...
08/11/2017 $10,000
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Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
ACF - Donations
5. Date of Written Commitment: 08/11/2017
6. Value of Written Commitment: $5,700
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Phenix Rising Behavioral Healh
5. Date of Written Commitment: 08/11/2017
6. Value of Written Commitment: $5,300
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
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3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Canton City Schools
5. Date of Written Commitment: 08/11/2017
6. Value of Written Commitment: $7,500
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
University of Mount Union
5. Date of Written Commitment: 08/11/2017
6. Value of Written Commitment: $10,000
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
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6E. Summary Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $0
1b. Leased Structures $0
2. Rental Assistance $0
3. Supportive Services $11,945
4. Operating $89,209
5. HMIS $0
6. Sub-total Costs Requested $101,154
7. Admin (Up to 10%)
$7,019
8. Total Assistanceplus Admin Requested
$108,173
9. Cash Match $5,700
10. In-Kind Match $22,800
11. Total Match $28,500
12. Total Budget $136,673
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No
3) Other Attachment No
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Attachment Details
Document Description:
Attachment Details
Document Description:
Attachment Details
Document Description:
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7A. In-Kind Match MOU Attachment
Document Type Required? Document Description Date Attached
In-Kind Match MOU No
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Attachment Details
Document Description:
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7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
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It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Shirene Tapyrik
Date: 08/12/2017
Title: CEO/Exeuctive Director
Applicant Organization: Alliance for Children & Families
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
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Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
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Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Submit without changes
The applicant has selected “Submit without changes” to Question 2above. If the applicant has identified project information on the precedingscreens that does not match the current contract, select “Make changes”above and update the relevant project information.
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8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/11/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 08/11/2017
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1E. SF-424 Compliance 08/11/2017
1F. SF-424 Declaration 08/11/2017
1G. HUD-2880 08/11/2017
1H. HUD-50070 08/11/2017
1I. Cert. Lobbying 08/11/2017
1J. SF-LLL 08/11/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/11/2017
3A. Project Detail 08/11/2017
3B. Description 08/11/2017
3C. Dedicated Plus 08/11/2017
4A. Services 08/11/2017
4B. Housing Type 08/11/2017
5A. Households 08/11/2017
5B. Subpopulations 08/11/2017
5C. Outreach 08/11/2017
6A. Funding Request 08/11/2017
6D. Match 08/12/2017
6E. Summary Budget No Input Required
7A. Attachment(s) No Input Required
7A. In-Kind Match MOU Attachment No Input Required
7B. Certification 08/12/2017
Submission Without Changes 08/11/2017
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Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
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1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/16/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0242
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
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1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: CommQuest Services, Inc.
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-0737793
c. Organizational DUNS: 026282942 PLUS 4
d. Address
Street 1: 625 Cleveland Ave. NW
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702
e. Organizational Unit (optional)
Department Name: Homeless Services
Division Name: Supportive Services
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Mrs.
First Name: Amy
Middle Name:
Last Name: Dornack
Suffix:
Title: Manager-Homeless Services
Organizational Affiliation: CommQuest Services, Inc.
Telephone Number: (330) 453-0789
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Extension: 202
Fax Number: (330) 453-0786
Email: [email protected]
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1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: Supportive Services for the Homeless
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
17. Proposed Project
a. Start Date: 08/01/2018
b. End Date: 07/31/2019
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Mr.
First Name: Keith
Middle Name:
Last Name: Hochadel
Suffix:
Title: Chief Executive Officer/President
Telephone Number:(Format: 123-456-7890)
(330) 455-0374
Fax Number:(Format: 123-456-7890)
(330) 455-2101
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/16/2017
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1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: CommQuest Services, Inc.
Prefix: Mr.
First Name: Keith
Middle Name:
Last Name: Hochadel
Suffix:
Title: Chief Executive Officer/President
Organizational Affiliation: CommQuest Services, Inc.
Telephone Number: (330) 455-0374
Extension:
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44702
2. Employer ID Number (EIN): 34-0737793
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$60,990.00
(Requested amounts will be automatically entered within applications)
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5. State the name and location (streetaddress, city and state) of the project or
activity:
Supportive Services for the Homeless 625Cleveland Ave. NW Canton Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
No
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Keith Hochadel, Chief ExecutiveOfficer/President
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/08/2017
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: CommQuest Services, Inc.
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
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accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Mr.
First Name: Keith
Middle Name
Last Name: Hochadel
Suffix:
Title: Chief Executive Officer/President
Telephone Number:(Format: 123-456-7890)
(330) 455-0374
Fax Number:(Format: 123-456-7890)
(330) 455-2101
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/16/2017
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CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
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the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: CommQuest Services, Inc.
Name / Title of Authorized Official: Keith Hochadel, Chief ExecutiveOfficer/President
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/16/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: CommQuest Services, Inc.
Street 1: 625 Cleveland Ave. NW
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
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Authorized Representative
Prefix: Mr.
First Name: Keith
Middle Name:
Last Name: Hochadel
Suffix:
Title: Chief Executive Officer/President
Telephone Number: (Format: 123-456-7890)
(330) 455-0374
Fax Number: (Format: 123-456-7890)
(330) 455-2101
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/16/2017
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Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
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2A. Project Subrecipients
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
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2B. Recipient Performance
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
Yes
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
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3A. Project Detail
1. Expiring Grant Number: OH0242(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: Supportive Services for the Homeless
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Provide a description that addresses the entire scope of the proposedproject.
The purpose of the Supportive Services program is to assist chronically andliterally homeless individuals and families obtain and maintain housing throughoutreach and supportive services. CSSC is currently providing on-sitesupportive services staff at two identified Housing First sites: Gateway Estates I& Gateway House II. Gateway I has 36 SRO units and there are 39 units ofmixed efficiency, 1 & 2 bedroom apartments at Gateway II. The YWCA ofCanton provides property management, Stark Metropolitan Housing Authoritysupplies rental subsidies, and The Stark County Mental Health and RecoveryServices Board also provides funding. The target population faces one or moreof the following barriers to sustainable housing: severe mental illness,substance abuse, developmental disability (cognitive, mild mental retardation),HIV/AIDS, criminal histories, physical disabilities, victims of domestic violence,and lack of sufficient income or financial resources. In addition to the targetpopulation, we serve the transition aged youth (under 25) population. Duringthe Supportive Services Intake process, referrals for PSH are verified ascategory 1, literally homeless coming from only emergency shelters or thestreet. After the tenant moves in, a Needs Assessment is completed tounderstand the level of services each individual needs at the time. Whenindividuals are already connected to a mental health provider, case coordinationis usually offered or full case management for those without main providers.However, participation in supportive services is not a condition of PSH tenancy.Our case management services include providing referrals, crisis intervention,Ohio Benefit Banks Assistance, and on-site events/activities. Transportationmay be provided by staffs' personal vehicle when bus passes are unavailablefor i.e. doctor appointments. In regards to Employment & Job Training, CaseManagers keep participants informed of job fairs, job postings, and job trainingprograms. Life Skills education teaches interviewing skills, resume` building,conflict resolution and problem solving, ways to increase socialization, andbasic housekeeping. Our Outreach Program offers immediate linkage andadvocacy to unconnected individuals in the community. We actively participatein our local CoC workgroups and trainings that are offered in order to providethe best quality services to our residents. Outcomes of the supportive servicesprogram are: A large percentage of residents who have been chronicallyhomeless have maintained their housing or stayed out of prison, the StateHospital, or other institutional settings. Participants have also been connectedto mainstream resources and have been linked to other community resourcesas needed. Participants have increased socialization, reduced isolation, andhave reduced other barriers.
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2. Does your project have a specificpopulation focus?
Yes
2a. Please identify the specific population focus. (Select ALL that apply)
Chronic HomelessX
Domestic ViolenceX
VeteransX
Substance AbuseX
Youth (under 25)X
Mental IllnessX
Families with ChildrenX
HIV/AIDSX
Other(Click 'Save' to update)
Other:
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
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Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
3d. Does the project follow a "Housing First"approach?
Yes
4. Does the PH project provide PSH or RRH? PSH
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3C. Dedicated Plus
Dedicated and DedicatedPLUS
A “100% Dedicated” project is a permanent supportive housing projectthat commits 100% of its beds to chronically homeless individuals andfamilies, according to NOFA Section III.3.b.
A “DedicatedPLUS” project is a permanent supportive housing projectwhere 100% of the beds are dedicated to serve individuals with disabilitiesand families in which one adult or child has a disability, includingunaccompanied homeless youth, that at a minimum, meet ONE of thefollowing criteria according to NOFA Section III.3.d:
(1) experiencing chronic homelessness as defined in 24 CFR 578.3; (2) residing in a transitional housing project that will be eliminated and meets the definition ofchronically homeless in effect at the time in which the individual or family entered the transitionalhousing project; (3) residing in a place not meant for human habitation, emergency shelter, or safe haven; butthe individuals or families experiencing chronic homelessness as defined at 24 CFR 578.3 hadbeen admitted and enrolled in a permanent housing project within the last year and were unableto maintain a housing placement; (4) residing in transitional housing funded by a joint TH and PH-RRH component project andwho were experiencing chronic homelessness as defined at 24 CFR 578.3 prior to entering theproject; (5)residing and has resided in a place not meant for human habitation, a safe haven, oremergency shelter for at least 12 months in the last three years, but has not done so on fourseparate occasions; or (6) receiving assistance through a Department of Veterans Affairs(VA)-funded homelessassistance program and met one of the above criteria at initial intake to the VA's homelessassistance system.
A renewal project where 100 percent of the beds are dedicated in their current grant asdescribed in NOFA Section III.A.3.b. must either become DedicatedPLUS or remain 100%Dedicated. If a renewal project currently has 100 percent of its beds dedicated to chronicallyhomeless individuals and families and elects to become a DedicatedPLUS project, the projectwill be required to adhere to all fair housing requirements at 24 CFR 578.93. Any beds that theapplicant identifies in this application as being dedicated to chronically homeless individuals andfamilies in a DedicatedPLUS project must continue to operate in accordance with SectionIII.A.3.b. Beds are identified on Screen 4B.
1. Indicate whether the project is "100%Dedicated", "DedicatedPLUS", or "N/A",
according to the information provided above.
N/A
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4A. Supportive Services for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Applicant Monthly
Assistance with Moving Costs Non-Partner As needed
Case Management Applicant As needed
Child Care Non-Partner As needed
Education Services Non-Partner As needed
Employment Assistance and Job Training Applicant Weekly
Food Non-Partner As needed
Housing Search and Counseling Services Applicant As needed
Legal Services Non-Partner As needed
Life Skills Training Applicant Bi-monthly
Mental Health Services Partner As needed
Outpatient Health Services Non-Partner As needed
Outreach Services Applicant As needed
Substance Abuse Treatment Services Applicant Weekly
Transportation Applicant As needed
Utility Deposits Non-Partner As needed
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
Yes
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are received and renewed?
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partneragency?
Yes
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
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4B. Housing Type and Location
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 75
Total Beds: 84
Total Dedicated CH Beds: 19Housing Type Units Beds
Single Room Occupancy (SRO)... 36 36
Clustered apartments 39 48
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4B. Housing Type and Location Detail
1. Housing Type: Single Room Occupancy (SRO) units
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 36
b. Beds: 36
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
0
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Street 1: 1700 Gateway Blvd. SE
Street 2:
City: Canton
State: Ohio
ZIP Code: 44707
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
399151 Stark County
4B. Housing Type and Location Detail
1. Housing Type: Clustered apartments
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 39
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b. Beds: 48
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
19
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Street 1: 626 Walnut Ave NE
Street 2:
City: Canton
State: Ohio
ZIP Code: 44702
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
399151 Stark County
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5A. Project Participants - Households
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 3 75 0 78
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 3 74 77
Adults ages 18-24 1 3 4
Accompanied Children under age 18 3 0 3
Unaccompanied Children under age 18 0 0
Total Persons 7 77 0 84
Click Save to automatically calculate totals
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5B. Project Participants - Subpopulations
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 1 0 0 1 0 1 1 1 0 0
Adults ages 18-24 0 0 0 0 0 0 0 0 0 1
Children under age 18 0 0 0 0 0 0 0 3
Total Persons 1 0 0 1 0 1 1 1 0 4
Click Save to automatically calculate totals
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 23 1 2 33 0 32 23 13 9 8
Adults ages 18-24 1 0 0 0 0 1 1 0 0 1
Total Persons 24 1 2 33 0 33 24 13 9 9
Click Save to automatically calculate totals
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
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Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
Describe the unlisted subpopulations referred to above:
Subpopulations include those with low intellectual functioning yet notdevelopmentally disabled. There is currently an adult mother and adult sonliving in one unit who do not represent any of the categories listed above.Children living at Gateway II are referred to case management specific tochildren, and therefore not represented above.
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5C. Outreach for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
20% Directly from the street or other locations not meant for human habitation.
80% Directly from emergency shelters.
0% Directly from safe havens.
0% Persons fleeing domestic violence.
0% Directly from transitional housing.
Directly from the TH Portion of a Joint TH and PH-RRH Component project.
Persons receiving services through a Department of Veterans Affairs(VA)-funded homeless assistance program.
100% Total of above percentages
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6A. Funding Request
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Do any of the properties in this projecthave an active restrictive covenant?
No
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
No
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Leased Units
Leased Structures
Rental Assistance
Supportive Services X
Operating
HMIS
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6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $32,080
Total Value of In-Kind Commitments: $0
Total Value of All Commitments: $32,080
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Match Type Source Contributor Date ofCommitment
Value ofCommitments
Yes Cash Government Stark CountyMent...
08/14/2017 $32,080
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Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Government
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Stark County Mental Health and AddictionRecovery Board
5. Date of Written Commitment: 08/14/2017
6. Value of Written Commitment: $32,080
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6E. Summary Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $0
1b. Leased Structures $0
2. Rental Assistance $0
3. Supportive Services $56,721
4. Operating $0
5. HMIS $0
6. Sub-total Costs Requested $56,721
7. Admin (Up to 10%)
$4,269
8. Total Assistanceplus Admin Requested
$60,990
9. Cash Match $32,080
10. In-Kind Match $0
11. Total Match $32,080
12. Total Budget $93,070
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No Non profit 501 C ... 08/08/2017
2) Other Attachmenbt No EEO Survey 08/08/2017
3) Other Attachment No
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Attachment Details
Document Description: Non profit 501 C 3 status
Attachment Details
Document Description: EEO Survey
Attachment Details
Document Description: Code of Conduct
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7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
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It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Keith Hochadel
Date: 08/16/2017
Title: Chief Executive Officer/President
Applicant Organization: CommQuest Services, Inc.
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
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Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
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Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Make changes
3. Specify which screens require changes by clicking the checkbox next tothe name and then clicking the Save button.
Part 2- Recipient and Subrecipient Information
2A. Subrecipients
2B. Recipient Performance
Part 3 - Project Information
3A. Project DetailX
3B. Description
3C. Dedicated PlusX
Part 4 - Housing Services and HMIS
4A. Services
4B. Housing Type
Part 5 - Participants and Outreach Information
5A. Households
5B. Subpopulations
5C. Outreach
Part 6 - Budget Information
6A. Funding Request
Applicant: CommQuest Services Inc. Amy DornackProject: Supportive Services for the Homeless 153463
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6D. MatchX
6E. Summary Budget
Part 7 - Attachment(s) & Certification
7A. Attachment(s)X
7B. CertificationX
The applicant has selected "Make Changes" to Question 2 above. Pleaseprovide a brief description of the changes that will be made to the projectinformation screens (bullets are appropriate):
Although our project was rated number 10 out of 23 projects within our localcontinuum, the local CoC made the determination to decrease our funding. Weare the only SSO-PH project within the local continuum. Changes to 6D. Matchand 6E. Summary Budget.
The applicant has selected "Make Changes". Once this screen is saved,the applicant will be prohibited from "unchecking" any box that has been
checked regardless of whether a change to data on the correspondingscreen will be made.
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8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/08/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 08/08/2017
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1E. SF-424 Compliance 08/08/2017
1F. SF-424 Declaration 08/08/2017
1G. HUD-2880 08/08/2017
1H. HUD-50070 08/08/2017
1I. Cert. Lobbying 08/08/2017
1J. SF-LLL 08/08/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/08/2017
3A. Project Detail 08/08/2017
3B. Description 08/08/2017
3C. Dedicated Plus 08/08/2017
4A. Services 08/08/2017
4B. Housing Type 08/08/2017
5A. Households 08/08/2017
5B. Subpopulations 08/08/2017
5C. Outreach 08/08/2017
6A. Funding Request 08/08/2017
6D. Match 08/16/2017
6E. Summary Budget No Input Required
7A. Attachment(s) 08/08/2017
7B. Certification 08/16/2017
Submission Without Changes 08/16/2017
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Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
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1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/16/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0421
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
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1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: Stark Metropolitan Housing Authority
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-6000508
c. Organizational DUNS: 010831279 PLUS 4 1111
d. Address
Street 1: 400 East Tuscarawas Street
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702
e. Organizational Unit (optional)
Department Name: Freed Housing
Division Name:
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Mr.
First Name: Martin
Middle Name: J
Last Name: Chumney
Suffix:
Title: HCV Program Director
Organizational Affiliation: Stark Metropolitan Housing Authority
Telephone Number: (330) 454-8051
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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Extension: 312
Fax Number: (330) 580-9000
Email: [email protected]
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1C. SF-424 Application Details
9. Type of Applicant: La. Public Housing Authority
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: Shelter Plus Care Hunter House 2011
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-007
b. Project:(for multiple selections hold CTRL key)
OH-007
17. Proposed Project
a. Start Date: 09/01/2018
b. End Date: 08/31/2019
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Mr.
First Name: Herman
Middle Name: L
Last Name: Hill
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 454-8051
Fax Number:(Format: 123-456-7890)
(330) 454-8065
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/16/2017
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1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: Stark Metropolitan Housing Authority
Prefix: Mr.
First Name: Herman
Middle Name: L
Last Name: Hill
Suffix:
Title: Executive Director
Organizational Affiliation: Stark Metropolitan Housing Authority
Telephone Number: (330) 454-8051
Extension: 332
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44702
2. Employer ID Number (EIN): 34-6000508
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$45,107.00
(Requested amounts will be automatically entered within applications)
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5. State the name and location (streetaddress, city and state) of the project or
activity:
Shelter Plus Care Hunter House 2011 400 EastTuscarawas Street Canton Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
Yes
Part II Other Government Assistance Provided or Requested/ExpectedSources and Use of Funds
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance,payment, credit, or tax benefit.
Department/Local Agency Name and Address Type of Assistance AmountRequested /
Provided
Expected Uses of the Funds
NA NA $0.00 NA
Part III Interested Parties
You must disclose:1. All developers, contractors, or consultants involved in the application for the assistance or inthe planning, development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which theassistance is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower).
Alphabetical list of all persons with a Social Security No. Type of Financial Interest Financial Interest
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reportable financial interest in theproject or activity
(For individuals, give the last namefirst)
or Employee ID No. Participation in Project/Activity($)
in Project/Activity(%)
NA NA NA $0.00 0%
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Herman Hill, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 07/18/2017
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: Stark Metropolitan Housing Authority
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
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accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Mr.
First Name: Herman
Middle Name L
Last Name: Hill
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 454-8051
Fax Number:(Format: 123-456-7890)
(330) 454-8065
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/16/2017
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CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: Stark Metropolitan Housing Authority
Name / Title of Authorized Official: Herman Hill, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/16/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: Stark Metropolitan Housing Authority
Street 1: 400 East Tuscarawas Street
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
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Authorized Representative
Prefix: Mr.
First Name: Herman
Middle Name: L
Last Name: Hill
Suffix:
Title: Executive Director
Telephone Number: (Format: 123-456-7890)
(330) 454-8051
Fax Number: (Format: 123-456-7890)
(330) 454-8065
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/16/2017
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Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
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2A. Project Subrecipients
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
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2B. Recipient Performance
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
Yes
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
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3A. Project Detail
1. Expiring Grant Number: OH0421(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: Shelter Plus Care Hunter House 2011
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
1. Provide a description that addresses the entire scope of the proposedproject.
Project house chronic homeless individuals with a dual diagnosis of mentalillness and substance abuse. On site services are provided by a local mentalhealth organization who case manages the clients.
2. Does your project have a specificpopulation focus?
Yes
2a. Please identify the specific population focus. (Select ALL that apply)
Chronic HomelessX
Domestic Violence
Veterans Substance AbuseX
Youth (under 25) Mental IllnessX
Families with Children HIV/AIDS
Other(Click 'Save' to update)
Other:
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
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None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
3d. Does the project follow a "Housing First"approach?
Yes
4. Does the PH project provide PSH or RRH? PSH
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3C. Dedicated Plus
Dedicated and DedicatedPLUS
A “100% Dedicated” project is a permanent supportive housing projectthat commits 100% of its beds to chronically homeless individuals andfamilies, according to NOFA Section III.3.b.
A “DedicatedPLUS” project is a permanent supportive housing projectwhere 100% of the beds are dedicated to serve individuals with disabilitiesand families in which one adult or child has a disability, includingunaccompanied homeless youth, that at a minimum, meet ONE of thefollowing criteria according to NOFA Section III.3.d:
(1) experiencing chronic homelessness as defined in 24 CFR 578.3; (2) residing in a transitional housing project that will be eliminated and meets the definition ofchronically homeless in effect at the time in which the individual or family entered the transitionalhousing project; (3) residing in a place not meant for human habitation, emergency shelter, or safe haven; butthe individuals or families experiencing chronic homelessness as defined at 24 CFR 578.3 hadbeen admitted and enrolled in a permanent housing project within the last year and were unableto maintain a housing placement; (4) residing in transitional housing funded by a joint TH and PH-RRH component project andwho were experiencing chronic homelessness as defined at 24 CFR 578.3 prior to entering theproject; (5)residing and has resided in a place not meant for human habitation, a safe haven, oremergency shelter for at least 12 months in the last three years, but has not done so on fourseparate occasions; or (6) receiving assistance through a Department of Veterans Affairs(VA)-funded homelessassistance program and met one of the above criteria at initial intake to the VA's homelessassistance system.
A renewal project where 100 percent of the beds are dedicated in their current grant asdescribed in NOFA Section III.A.3.b. must either become DedicatedPLUS or remain 100%Dedicated. If a renewal project currently has 100 percent of its beds dedicated to chronicallyhomeless individuals and families and elects to become a DedicatedPLUS project, the projectwill be required to adhere to all fair housing requirements at 24 CFR 578.93. Any beds that theapplicant identifies in this application as being dedicated to chronically homeless individuals andfamilies in a DedicatedPLUS project must continue to operate in accordance with SectionIII.A.3.b. Beds are identified on Screen 4B.
1. Indicate whether the project is "100%Dedicated", "DedicatedPLUS", or "N/A",
according to the information provided above.
DedicatedPLUS
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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4A. Supportive Services for Participants
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Partner As needed
Assistance with Moving Costs Non-Partner As needed
Case Management Partner As needed
Child Care Non-Partner As needed
Education Services Partner As needed
Employment Assistance and Job Training Partner As needed
Food Partner As needed
Housing Search and Counseling Services Partner As needed
Legal Services Non-Partner As needed
Life Skills Training Partner As needed
Mental Health Services Partner As needed
Outpatient Health Services Partner As needed
Outreach Services Partner As needed
Substance Abuse Treatment Services Partner As needed
Transportation Partner As needed
Utility Deposits Applicant As needed
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
are received and renewed?
Yes
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partner
Yes
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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agency?
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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4B. Housing Type and Location
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 7
Total Beds: 7
Total Dedicated CH Beds: 4Housing Type Units Beds
Clustered apartments 7 7
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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4B. Housing Type and Location Detail
1. Housing Type: Clustered apartments
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 7
b. Beds: 7
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
4
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Street 1: 1114 Gonder AVe SE
Street 2:
City: Canton
State: Ohio
ZIP Code: 44707
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
390858 Canton
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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5A. Project Participants - Households
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 0 7 0 7
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 0 7 7
Adults ages 18-24 0 0 0
Accompanied Children under age 18 0 0 0
Unaccompanied Children under age 18 0 0
Total Persons 0 7 0 7
Click Save to automatically calculate totals
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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5B. Project Participants - Subpopulations
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Children under age 18
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 7
Adults ages 18-24 0
Total Persons 7 0 0 0 0 0 0 0 0 0
Click Save to automatically calculate totals
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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5C. Outreach for Participants
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
50% Directly from the street or other locations not meant for human habitation.
50% Directly from emergency shelters.
Directly from safe havens.
Persons fleeing domestic violence.
Directly from transitional housing eliminated in the FY 2017 CoC Program Competition.
Directly from the TH Portion of a Joint TH and PH-RRH Component project.
Persons receiving services through a Department of Veterans Affairs(VA)-funded homeless assistance program.
100% Total of above percentages
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6A. Funding Request
1. Do any of the properties in this projecthave an active restrictive covenant?
No
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
No
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Leased Units X
Leased Structures
Rental Assistance
Supportive Services
Operating
HMIS
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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6B. Leased Units Budget
The following list summarizes the funds being requested for one or moreunits leased for operating the projects. To add information to the list,select the icon. To view or update information already listed, select theicon.
Total Annual Assistance Requested: $45,107
Grant Term: 1 Year
Total Request for Grant Term: $45,107
Total Units: 7
FMR Area Total Units Requested Total Annual BudgetRequested
Total Budget Requested
OH - Canton-Massi... 7 $45,107 $45,107
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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Leased Units Budget Detail
Enter the appropriate values in the "Number of Units" AND "TotalRequest" fields.
Metropolitan or non-metropolitanfair market rent area:
OH - Canton-Massillon, OH MSA (3901999999)
Leased Units Annual BudgetSize of Units # of Units
(Applicant)Total
Request(Applicant)
SRO 0
0 Bedroom 1
1 Bedroom 6
2 Bedroom 0
3 Bedroom 0
4 Bedroom 0
5 Bedroom 0
6 Bedroom 0
7 Bedroom 0
8 Bedroom 0
9 Bedroom 0
Total Units and AnnualAssistance Requested
7 $45,107
Grant Term 1 Year
Total Request for Grant Term $45,107
Click the 'Save' button to automatically calculate totals.
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $0
Total Value of In-Kind Commitments: $11,277
Total Value of All Commitments: $11,277
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.Match Type Source Contributor Date of
CommitmentValue ofCommitments
Yes In-Kind Government Stark MHAR 12/15/2017 $11,277
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
3. Type of Source: Government
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Stark MHAR
5. Date of Written Commitment: 12/15/2017
6. Value of Written Commitment: $11,277
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
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6E. Summary Budget
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $45,107
1b. Leased Structures $0
2. Rental Assistance $0
3. Supportive Services $0
4. Operating $0
5. HMIS $0
6. Sub-total Costs Requested $45,107
7. Admin (Up to 10%)
8. Total Assistanceplus Admin Requested
$45,107
9. Cash Match $0
10. In-Kind Match $11,277
11. Total Match $11,277
12. Total Budget $56,384
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No
3) Other Attachment No
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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Attachment Details
Document Description:
Attachment Details
Document Description:
Attachment Details
Document Description:
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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7A. In-Kind Match MOU Attachment
Document Type Required? Document Description Date Attached
In-Kind Match MOU No
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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Attachment Details
Document Description:
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7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
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It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Herman Hill
Date: 08/16/2017
Title: Executive Director
Applicant Organization: Stark Metropolitan Housing Authority
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
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Renewal Project Application FY2017 Page 43 09/22/2017
Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Make changes
3. Specify which screens require changes by clicking the checkbox next tothe name and then clicking the Save button.
Part 2- Recipient and Subrecipient Information
2A. SubrecipientsX
2B. Recipient PerformanceX
Part 3 - Project Information
3A. Project DetailX
3B. DescriptionX
3C. Dedicated PlusX
Part 4 - Housing Services and HMIS
4A. ServicesX
4B. Housing TypeX
Part 5 - Participants and Outreach Information
5A. HouseholdsX
5B. SubpopulationsX
5C. OutreachX
Part 6 - Budget Information
6A. Funding RequestX
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6B. Leased UnitsX
6D. MatchX
6E. Summary BudgetX
Part 7 - Attachment(s) & Certification
7A. Attachment(s)X
7A. In-Kind Match MOU AttachmentX
7B. CertificationX
The applicant has selected "Make Changes" to Question 2 above. Pleaseprovide a brief description of the changes that will be made to the projectinformation screens (bullets are appropriate):
This was originally a 5 year grant that is completing with extensions added. Thegrant will now be renewed on one year terms.
The applicant has selected "Make Changes". Once this screen is saved,the applicant will be prohibited from "unchecking" any box that has been
checked regardless of whether a change to data on the correspondingscreen will be made.
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8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/16/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care Hunter House 2011 153984
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1D. SF-424 Congressional District(s) 08/16/2017
1E. SF-424 Compliance 08/16/2017
1F. SF-424 Declaration 08/16/2017
1G. HUD-2880 08/16/2017
1H. HUD-50070 08/16/2017
1I. Cert. Lobbying 08/16/2017
1J. SF-LLL 08/16/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/16/2017
3A. Project Detail 08/16/2017
3B. Description 08/16/2017
3C. Dedicated Plus 08/16/2017
4A. Services 08/16/2017
4B. Housing Type 08/16/2017
5A. Households 08/16/2017
5B. Subpopulations No Input Required
5C. Outreach 08/16/2017
6A. Funding Request 08/16/2017
6B. Leased Units 08/16/2017
6D. Match 08/16/2017
6E. Summary Budget No Input Required
7A. Attachment(s) No Input Required
7A. In-Kind Match MOU Attachment No Input Required
7B. Certification 08/16/2017
Submission Without Changes 08/16/2017
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Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
Renewal Project Application FY2017 Page 1 09/22/2017
1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/15/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0234
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
Renewal Project Application FY2017 Page 2 09/22/2017
1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: ICAN Inc.
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-1575839
c. Organizational DUNS: 189042914 PLUS 4
d. Address
Street 1: 1214 Market Ave N
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44714
e. Organizational Unit (optional)
Department Name:
Division Name:
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Mrs.
First Name: Natalie
Middle Name:
Last Name: McCleskey
Suffix:
Title: Development Director
Organizational Affiliation: ICAN Inc.
Telephone Number: (330) 455-9100
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
Renewal Project Application FY2017 Page 3 09/22/2017
Extension: 150
Fax Number: (330) 455-4702
Email: [email protected]
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
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1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
Renewal Project Application FY2017 Page 5 09/22/2017
1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: Housing First Leasing Assistance
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-016, OH-007
17. Proposed Project
a. Start Date: 04/01/2017
b. End Date: 03/31/2018
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
Renewal Project Application FY2017 Page 6 09/22/2017
1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
Renewal Project Application FY2017 Page 7 09/22/2017
1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-9100
Fax Number:(Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
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Renewal Project Application FY2017 Page 8 09/22/2017
1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: ICAN Inc.
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Organizational Affiliation: ICAN Inc.
Telephone Number: (330) 455-9100
Extension:
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44714
2. Employer ID Number (EIN): 34-1575839
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$110,440.00
(Requested amounts will be automatically entered within applications)
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Renewal Project Application FY2017 Page 9 09/22/2017
5. State the name and location (streetaddress, city and state) of the project or
activity:
Housing First Leasing Assistance 1214 MarketAve N Canton Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
Yes
Part II Other Government Assistance Provided or Requested/ExpectedSources and Use of Funds
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance,payment, credit, or tax benefit.
Department/Local Agency Name and Address Type of Assistance AmountRequested /
Provided
Expected Uses of the Funds
Ohio Development Services Agency, 77 S. HighStreet, Columbus, OH 43215
Grant $19,851.00 Cherry Grove - Maintainance, Utilitiesand Insurance
Ohio Development Services Agency, 77 S. HighStreet, Columbus, OH 43215
Grant 37834.0 Rapid Re-Housing - Salaries andBenefits
Stark Mental Health & Addiction Recovery, 121Cleveland Ave SW, Canton, OH 44702
Grant $45,389.00 Shelter Plus Care and West Park -Supportive Services; Peer Support;Employment; Critical TimeInterventionist Salary; Benefits andTravel
Part III Interested Parties
You must disclose:1. All developers, contractors, or consultants involved in the application for the assistance or in
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
Renewal Project Application FY2017 Page 10 09/22/2017
the planning, development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which theassistance is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower).
Alphabetical list of all persons with areportable financial interest in the
project or activity (For individuals, give the last name
first)
Social Security No.or Employee ID No.
Type ofParticipation
Financial Interestin Project/Activity
($)
Financial Interestin Project/Activity
(%)
NA NA NA $0.00 0%
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Julie Sparks, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/14/2017
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: ICAN Inc.
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
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Renewal Project Application FY2017 Page 12 09/22/2017
accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-9100
Fax Number:(Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
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Renewal Project Application FY2017 Page 13 09/22/2017
CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
Renewal Project Application FY2017 Page 14 09/22/2017
the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: ICAN Inc.
Name / Title of Authorized Official: Julie Sparks, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
Renewal Project Application FY2017 Page 15 09/22/2017
1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: ICAN Inc.
Street 1: 1214 Market Ave N
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44714
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
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Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number: (Format: 123-456-7890)
(330) 455-9100
Fax Number: (Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
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Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
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2A. Project Subrecipients
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
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2B. Recipient Performance
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
Yes
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
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3A. Project Detail
1. Expiring Grant Number: OH0234(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: Housing First Leasing Assistance
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Provide a description that addresses the entire scope of the proposedproject.
Our community needs housing for homeless, single adults. Housing FirstLeasing Assistance provides permanent housing for this population. Eligibleapplicants primarily come from the street or shelters, and have serious andpersistent mental illness. Centralized intake and assessment is conducted bythe local HMIS Homeless Hotline. ICAN is on the CoC Centralized Intake andAssessment Committee and utilizes the central process approved by the CoC tofill vacancies. In compliance with the local CoC Central Intake and Assessmentpolicies, chronically homeless persons with the most severe need will be placedhigher on the wait list. First priority will be given to chronically homeless personswith the longest history of homelessness and with the most severe serviceneeds. Consistent with HUD’s Housing First approach, ICAN overlooks historyof evictions, poor financial history, minor criminal convictions, substance abuseissues, and other traditional barriers to house clients quickly.
The Project serves at least 13 clients in scattered site units. Most have zeroincome at entry. Clients choose their apartments from private market landlords.A Supported Housing Specialist assists participants to identify suitableapartments. ICAN staff inspects each apartment to assure it meets HUD rentguidelines and housing quality standards. To comply with HEARTHrequirements, ICAN converted tenant/private landlord leases into leasesbetween the landlord and ICAN with a sublease for the tenant. The Specialistworks with each tenant to develop goals for a permanent housing outcome andincreased income. ICAN Housing and SSI Specialists help clients accessmainstream services and benefits through a partnership with Stark MentalHealth & Addiction Recovery (SMHAR). Clients use existing services within themental health system. ICAN will make referrals to Coleman ProfessionalServices (CPS) for assistance in applying for SSI and Medicaid and using theOhio Benefit Bank. ICAN Housing requires CoC funding to pay for the totalhousing related costs of rent and utilities. Participants pay an occupancycharge which may not exceed the highest of: a) 30 percent of the family’smonthly adjusted income; or b) 10% of the family’s monthly gross income.
2. Does your project have a specificpopulation focus?
Yes
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2a. Please identify the specific population focus. (Select ALL that apply)
Chronic Homeless Domestic Violence
VeteransX
Substance Abuse
Youth (under 25) Mental IllnessX
Families with Children HIV/AIDS
Other(Click 'Save' to update)
Other:
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
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3d. Does the project follow a "Housing First"approach?
Yes
4. Does the PH project provide PSH or RRH? PSH
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3C. Dedicated Plus
Dedicated and DedicatedPLUS
A “100% Dedicated” project is a permanent supportive housing projectthat commits 100% of its beds to chronically homeless individuals andfamilies, according to NOFA Section III.3.b.
A “DedicatedPLUS” project is a permanent supportive housing projectwhere 100% of the beds are dedicated to serve individuals with disabilitiesand families in which one adult or child has a disability, includingunaccompanied homeless youth, that at a minimum, meet ONE of thefollowing criteria according to NOFA Section III.3.d:
(1) experiencing chronic homelessness as defined in 24 CFR 578.3; (2) residing in a transitional housing project that will be eliminated and meets the definition ofchronically homeless in effect at the time in which the individual or family entered the transitionalhousing project; (3) residing in a place not meant for human habitation, emergency shelter, or safe haven; butthe individuals or families experiencing chronic homelessness as defined at 24 CFR 578.3 hadbeen admitted and enrolled in a permanent housing project within the last year and were unableto maintain a housing placement; (4) residing in transitional housing funded by a joint TH and PH-RRH component project andwho were experiencing chronic homelessness as defined at 24 CFR 578.3 prior to entering theproject; (5)residing and has resided in a place not meant for human habitation, a safe haven, oremergency shelter for at least 12 months in the last three years, but has not done so on fourseparate occasions; or (6) receiving assistance through a Department of Veterans Affairs(VA)-funded homelessassistance program and met one of the above criteria at initial intake to the VA's homelessassistance system.
A renewal project where 100 percent of the beds are dedicated in their current grant asdescribed in NOFA Section III.A.3.b. must either become DedicatedPLUS or remain 100%Dedicated. If a renewal project currently has 100 percent of its beds dedicated to chronicallyhomeless individuals and families and elects to become a DedicatedPLUS project, the projectwill be required to adhere to all fair housing requirements at 24 CFR 578.93. Any beds that theapplicant identifies in this application as being dedicated to chronically homeless individuals andfamilies in a DedicatedPLUS project must continue to operate in accordance with SectionIII.A.3.b. Beds are identified on Screen 4B.
1. Indicate whether the project is "100%Dedicated", "DedicatedPLUS", or "N/A",
according to the information provided above.
N/A
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4A. Supportive Services for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Applicant Annually
Assistance with Moving Costs
Case Management Partner Monthly
Child Care
Education Services Non-Partner Quarterly
Employment Assistance and Job Training Non-Partner Monthly
Food Non-Partner As needed
Housing Search and Counseling Services Applicant Monthly
Legal Services
Life Skills Training
Mental Health Services Partner Monthly
Outpatient Health Services Non-Partner As needed
Outreach Services Applicant As needed
Substance Abuse Treatment Services Partner Monthly
Transportation Applicant Daily
Utility Deposits Applicant As needed
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
Yes
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Renewal Project Application FY2017 Page 26 09/22/2017
are received and renewed?
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partneragency?
Yes
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
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4B. Housing Type and Location
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 13
Total Beds: 13
Total Dedicated CH Beds: 0Housing Type Units Beds
Scattered-site apartments (... 13 13
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4B. Housing Type and Location Detail
1. Housing Type: Scattered-site apartments (including efficiencies)
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 13
b. Beds: 13
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
0
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Street 1: 1214 Market Ave. N.
Street 2:
City: Canton
State: Ohio
ZIP Code: 44714
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
390858 Canton, 399151 Stark County
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5A. Project Participants - Households
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 0 13 0 13
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 0 12 12
Adults ages 18-24 0 1 1
Accompanied Children under age 18 0 0 0
Unaccompanied Children under age 18 0 0
Total Persons 0 13 0 13
Click Save to automatically calculate totals
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5B. Project Participants - Subpopulations
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Children under age 18
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 4 4 3 5 0 9 1 0 0 0
Adults ages 18-24 0 0 0 0 0 1 0 0 0 0
Total Persons 4 4 3 5 0 10 1 0 0 0
Click Save to automatically calculate totals
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
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Renewal Project Application FY2017 Page 31 09/22/2017
5C. Outreach for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
60% Directly from the street or other locations not meant for human habitation.
40% Directly from emergency shelters.
0% Directly from safe havens.
0% Persons fleeing domestic violence.
0% Directly from transitional housing.
Directly from the TH Portion of a Joint TH and PH-RRH Component project.
Persons receiving services through a Department of Veterans Affairs(VA)-funded homeless assistance program.
100% Total of above percentages
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6A. Funding Request
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Do any of the properties in this projecthave an active restrictive covenant?
No
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
No
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Leased Units X
Leased Structures
Rental Assistance
Supportive Services
Operating X
HMIS
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
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6B. Leased Units Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes the funds being requested for one or moreunits leased for operating the projects. To add information to the list,select the icon. To view or update information already listed, select theicon.
Total Annual Assistance Requested: $95,213
Grant Term: 1 Year
Total Request for Grant Term: $95,213
Total Units: 13
FMR Area Total Units Requested Total Annual BudgetRequested
Total Budget Requested
OH - Canton-Massi... 13 $95,213 $95,213
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
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Leased Units Budget Detail
Enter the appropriate values in the "Number of Units" AND "TotalRequest" fields.
Metropolitan or non-metropolitanfair market rent area:
OH - Canton-Massillon, OH MSA (3901999999)
Leased Units Annual BudgetSize of Units # of Units
(Applicant)Total
Request(Applicant)
SRO
0 Bedroom
1 Bedroom 13
2 Bedroom
3 Bedroom
4 Bedroom
5 Bedroom
6 Bedroom
7 Bedroom
8 Bedroom
9 Bedroom
Total Units and AnnualAssistance Requested
13 $95,213
Grant Term 1 Year
Total Request for Grant Term $95,213
Click the 'Save' button to automatically calculate totals.
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6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $3,807
Total Value of In-Kind Commitments: $0
Total Value of All Commitments: $3,807
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
Yes
1a. Briefly describe the source of the program income:
Program Income will be generated from occupancy charges paid to ICAN Inc.by the participants that does not exceed the highest of: a) 30% of the family'smonthly adjusted income; or b) 10% of the family's monthly gross income.
1b. Estimate the amount of program income that will be used as Match for this project:
$3,807
Match Type Source Contributor Date ofCommitment
Value ofCommitments
Yes Cash Private ICAN, Inc. rental... 08/12/2017 $3,807
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
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Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
ICAN, Inc. rental income.
5. Date of Written Commitment: 08/12/2017
6. Value of Written Commitment: $3,807
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6E. Summary Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $95,213
1b. Leased Structures $0
2. Rental Assistance $0
3. Supportive Services $0
4. Operating $8,350
5. HMIS $0
6. Sub-total Costs Requested $103,563
7. Admin (Up to 10%)
$6,877
8. Total Assistanceplus Admin Requested
$110,440
9. Cash Match $3,807
10. In-Kind Match $0
11. Total Match $3,807
12. Total Budget $114,247
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No Match Commitment ... 08/09/2017
3) Other Attachment No
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
Renewal Project Application FY2017 Page 39 09/22/2017
Attachment Details
Document Description:
Attachment Details
Document Description: Match Commitment Letter - Housing FirstLeasing Assistance
Attachment Details
Document Description:
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Renewal Project Application FY2017 Page 40 09/22/2017
7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
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It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Julie Sparks
Date: 08/15/2017
Title: Executive Director
Applicant Organization: ICAN Inc.
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
Renewal Project Application FY2017 Page 42 09/22/2017
Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
Renewal Project Application FY2017 Page 43 09/22/2017
Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Make changes
3. Specify which screens require changes by clicking the checkbox next tothe name and then clicking the Save button.
Part 2- Recipient and Subrecipient Information
2A. Subrecipients
2B. Recipient Performance
Part 3 - Project Information
3A. Project DetailX
3B. Description
3C. Dedicated PlusX
Part 4 - Housing Services and HMIS
4A. Services
4B. Housing Type
Part 5 - Participants and Outreach Information
5A. Households
5B. Subpopulations
5C. Outreach
Part 6 - Budget Information
6A. Funding Request
Applicant: ICAN Inc. 189042914Project: Housing First Leasing Assistance 152193
Renewal Project Application FY2017 Page 44 09/22/2017
6B. Leased Units
6D. MatchX
6E. Summary Budget
Part 7 - Attachment(s) & Certification
7A. Attachment(s)X
7B. CertificationX
The applicant has selected "Make Changes" to Question 2 above. Pleaseprovide a brief description of the changes that will be made to the projectinformation screens (bullets are appropriate):
* 2B. Recipient Performance - No funds were recaptured by HUD in most recentgrant cycle.* 3B. Project Description - Removing final paragraph in the narrative section,that previously provided annual APR outcomes, in order to align with HUD'sInstructional Guidance regarding to desire for Applicants to avoid the need tomake annual updates in renewal project applications.
The applicant has selected "Make Changes". Once this screen is saved,the applicant will be prohibited from "unchecking" any box that has been
checked regardless of whether a change to data on the correspondingscreen will be made.
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8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/03/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 08/03/2017
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1E. SF-424 Compliance 08/03/2017
1F. SF-424 Declaration 08/03/2017
1G. HUD-2880 08/03/2017
1H. HUD-50070 08/03/2017
1I. Cert. Lobbying 08/03/2017
1J. SF-LLL 08/03/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/14/2017
3A. Project Detail 08/03/2017
3B. Description 08/03/2017
3C. Dedicated Plus 08/03/2017
4A. Services 08/03/2017
4B. Housing Type 08/03/2017
5A. Households 08/03/2017
5B. Subpopulations No Input Required
5C. Outreach 08/03/2017
6A. Funding Request 08/03/2017
6B. Leased Units 08/03/2017
6D. Match 08/09/2017
6E. Summary Budget No Input Required
7A. Attachment(s) 08/09/2017
7B. Certification 08/15/2017
Submission Without Changes 08/14/2017
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Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 1 09/22/2017
1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/15/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0299
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
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Renewal Project Application FY2017 Page 2 09/22/2017
1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: ICAN Inc.
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-1575839
c. Organizational DUNS: 189042914 PLUS 4
d. Address
Street 1: 1214 Market Ave N
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44714
e. Organizational Unit (optional)
Department Name:
Division Name:
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Mrs.
First Name: Natalie
Middle Name:
Last Name: McCleskey
Suffix:
Title: Development Director
Organizational Affiliation: ICAN Inc.
Telephone Number: (330) 455-9100
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 3 09/22/2017
Extension: 150
Fax Number: (330) 455-4702
Email: [email protected]
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 4 09/22/2017
1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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Renewal Project Application FY2017 Page 5 09/22/2017
1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: Supported Apartments
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-016, OH-007
17. Proposed Project
a. Start Date: 05/01/2017
b. End Date: 04/30/2018
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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Renewal Project Application FY2017 Page 6 09/22/2017
1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
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Renewal Project Application FY2017 Page 7 09/22/2017
1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-9100
Fax Number:(Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
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Renewal Project Application FY2017 Page 8 09/22/2017
1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: ICAN Inc.
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Organizational Affiliation: ICAN Inc.
Telephone Number: (330) 455-9100
Extension:
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44714
2. Employer ID Number (EIN): 34-1575839
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$204,292.00
(Requested amounts will be automatically entered within applications)
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 9 09/22/2017
5. State the name and location (streetaddress, city and state) of the project or
activity:
Supported Apartments 1214 Market Ave NCanton Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
Yes
Part II Other Government Assistance Provided or Requested/ExpectedSources and Use of Funds
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance,payment, credit, or tax benefit.
Department/Local Agency Name and Address Type of Assistance AmountRequested /
Provided
Expected Uses of the Funds
Ohio Development Services Agency, 77 S. HighStreet, Columbus, OH 43215
Grant $19,851.00 Cherry Grove - Maintainance, Utilitiesand Insurance
Ohio Development Services Agency, 77 S. HighStreet, Columbus, OH 43215
Grant 37834.0 Rapid Re-Housing - Salaries andBenefits
Stark Mental Health & Addiction Recovery, 121Cleveland Ave SW, Canton, OH 44702
Grant $45,389.00 Shelter Plus Care and West Park -Supportive Services; Peer Support;Employment; Critical TimeInterventionist Salary; Benefits andTravel
Part III Interested Parties
You must disclose:1. All developers, contractors, or consultants involved in the application for the assistance or in
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 10 09/22/2017
the planning, development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which theassistance is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower).
Alphabetical list of all persons with areportable financial interest in the
project or activity (For individuals, give the last name
first)
Social Security No.or Employee ID No.
Type ofParticipation
Financial Interestin Project/Activity
($)
Financial Interestin Project/Activity
(%)
NA NA NA $0.00 0%
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Julie Sparks, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/14/2017
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Renewal Project Application FY2017 Page 11 09/22/2017
1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: ICAN Inc.
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 12 09/22/2017
accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-9100
Fax Number:(Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 13 09/22/2017
CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 14 09/22/2017
the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: ICAN Inc.
Name / Title of Authorized Official: Julie Sparks, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 15 09/22/2017
1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: ICAN Inc.
Street 1: 1214 Market Ave N
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44714
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 16 09/22/2017
Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number: (Format: 123-456-7890)
(330) 455-9100
Fax Number: (Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 17 09/22/2017
Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
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2A. Project Subrecipients
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
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2B. Recipient Performance
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
Yes
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
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3A. Project Detail
1. Expiring Grant Number: OH0299(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: Supported Apartments
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Provide a description that addresses the entire scope of the proposedproject.
Our community needs housing for chronically homeless single adults. TheSupported Apartments Project provides permanent housing for this targetgroup. Eligible applicants must have incomes at/below 50% AMI and primarilycome from the street or shelters and have serious and persistent mental illness,possibly complicated by substance abuse issues. Centralized intake andassessment is conducted by the local HMIS Homeless Hotline. ICAN is on theCoC Centralized Intake and Assessment Committee and utilizes the centralprocess approved by the CoC to fill vacancies. In compliance with the local CoCCentral Intake and Assessment policies, chronically homeless persons with themost severe need will be placed higher on the wait list. First priority will be givento chronically homeless persons with the longest history of homelessness andwith the most severe service needs. Consistent with HUD’s Housing Firstapproach, ICAN overlooks history of evictions, poor financial history, minorcriminal convictions, substance abuse issues, and other traditional barriers tohouse clients quickly.
The Project serves 29 clients in scattered sites. Most have $0 income at entry.Clients choose their apartments from private market landlords. A SupportedHousing Specialist assists participants to identify suitable apartments. ICANstaff inspects each apartment to assure it meets HUD rent guidelines andhousing quality standards. To comply with Hearth requirements, ICANconverted tenant/private landlord leases into leases between the landlord andICAN with a sublease for the tenant. The Specialist works with each tenant todevelop goals for a permanent housing outcome and increased income. ICANHousing refers clients co Coleman Professional Services (CPS) for assistancein accessing mainstream services and benefits through a partnership with theMental Health & Recovery Services Board. Clients use existing services withinthe mental health system. ICAN Housing requires CoC funding to pay for thetotal housing related costs of rent and utilities. Participants pay an occupancycharge which may not exceed the highest of: a) 30 percent of the family’smonthly adjusted income; or b) 10% of the family’s monthly gross income.
2. Does your project have a specificpopulation focus?
Yes
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 22 09/22/2017
2a. Please identify the specific population focus. (Select ALL that apply)
Chronic HomelessX
Domestic Violence
Veterans Substance Abuse
Youth (under 25) Mental IllnessX
Families with Children HIV/AIDS
Other(Click 'Save' to update)
Other:
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 23 09/22/2017
3d. Does the project follow a "Housing First"approach?
Yes
4. Does the PH project provide PSH or RRH? PSH
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 24 09/22/2017
3C. Dedicated Plus
Dedicated and DedicatedPLUS
A “100% Dedicated” project is a permanent supportive housing projectthat commits 100% of its beds to chronically homeless individuals andfamilies, according to NOFA Section III.3.b.
A “DedicatedPLUS” project is a permanent supportive housing projectwhere 100% of the beds are dedicated to serve individuals with disabilitiesand families in which one adult or child has a disability, includingunaccompanied homeless youth, that at a minimum, meet ONE of thefollowing criteria according to NOFA Section III.3.d:
(1) experiencing chronic homelessness as defined in 24 CFR 578.3; (2) residing in a transitional housing project that will be eliminated and meets the definition ofchronically homeless in effect at the time in which the individual or family entered the transitionalhousing project; (3) residing in a place not meant for human habitation, emergency shelter, or safe haven; butthe individuals or families experiencing chronic homelessness as defined at 24 CFR 578.3 hadbeen admitted and enrolled in a permanent housing project within the last year and were unableto maintain a housing placement; (4) residing in transitional housing funded by a joint TH and PH-RRH component project andwho were experiencing chronic homelessness as defined at 24 CFR 578.3 prior to entering theproject; (5)residing and has resided in a place not meant for human habitation, a safe haven, oremergency shelter for at least 12 months in the last three years, but has not done so on fourseparate occasions; or (6) receiving assistance through a Department of Veterans Affairs(VA)-funded homelessassistance program and met one of the above criteria at initial intake to the VA's homelessassistance system.
A renewal project where 100 percent of the beds are dedicated in their current grant asdescribed in NOFA Section III.A.3.b. must either become DedicatedPLUS or remain 100%Dedicated. If a renewal project currently has 100 percent of its beds dedicated to chronicallyhomeless individuals and families and elects to become a DedicatedPLUS project, the projectwill be required to adhere to all fair housing requirements at 24 CFR 578.93. Any beds that theapplicant identifies in this application as being dedicated to chronically homeless individuals andfamilies in a DedicatedPLUS project must continue to operate in accordance with SectionIII.A.3.b. Beds are identified on Screen 4B.
1. Indicate whether the project is "100%Dedicated", "DedicatedPLUS", or "N/A",
according to the information provided above.
100% Dedicated
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
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4A. Supportive Services for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Applicant Annually
Assistance with Moving Costs
Case Management Partner Monthly
Child Care
Education Services Non-Partner Quarterly
Employment Assistance and Job Training Non-Partner Monthly
Food Non-Partner As needed
Housing Search and Counseling Services Applicant Monthly
Legal Services
Life Skills Training
Mental Health Services Partner Monthly
Outpatient Health Services Non-Partner As needed
Outreach Services Applicant As needed
Substance Abuse Treatment Services Partner Monthly
Transportation Applicant As needed
Utility Deposits Applicant As needed
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
Yes
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 26 09/22/2017
are received and renewed?
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partneragency?
Yes
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
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4B. Housing Type and Location
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 29
Total Beds: 29
Total Dedicated CH Beds: 29Housing Type Units Beds
Scattered-site apartments (... 29 29
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4B. Housing Type and Location Detail
1. Housing Type: Scattered-site apartments (including efficiencies)
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 29
b. Beds: 29
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
29
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Street 1: 1214 Market Ave. N.
Street 2:
City: Canton
State: Ohio
ZIP Code: 44714
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
390858 Canton, 399151 Stark County
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5A. Project Participants - Households
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 0 29 0 29
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 0 29 29
Adults ages 18-24 0 0 0
Accompanied Children under age 18 0 0 0
Unaccompanied Children under age 18 0 0
Total Persons 0 29 0 29
Click Save to automatically calculate totals
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
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5B. Project Participants - Subpopulations
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Children under age 18
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 28 1 0 15 0 29 4 0 0 0
Adults ages 18-24 0 0 0 0 0 0 0 0 0
Total Persons 28 1 0 15 0 29 4 0 0 0
Click Save to automatically calculate totals
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
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5C. Outreach for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
42% Directly from the street or other locations not meant for human habitation.
58% Directly from emergency shelters.
0% Directly from safe havens.
0% Persons fleeing domestic violence.
100% Total of above percentages
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6A. Funding Request
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Do any of the properties in this projecthave an active restrictive covenant?
No
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
Yes
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Leased Units X
Leased Structures
Rental Assistance
Supportive Services
Operating X
HMIS
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6B. Leased Units Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes the funds being requested for one or moreunits leased for operating the projects. To add information to the list,select the icon. To view or update information already listed, select theicon.
Total Annual Assistance Requested: $180,846
Grant Term: 1 Year
Total Request for Grant Term: $180,846
Total Units: 29
FMR Area Total Units Requested Total Annual BudgetRequested
Total Budget Requested
OH - Canton-Massi... 29 $180,846 $180,846
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 34 09/22/2017
Leased Units Budget Detail
Enter the appropriate values in the "Number of Units" AND "TotalRequest" fields.
Metropolitan or non-metropolitanfair market rent area:
OH - Canton-Massillon, OH MSA (3901999999)
Leased Units Annual BudgetSize of Units # of Units
(Applicant)Total
Request(Applicant)
SRO
0 Bedroom
1 Bedroom 29
2 Bedroom
3 Bedroom
4 Bedroom
5 Bedroom
6 Bedroom
7 Bedroom
8 Bedroom
9 Bedroom
Total Units and AnnualAssistance Requested
29 $180,846
Grant Term 1 Year
Total Request for Grant Term $180,846
Click the 'Save' button to automatically calculate totals.
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
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6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $5,862
Total Value of In-Kind Commitments: $0
Total Value of All Commitments: $5,862
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
Yes
1a. Briefly describe the source of the program income:
Program Income will be generated from occupancy charges paid to ICAN Inc.by the participants that does not exceed the highest of: a) 30% of the family'smonthly adjusted income; or b) 10% of the family's monthly gross income.
1b. Estimate the amount of program income that will be used as Match for this project:
$5,862
Match Type Source Contributor Date ofCommitment
Value ofCommitments
Yes Cash Private ICAN, Inc. rental... 08/12/2017 $5,862
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 36 09/22/2017
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
ICAN, Inc. rental income.
5. Date of Written Commitment: 08/12/2017
6. Value of Written Commitment: $5,862
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
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6E. Summary Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $180,846
1b. Leased Structures $0
2. Rental Assistance $0
3. Supportive Services $0
4. Operating $10,752
5. HMIS $0
6. Sub-total Costs Requested $191,598
7. Admin (Up to 10%)
$12,694
8. Total Assistanceplus Admin Requested
$204,292
9. Cash Match $5,862
10. In-Kind Match $0
11. Total Match $5,862
12. Total Budget $210,154
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 38 09/22/2017
7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No Match Commitment ... 08/09/2017
3) Other Attachment No
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 39 09/22/2017
Attachment Details
Document Description:
Attachment Details
Document Description: Match Commitment Letter - SupportedApartments
Attachment Details
Document Description:
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 40 09/22/2017
7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
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It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Julie Sparks
Date: 08/15/2017
Title: Executive Director
Applicant Organization: ICAN Inc.
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 42 09/22/2017
Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 43 09/22/2017
Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Make changes
3. Specify which screens require changes by clicking the checkbox next tothe name and then clicking the Save button.
Part 2- Recipient and Subrecipient Information
2A. Subrecipients
2B. Recipient Performance
Part 3 - Project Information
3A. Project DetailX
3B. Description
3C. Dedicated PlusX
Part 4 - Housing Services and HMIS
4A. Services
4B. Housing Type
Part 5 - Participants and Outreach Information
5A. Households
5B. Subpopulations
5C. Outreach
Part 6 - Budget Information
6A. Funding Request
Applicant: ICAN Inc. 189042914Project: Supported Apartments 152000
Renewal Project Application FY2017 Page 44 09/22/2017
6B. Leased Units
6D. MatchX
6E. Summary Budget
Part 7 - Attachment(s) & Certification
7A. Attachment(s)X
7B. CertificationX
The applicant has selected "Make Changes" to Question 2 above. Pleaseprovide a brief description of the changes that will be made to the projectinformation screens (bullets are appropriate):
* 2B.Recipient Performance - Funds were fully expended.* 3B.Project Description - Removing final paragraph in the narrative section,that previously provided annual APR outcomes, in order to align with HUD'sInstructional Guidance regarding avoidance of the need to make annualupdates in renewal applications.* 5C.Outreach - Our local Continuum no longer has a Safe Haven as itconverted to PSH, therefore no persons will be entering from a Safe Haven.Percentages were adjusted accordingly.
The applicant has selected "Make Changes". Once this screen is saved,the applicant will be prohibited from "unchecking" any box that has been
checked regardless of whether a change to data on the correspondingscreen will be made.
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8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/03/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 08/03/2017
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Renewal Project Application FY2017 Page 46 09/22/2017
1E. SF-424 Compliance 08/03/2017
1F. SF-424 Declaration 08/03/2017
1G. HUD-2880 08/03/2017
1H. HUD-50070 08/03/2017
1I. Cert. Lobbying 08/03/2017
1J. SF-LLL 08/03/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/14/2017
3A. Project Detail 08/03/2017
3B. Description 08/03/2017
3C. Dedicated Plus 08/03/2017
4A. Services 08/03/2017
4B. Housing Type 08/03/2017
5A. Households 08/03/2017
5B. Subpopulations No Input Required
5C. Outreach 08/03/2017
6A. Funding Request 08/03/2017
6B. Leased Units 08/03/2017
6D. Match 08/09/2017
6E. Summary Budget No Input Required
7A. Attachment(s) 08/09/2017
7B. Certification 08/15/2017
Submission Without Changes 08/14/2017
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Renewal Project Application FY2017 Page 47 09/22/2017
Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 1 09/22/2017
1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/15/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0236
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
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Renewal Project Application FY2017 Page 2 09/22/2017
1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: ICAN Inc.
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-1575839
c. Organizational DUNS: 189042914 PLUS 4
d. Address
Street 1: 1214 Market Ave N
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44714
e. Organizational Unit (optional)
Department Name:
Division Name:
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Mrs.
First Name: Natalie
Middle Name:
Last Name: McCleskey
Suffix:
Title: Development Director
Organizational Affiliation: ICAN Inc.
Telephone Number: (330) 455-9100
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 3 09/22/2017
Extension: 150
Fax Number: (330) 455-4702
Email: [email protected]
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 4 09/22/2017
1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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Renewal Project Application FY2017 Page 5 09/22/2017
1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: Shelter Plus Care SRA
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
17. Proposed Project
a. Start Date: 06/01/2017
b. End Date: 05/31/2018
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-9100
Fax Number:(Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
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1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: ICAN Inc.
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Organizational Affiliation: ICAN Inc.
Telephone Number: (330) 455-9100
Extension:
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44714
2. Employer ID Number (EIN): 34-1575839
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$181,555.00
(Requested amounts will be automatically entered within applications)
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 9 09/22/2017
5. State the name and location (streetaddress, city and state) of the project or
activity:
Shelter Plus Care SRA 1214 Market Ave NCanton Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
Yes
Part II Other Government Assistance Provided or Requested/ExpectedSources and Use of Funds
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance,payment, credit, or tax benefit.
Department/Local Agency Name and Address Type of Assistance AmountRequested /
Provided
Expected Uses of the Funds
Ohio Development Services Agency, 77 S. HighStreet, Columbus, OH 43215
Grant $19,851.00 Cherry Grove - Maintainance, Utilitiesand Insurance
Ohio Development Services Agency, 77 S. HighStreet, Columbus, OH 43215
Grant 37834.0 Rapid Re-Housing - Salaries andBenefits
Stark Mental Health & Addiction Recovery, 121Cleveland Ave SW, Canton, OH 44702
Grant $45,389.00 Shelter Plus Care and West Park -Supportive Services; Peer Support;Employment; Critical TimeInterventionist Salary; Benefits andTravel
Part III Interested Parties
You must disclose:1. All developers, contractors, or consultants involved in the application for the assistance or in
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Renewal Project Application FY2017 Page 10 09/22/2017
the planning, development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which theassistance is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower).
Alphabetical list of all persons with areportable financial interest in the
project or activity (For individuals, give the last name
first)
Social Security No.or Employee ID No.
Type ofParticipation
Financial Interestin Project/Activity
($)
Financial Interestin Project/Activity
(%)
NA NA NA $0.00 0%
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Julie Sparks, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/14/2017
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: ICAN Inc.
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
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Renewal Project Application FY2017 Page 12 09/22/2017
accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-9100
Fax Number:(Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
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CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
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Renewal Project Application FY2017 Page 14 09/22/2017
the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: ICAN Inc.
Name / Title of Authorized Official: Julie Sparks, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: ICAN Inc.
Street 1: 1214 Market Ave N
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44714
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 16 09/22/2017
Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number: (Format: 123-456-7890)
(330) 455-9100
Fax Number: (Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 17 09/22/2017
Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 18 09/22/2017
2A. Project Subrecipients
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
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2B. Recipient Performance
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
No
Explain why the APR for the most recently expired grant term related tothis renewal project request has not been submitted.
This is the first year that ICAN Housing will administer this project directly as therecipient. We were formerly a subrecipient, and the APR for the most recentlyexpired grant term related to this renewal project was to be submitted by theprevious recipient.
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 20 09/22/2017
3A. Project Detail
1. Expiring Grant Number: OH0236(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: Shelter Plus Care SRA
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 21 09/22/2017
3B. Project Description
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Provide a description that addresses the entire scope of the proposedproject.
The Shelter Plus Care SRA project provides rental assistance to 28 homeless,disabled individuals and their families - targeting those with MI, possiblycomplicated by AoD.Eligible participants have incomes at or below 35% of AMI and are living instreets, shelters or transitional housing, or are displaced by domestic violenceat program entry. Referrals are accepted regardless of their sobriety, use ofsubstances or completion of Treatment programs.
ICAN Housing actively participates in the Homeless Continuum of Care of StarkCounty (HCCSC). HCCSC has established a central intake and assessmentsystem. All homeless service providers in Stark County that are receivingContinuum of Care funds are required to participate in this system, which ismanaged by the County’s Homeless Hotline and HMIS. First priority is placedon chronically homeless (CH) individuals and families. Continuum of Care-funded providers of permanent supportive housing must fillvacancies from the central waiting list.
Before admitting any clients to a program, ICAN staff will meet the client toconduct a personal interview, verify basic facts, and review the documentationrequired to certify their eligibility for the Program. Participants are offeredvoluntary support services through contract agencies of Stark Mental Healthand Addiction Recovery (SMHAR). Engagement and problem-solving areemphasized over therapeutic goals. Service plans are highly tenant-drivenwithout predetermined goals. Participation in services or program compliance isnot a condition of tenancy. Participants receive an ongoing assessment ofneeds.
Program funds will provide assistance for 11 efficiency units; 15, 1-bedroomunits; and 2, 3-bedroom units. Units are owned and managed by ICAN and arelocated throughout Stark County; in Canton, Massillon, and Alliance.
2. Does your project have a specificpopulation focus?
Yes
2a. Please identify the specific population focus. (Select ALL that apply)
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 22 09/22/2017
Chronic HomelessX
Domestic Violence
Veterans Substance AbuseX
Youth (under 25) Mental IllnessX
Families with Children HIV/AIDS
Other(Click 'Save' to update)
Other:
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
3d. Does the project follow a "Housing First"approach?
Yes
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 23 09/22/2017
4. Does the PH project provide PSH or RRH? PSH
Is this an SHP Project that had been approvedby HUD to change the renewal project budget
from leasing to rental assistance?
No
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3C. Dedicated Plus
Dedicated and DedicatedPLUS
A “100% Dedicated” project is a permanent supportive housing projectthat commits 100% of its beds to chronically homeless individuals andfamilies, according to NOFA Section III.3.b.
A “DedicatedPLUS” project is a permanent supportive housing projectwhere 100% of the beds are dedicated to serve individuals with disabilitiesand families in which one adult or child has a disability, includingunaccompanied homeless youth, that at a minimum, meet ONE of thefollowing criteria according to NOFA Section III.3.d:
(1) experiencing chronic homelessness as defined in 24 CFR 578.3; (2) residing in a transitional housing project that will be eliminated and meets the definition ofchronically homeless in effect at the time in which the individual or family entered the transitionalhousing project; (3) residing in a place not meant for human habitation, emergency shelter, or safe haven; butthe individuals or families experiencing chronic homelessness as defined at 24 CFR 578.3 hadbeen admitted and enrolled in a permanent housing project within the last year and were unableto maintain a housing placement; (4) residing in transitional housing funded by a joint TH and PH-RRH component project andwho were experiencing chronic homelessness as defined at 24 CFR 578.3 prior to entering theproject; (5)residing and has resided in a place not meant for human habitation, a safe haven, oremergency shelter for at least 12 months in the last three years, but has not done so on fourseparate occasions; or (6) receiving assistance through a Department of Veterans Affairs(VA)-funded homelessassistance program and met one of the above criteria at initial intake to the VA's homelessassistance system.
A renewal project where 100 percent of the beds are dedicated in their current grant asdescribed in NOFA Section III.A.3.b. must either become DedicatedPLUS or remain 100%Dedicated. If a renewal project currently has 100 percent of its beds dedicated to chronicallyhomeless individuals and families and elects to become a DedicatedPLUS project, the projectwill be required to adhere to all fair housing requirements at 24 CFR 578.93. Any beds that theapplicant identifies in this application as being dedicated to chronically homeless individuals andfamilies in a DedicatedPLUS project must continue to operate in accordance with SectionIII.A.3.b. Beds are identified on Screen 4B.
1. Indicate whether the project is "100%Dedicated", "DedicatedPLUS", or "N/A",
according to the information provided above.
N/A
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 25 09/22/2017
4A. Supportive Services for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Partner Annually
Assistance with Moving Costs
Case Management Partner Monthly
Child Care Non-Partner As needed
Education Services Non-Partner As needed
Employment Assistance and Job Training Non-Partner As needed
Food Non-Partner Monthly
Housing Search and Counseling Services Applicant As needed
Legal Services Non-Partner As needed
Life Skills Training Applicant As needed
Mental Health Services Partner As needed
Outpatient Health Services Non-Partner As needed
Outreach Services Applicant Monthly
Substance Abuse Treatment Services Partner As needed
Transportation Non-Partner As needed
Utility Deposits
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
Yes
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 26 09/22/2017
are received and renewed?
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partneragency?
Yes
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 27 09/22/2017
4B. Housing Type and Location
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 28
Total Beds: 32
Total Dedicated CH Beds: 24Housing Type Units Beds
Scattered-site apartments (... 28 32
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 28 09/22/2017
4B. Housing Type and Location Detail
1. Housing Type: Scattered-site apartments (including efficiencies)
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 28
b. Beds: 32
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
24
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Street 1: 1214 Market Ave N
Street 2:
City: Canton
State: Ohio
ZIP Code: 44714
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
399151 Stark County
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 29 09/22/2017
5A. Project Participants - Households
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 9 28 0 37
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 9 28 37
Adults ages 18-24 0
Accompanied Children under age 18 17 17
Unaccompanied Children under age 18 0
Total Persons 26 28 0 54
Click Save to automatically calculate totals
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
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5B. Project Participants - Subpopulations
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 9 1 9 1
Adults ages 18-24
Children under age 18 17
Total Persons 9 0 0 1 0 9 1 0 0 17
Click Save to automatically calculate totals
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 28 28
Adults ages 18-24
Total Persons 28 0 0 0 0 28 0 0 0 0
Click Save to automatically calculate totals
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 31 09/22/2017
Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
Describe the unlisted subpopulations referred to above:
Children of participants.
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5C. Outreach for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
51% Directly from the street or other locations not meant for human habitation.
49% Directly from emergency shelters.
Directly from safe havens.
0% Persons fleeing domestic violence.
0% Directly from transitional housing.
Directly from the TH Portion of a Joint TH and PH-RRH Component project.
Persons receiving services through a Department of Veterans Affairs(VA)-funded homeless assistance program.
100% Total of above percentages
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6A. Funding Request
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Do any of the properties in this projecthave an active restrictive covenant?
No
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
No
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Leased Units
Leased Structures
Rental Assistance X
Supportive Services
Operating
HMIS
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
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6C. Rental Assistance Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes the rental assistance funding request for thetotal term of the project. To add information to the list, select the icon. Toview or update information already listed, select the icon.
Total Request for Grant Term: $169,536
Total Units: 28
Type of RentalAssistance
FMR Area Total UnitsRequested
Total Request
SRA OH - Canton-Massillon, OH MSA (390199... 28 $169,536
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 35 09/22/2017
Rental Assistance Budget Detail
Type of Rental Assistance: SRA
Metropolitan or non-metropolitanfair market rent area:
OH - Canton-Massillon, OH MSA (3901999999)
Does the applicant request rental assistancefunding for less than the area's per unit size
fair market rents?
No
Size of Units # of Units(Applicant)
FMR Area(Applicant)
HUD PaidRent
(Applicant)
12 Months TotalRequest
(Applicant)
SRO x $317 $317 x = $0
0 Bedroom 11 x $422 $422 x = $55,704
1 Bedroom 15 x $516 $516 x = $92,880
2 Bedrooms x $684 $684 x = $0
3 Bedrooms 2 x $873 $873 x = $20,952
4 Bedrooms x $938 $938 x = $0
5 Bedrooms x $1,079 $1,079 x = $0
6 Bedrooms x $1,219 $1,219 x = $0
7 Bedrooms x $1,360 $1,360 x = $0
8 Bedrooms x $1,501 $1,501 x = $0
9 Bedrooms x $1,642 $1,642 x = $0
Total Units and Annual AssistanceRequested
28 $169,536
Grant Term 1 Year
Total Request for Grant Term $169,536
Click the 'Save' button to automatically calculate totals.
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 36 09/22/2017
6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $45,389
Total Value of In-Kind Commitments: $0
Total Value of All Commitments: $45,389
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
Yes
1a. Briefly describe the source of the program income:
Program Income will be generated from occupancy charges paid to ICAN Inc.by the participants that does not exceed the highest of: a) 30% of the family'smonthly adjusted income; or b) 10% of the family's monthly gross income.
1b. Estimate the amount of program income that will be used as Match for this project:
$45,389
Match Type Source Contributor Date ofCommitment
Value ofCommitments
Yes Cash Private ICAN, Inc. rental... 08/12/2017 $45,389
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 37 09/22/2017
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
ICAN, Inc. rental income.
5. Date of Written Commitment: 08/12/2017
6. Value of Written Commitment: $45,389
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
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6E. Summary Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $0
1b. Leased Structures $0
2. Rental Assistance $169,536
3. Supportive Services $0
4. Operating $0
5. HMIS $0
6. Sub-total Costs Requested $169,536
7. Admin (Up to 10%)
$12,019
8. Total Assistanceplus Admin Requested
$181,555
9. Cash Match $45,389
10. In-Kind Match $0
11. Total Match $45,389
12. Total Budget $226,944
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No Match Commitment ... 08/09/2017
3) Other Attachment No
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 40 09/22/2017
Attachment Details
Document Description:
Attachment Details
Document Description: Match Commitment Letter - SPC SRA
Attachment Details
Document Description:
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 41 09/22/2017
7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 42 09/22/2017
It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Julie Sparks
Date: 08/15/2017
Title: Executive Director
Applicant Organization: ICAN Inc.
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 43 09/22/2017
Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 44 09/22/2017
Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Make changes
3. Specify which screens require changes by clicking the checkbox next tothe name and then clicking the Save button.
Part 2- Recipient and Subrecipient Information
2A. Subrecipients
2B. Recipient Performance
Part 3 - Project Information
3A. Project DetailX
3B. Description
3C. Dedicated PlusX
Part 4 - Housing Services and HMIS
4A. Services
4B. Housing Type
Part 5 - Participants and Outreach Information
5A. Households
5B. Subpopulations
5C. Outreach
Part 6 - Budget Information
6A. Funding Request
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 45 09/22/2017
6C. Rental Assistance
6D. MatchX
6E. Summary Budget
Part 7 - Attachment(s) & Certification
7A. Attachment(s)X
7B. CertificationX
The applicant has selected "Make Changes" to Question 2 above. Pleaseprovide a brief description of the changes that will be made to the projectinformation screens (bullets are appropriate):
* 3B. Project Description - Removing final paragraph in the narrative section,that previously provided annual APR outcomes, in order to align with HUD'sInstructional Guidance regarding to desire for Applicants to avoid the need tomake annual updates in renewal project applications.* 4B. Housing Type - Address for Scattered Sites was changed to the Agencyaddress, per guidance in the Detailed Instructions.
The applicant has selected "Make Changes". Once this screen is saved,the applicant will be prohibited from "unchecking" any box that has been
checked regardless of whether a change to data on the correspondingscreen will be made.
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 46 09/22/2017
8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/03/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 08/03/2017
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 47 09/22/2017
1E. SF-424 Compliance 08/03/2017
1F. SF-424 Declaration 08/03/2017
1G. HUD-2880 08/03/2017
1H. HUD-50070 08/03/2017
1I. Cert. Lobbying 08/03/2017
1J. SF-LLL 08/03/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/03/2017
3A. Project Detail 08/03/2017
3B. Description 08/03/2017
3C. Dedicated Plus 08/03/2017
4A. Services 08/03/2017
4B. Housing Type 08/14/2017
5A. Households 08/03/2017
5B. Subpopulations 08/03/2017
5C. Outreach 08/03/2017
6A. Funding Request 08/03/2017
6C. Rental Assistance 08/03/2017
6D. Match 08/09/2017
6E. Summary Budget No Input Required
7A. Attachment(s) 08/09/2017
7B. Certification 08/15/2017
Submission Without Changes 08/14/2017
Applicant: ICAN Inc. 189042914Project: Shelter Plus Care SRA 152196
Renewal Project Application FY2017 Page 48 09/22/2017
Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
Applicant: YWCA of Canton 340714799Project: STARR II 153006
Renewal Project Application FY2017 Page 1 09/22/2017
1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 09/21/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0495
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
Applicant: YWCA of Canton 340714799Project: STARR II 153006
Renewal Project Application FY2017 Page 2 09/22/2017
1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: Young Women's Christian Association of Canton
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-0714799
c. Organizational DUNS: 123409864 PLUS 4 0000
d. Address
Street 1: YWCA of Canton
Street 2: 231 6th Street NE
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702-1092
e. Organizational Unit (optional)
Department Name: YWCA of Canton
Division Name: Housing
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Ms.
First Name: Linda
Middle Name: Louise
Last Name: Angelo
Suffix:
Title: Chief Financial Officer
Organizational Affiliation: Young Women's Christian Association of Canton
Telephone Number: (330) 453-7644
Applicant: YWCA of Canton 340714799Project: STARR II 153006
Renewal Project Application FY2017 Page 3 09/22/2017
Extension:
Fax Number: (330) 453-2735
Email: [email protected]
Applicant: YWCA of Canton 340714799Project: STARR II 153006
Renewal Project Application FY2017 Page 4 09/22/2017
1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
Applicant: YWCA of Canton 340714799Project: STARR II 153006
Renewal Project Application FY2017 Page 5 09/22/2017
1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: STARR II
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
17. Proposed Project
a. Start Date: 12/01/2018
b. End Date: 11/30/2019
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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Renewal Project Application FY2017 Page 6 09/22/2017
1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation: input type='hidden'name='IgnoreCapitalizedWords' value='false'>";spellBoot += "<input type='hidden'name='GuiLanguage' value='ENGLISH'><inputtype='hidden' name='LanguageParser'value='ENGLISH'><input type='hidden'name='Modal' value='false'><input type='hidden'name='AllowAnyCase' value='false'><inputtype='hidden' name='IgnoreWordsWithDigits'value='true'>"; spellBoot += "<input type='hidden'name='ShowFinishedMessage'value='false'><input type='hidden'name='ShowNoErrorsMessage'value='false'><input type='hidden'name='ShowXMLTags' value='false'><inputtype='hidden' name='AllowMixedCase'value='false'><input type='hidden'name='RswlClientID'value='inputTextLauncher37082'><inputtype='hidden' name='WarnDuplicates'value='true'>"; spellBoot += "<input type='hidden'name='DictFile' value='/opt/jboss-4.0.5.GA/server/default/./tmp/deploy/tmp5826993706184173567grantium-exp.war/WEB-INF/classes/combined-english-v2-whole.dict'><input type='hidden'name='PopUpWindowName'value='RapidSpellWebMultiple1_PopUpWin'><input type='hidden' name='CreatePopUpWindow'value='false'><input type='hidden'name='ConsiderationRange' value='80'><inputtype='hidden' name='UseUpdate'value='"+(typeof(rsw_mult_use_update)!='undefined'?rsw_mult_use_update:'')+"'><inputtype='hidden' name='LookIntoHyphenatedText'value='true'><input type='hidden'name='CheckCompoundWords'value='false'><input type='hidden'name='EnableUndo'
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Renewal Project Application FY2017 Page 7 09/22/2017
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Applicant: YWCA of Canton 340714799Project: STARR II 153006
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Ms.
First Name: Cathy
Middle Name:
Last Name: Jennings
Suffix:
Title: Chief Executive Officer
Telephone Number:(Format: 123-456-7890)
(330) 453-7644
Fax Number:(Format: 123-456-7890)
(330) 453-2735
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 09/21/2017
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Renewal Project Application FY2017 Page 9 09/22/2017
1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: Young Women's Christian Association of Canton
Prefix: Ms.
First Name: Cathy
Middle Name:
Last Name: Jennings
Suffix:
Title: Chief Executive Officer
Organizational Affiliation: Young Women's Christian Association of Canton
Telephone Number: (330) 453-7644
Extension:
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44702-1092
2. Employer ID Number (EIN): 34-0714799
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$231,431.00
(Requested amounts will be automatically entered within applications)
Applicant: YWCA of Canton 340714799Project: STARR II 153006
Renewal Project Application FY2017 Page 10 09/22/2017
5. State the name and location (streetaddress, city and state) of the project or
activity:
STARR II YWCA of Canton Canton Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
Yes
Part II Other Government Assistance Provided or Requested/ExpectedSources and Use of Funds
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance,payment, credit, or tax benefit.
Department/Local Agency Name and Address Type of Assistance AmountRequested /
Provided
Expected Uses of the Funds
Ohio Development Services Agency Housing Trust Fund Grant $8,422.00 New Beginnings PSH ProgramOperating Costs
Stark County Community Planning (ODSA Grant) HPRP 24150.0 Rapid Re-Housing RentalAssistance/Case Management
Part III Interested Parties
You must disclose:1. All developers, contractors, or consultants involved in the application for the assistance or inthe planning, development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which theassistance is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower).
Applicant: YWCA of Canton 340714799Project: STARR II 153006
Renewal Project Application FY2017 Page 11 09/22/2017
Alphabetical list of all persons with areportable financial interest in the
project or activity (For individuals, give the last name
first)
Social Security No.or Employee ID No.
Type ofParticipation
Financial Interestin Project/Activity
($)
Financial Interestin Project/Activity
(%)
NA NA NA $0.00 0%
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Cathy Jennings, Chief Executive Officer
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/07/2017
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Renewal Project Application FY2017 Page 12 09/22/2017
1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: Young Women's Christian Association of Canton
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
Applicant: YWCA of Canton 340714799Project: STARR II 153006
Renewal Project Application FY2017 Page 13 09/22/2017
accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Ms.
First Name: Cathy
Middle Name
Last Name: Jennings
Suffix:
Title: Chief Executive Officer
Telephone Number:(Format: 123-456-7890)
(330) 453-7644
Fax Number:(Format: 123-456-7890)
(330) 453-2735
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 09/21/2017
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Renewal Project Application FY2017 Page 14 09/22/2017
CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
Applicant: YWCA of Canton 340714799Project: STARR II 153006
Renewal Project Application FY2017 Page 15 09/22/2017
the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: Young Women's Christian Association of Canton
Name / Title of Authorized Official: Cathy Jennings, Chief Executive Officer
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 09/21/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: Young Women's Christian Association of Canton
Street 1: YWCA of Canton
Street 2: 231 6th Street NE
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702-1092
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
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Authorized Representative
Prefix: Ms.
First Name: Cathy
Middle Name:
Last Name: Jennings
Suffix:
Title: Chief Executive Officer
Telephone Number: (Format: 123-456-7890)
(330) 453-7644
Fax Number: (Format: 123-456-7890)
(330) 453-2735
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 09/21/2017
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Renewal Project Application FY2017 Page 18 09/22/2017
Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
Applicant: YWCA of Canton 340714799Project: STARR II 153006
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2A. Project Subrecipients
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $21,825Organization Type Type Sub-
AwardAmount
ColemanProfessionalServices
M. Nonprofit with 501C3 IRS Status M. Nonprofit with 501C3 IRS Status $21,825
Applicant: YWCA of Canton 340714799Project: STARR II 153006
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2A. Project Subrecipients Detail
a. Organization Name: Coleman Professional Services
b. Organization Type: M. Nonprofit with 501C3 IRS Status
c. Employer or Tax Identification Number: 34-1240178
* d. Organizational DUNS: 089247571 PLUS 4
e. Physical Address
Street 1: 400 Tuscarawas Street W
Street 2:
City: Canton
State: Ohio
Zip Code: 44702
f. Congressional District(s):(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
g. Is the subrecipient a Faith-BasedOrganization?
No
h. Has the subrecipient ever received afederal grant, either directly from a federal
agency or through a State/local agency?
Yes
i. Expected Sub-Award Amount: $21,825
j. Contact Person
Prefix: Mr.
First Name: Stephen
Middle Name:
Last Name: Inchak
Applicant: YWCA of Canton 340714799Project: STARR II 153006
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Suffix:
Title: Behavioral Health Chief Officer
E-mail Address: [email protected]
Confirm E-mail Address: [email protected]
Phone Number: 330-438-4200
Extension:
Fax Number: 330-438-3003
Documentation of the subrecipient's nonprofit status is required with the submission of thisapplication.
Applicant: YWCA of Canton 340714799Project: STARR II 153006
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2B. Recipient Performance
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
Yes
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
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3A. Project Detail
1. Expiring Grant Number: OH0495(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: STARR II
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Provide a description that addresses the entire scope of the proposedproject.
Stark Area Rapid Re-housing (STARR II) will assist households that arecomprised of families with children and are deemed homeless and referred tothe project by the Homeless Hotline.Families must meet the HUD homelesscriteria for category #1 and #4(only if they meet Cat.#1 also)only. Familiescannot enter the project from Transitional Housing, even if category 1 prior totransitional housing.Families must be living in an emergencyshelter,living on the streets;or fleeing and/or attempting to flee domesticviolence.HMIS system currently identifies over 300 families currently in need ofpermanent housing. Time-limited case management services (not to exceed 18months)will be delivered to assist program participants with rentalassistance,lease compliance, housing stability, supportive services, medicaland/or mental health, counseling,increasing clients income fromemployment and other sources.The STARR II project will serve an estimated 38 families with children(145persons in the household)during the grant period. The project will utilize theHousing First approach in providing families with short term assistance to findpermanent housing quickly and without conditions.1. Intake: The Homeless Hotline structure utilizes a central intake system forreferral to the STARR II project. The Homeless Hotline assessment will gatherdata to determine if the caller is to be placed on the prioritization list for STARRII. The project will administer an assessment tool to determine information andprogram eligibility.2. Assessment: The prioritization list will be utilized to identify families. Thefamily next on list will be contacted by a STARR II case manager, they willperform an initial assessment over the phone which will be followed up by aformal intake in person. The intake will determine further eligibility and theverification and documentation process will take place.3. Stabilization: Upon acceptance,the STARR II case manager enters eligibleparticipants into the program,develops the housing/service plan and provideslandlord liaison services. Assistance is provided to located permanentaffordable housing through housing search,negotiating with landlord's andsecuring a signed lease for the client. The participant will obtain education forbasics of tenant rights and responsibilities. Monthly home visits will beconducted by the STARR III case manager for up to 18 months to providesupport in budgeting, lease compliance, and connection to mainstream services(co-grantee). The co-grantee will provide support in areas of household andmoney management, employment, parenting, mental health, and substanceabuse. The two partners that will provide with supportive services for this project
Applicant: YWCA of Canton 340714799Project: STARR II 153006
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are: Ohio Means Jobs and Coleman Behavioral Health.4. The project will serve families throughout Stark County. The case managerhas an established network of landlords in which they work with to secureaffordable housing for program participants.
2. Does your project have a specificpopulation focus?
Yes
2a. Please identify the specific population focus. (Select ALL that apply)
Chronic HomelessX
Domestic ViolenceX
Veterans Substance Abuse
Youth (under 25) Mental Illness
Families with ChildrenX
HIV/AIDS
Other(Click 'Save' to update)
Other:
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Applicant: YWCA of Canton 340714799Project: STARR II 153006
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Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
3d. Does the project follow a "Housing First"approach?
Yes
4. Does the PH project provide PSH or RRH? RRH
Is this an SHP Project that had been approvedby HUD to change the renewal project budget
from leasing to rental assistance?
No
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4A. Supportive Services for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Applicant Monthly
Assistance with Moving Costs Applicant As needed
Case Management Applicant Monthly
Child Care Non-Partner As needed
Education Services Applicant Semi-annually
Employment Assistance and Job Training Subrecipient Monthly
Food Applicant As needed
Housing Search and Counseling Services Applicant Monthly
Legal Services Non-Partner As needed
Life Skills Training Subrecipient Monthly
Mental Health Services Subrecipient As needed
Outpatient Health Services Non-Partner As needed
Outreach Services Applicant As needed
Substance Abuse Treatment Services Subrecipient As needed
Transportation Applicant Monthly
Utility Deposits Applicant As needed
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
Yes
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are received and renewed?
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partneragency?
Yes
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
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4B. Housing Type and Location
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 27
Total Beds: 66Housing Type Units Beds
Single family homes/townhou... 27 66
Applicant: YWCA of Canton 340714799Project: STARR II 153006
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4B. Housing Type and Location Detail
1. Housing Type: Single family homes/townhouses/duplexes
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 27
b. Beds: 66
3. Address
Street 1:
Street 2:
City: Canton
State: Ohio
ZIP Code: 44702
4. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
390066 Alliance, 390858 Canton, 399151 StarkCounty, 393114 Massillon
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5A. Project Participants - Households
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 27 27
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 12 12
Adults ages 18-24 15 15
Accompanied Children under age 18 39 39
Unaccompanied Children under age 18 0
Total Persons 66 0 0 66
Click Save to automatically calculate totals
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5B. Project Participants - Subpopulations
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 12 0 0 0 0 0 4 1 0 0
Adults ages 18-24 15 0 0 0 0 0 8 0 0 0
Children under age 18 39 0 0 0 0 0 0 0
Total Persons 66 0 0 0 0 0 12 1 0 0
Click Save to automatically calculate totals
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
Applicant: YWCA of Canton 340714799Project: STARR II 153006
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5C. Outreach for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
10% Directly from the street or other locations not meant for human habitation.
80% Directly from emergency shelters.
Directly from safe havens.
0% Persons fleeing domestic violence.
10% Directly from transitional housing eliminated in the FY 2017 CoC Program Competition.
Directly from the TH Portion of a Joint TH and PH-RRH Component project.
Persons receiving services through a Department of Veterans Affairs(VA)-funded homeless assistance program.
100% Total of above percentages
Applicant: YWCA of Canton 340714799Project: STARR II 153006
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6A. Funding Request
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Do any of the properties in this projecthave an active restrictive covenant?
No
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
No
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Rental Assistance X
Supportive Services X
HMIS
Applicant: YWCA of Canton 340714799Project: STARR II 153006
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6C. Rental Assistance Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes the rental assistance funding request for thetotal term of the project. To add information to the list, select the icon. Toview or update information already listed, select the icon.
Total Request for Grant Term: $127,896
Total Units: 13
Type of RentalAssistance
FMR Area Total UnitsRequested
Total Request
TRA OH - Canton-Massillon, OH MSA (390199... 13 $127,896
Applicant: YWCA of Canton 340714799Project: STARR II 153006
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Rental Assistance Budget Detail
Type of Rental Assistance: TRA
Metropolitan or non-metropolitanfair market rent area:
OH - Canton-Massillon, OH MSA (3901999999)
Does the applicant request rental assistancefunding for less than the area's per unit size
fair market rents?
No
Size of Units # of Units(Applicant)
FMR Area(Applicant)
HUD PaidRent
(Applicant)
12 Months TotalRequest
(Applicant)
SRO x $317 $317 x = $0
0 Bedroom x $422 $422 x = $0
1 Bedroom 0 x $516 $516 x = $0
2 Bedrooms 4 x $684 $684 x = $32,832
3 Bedrooms 8 x $873 $873 x = $83,808
4 Bedrooms 1 x $938 $938 x = $11,256
5 Bedrooms x $1,079 $1,079 x = $0
6 Bedrooms x $1,219 $1,219 x = $0
7 Bedrooms x $1,360 $1,360 x = $0
8 Bedrooms x $1,501 $1,501 x = $0
9 Bedrooms x $1,642 $1,642 x = $0
Total Units and Annual AssistanceRequested
13 $127,896
Grant Term 1 Year
Total Request for Grant Term $127,896
Click the 'Save' button to automatically calculate totals.
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6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $57,858
Total Value of In-Kind Commitments: $0
Total Value of All Commitments: $57,858
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Match Type Source Contributor Date ofCommitment
Value ofCommitments
Yes Cash Private ColemanBehaviora...
08/14/2017 $40,000
Yes Cash Private Sisters of Charit... 08/14/2017 $7,558
Yes Cash Private YWCA Donations 08/14/2017 $10,300
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Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Coleman Behavioral Health
5. Date of Written Commitment: 08/14/2017
6. Value of Written Commitment: $40,000
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Sisters of Charity Foundation
5. Date of Written Commitment: 08/14/2017
6. Value of Written Commitment: $7,558
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
YWCA Donations
Applicant: YWCA of Canton 340714799Project: STARR II 153006
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office or grant program as applicable)
5. Date of Written Commitment: 08/14/2017
6. Value of Written Commitment: $10,300
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6E. Summary Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $0
1b. Leased Structures $0
2. Rental Assistance $127,896
3. Supportive Services $88,587
4. Operating $0
5. HMIS $0
6. Sub-total Costs Requested $216,483
7. Admin (Up to 10%)
$14,948
8. Total Assistanceplus Admin Requested
$231,431
9. Cash Match $57,858
10. In-Kind Match $0
11. Total Match $57,858
12. Total Budget $289,289
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No Coleman Professio... 10/19/2015
2) Other Attachmenbt No
3) Other Attachment No
Applicant: YWCA of Canton 340714799Project: STARR II 153006
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Attachment Details
Document Description: Coleman Professional Services 501c3 Letter
Attachment Details
Document Description:
Attachment Details
Document Description:
Applicant: YWCA of Canton 340714799Project: STARR II 153006
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7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
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It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Cathy Jennings
Date: 09/21/2017
Title: Chief Executive Officer
Applicant Organization: Young Women's Christian Association of Canton
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
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Renewal Project Application FY2017 Page 45 09/22/2017
Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
Applicant: YWCA of Canton 340714799Project: STARR II 153006
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Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Make changes
3. Specify which screens require changes by clicking the checkbox next tothe name and then clicking the Save button.
Part 2- Recipient and Subrecipient Information
2A. Subrecipients
2B. Recipient Performance
Part 3 - Project Information
3A. Project DetailX
3B. Description
Part 4 - Housing Services and HMIS
4A. Services
4B. Housing TypeX
Part 5 - Participants and Outreach Information
5A. HouseholdsX
5B. SubpopulationsX
5C. Outreach
Part 6 - Budget Information
6A. Funding Request
6C. Rental Assistance
Applicant: YWCA of Canton 340714799Project: STARR II 153006
Renewal Project Application FY2017 Page 47 09/22/2017
6D. MatchX
6E. Summary Budget
Part 7 - Attachment(s) & Certification
7A. Attachment(s)X
7B. CertificationX
The applicant has selected "Make Changes" to Question 2 above. Pleaseprovide a brief description of the changes that will be made to the projectinformation screens (bullets are appropriate):
The changes made to the grant reflect changes due to the consolidation of thisgrant with our STARR III grant. The grants were consolidated after the 2016application submission in e-snaps. 4B.type/location chngd to 27 units/66beds toreflect prev. yrs. combining STARRII/III. 5A.Chng to 27 units/66 beds toaccommodate larger families srvd. 2,3 and 4 bedroom.
The applicant has selected "Make Changes". Once this screen is saved,the applicant will be prohibited from "unchecking" any box that has been
checked regardless of whether a change to data on the correspondingscreen will be made.
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8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/17/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 08/17/2017
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1E. SF-424 Compliance 08/17/2017
1F. SF-424 Declaration 08/17/2017
1G. HUD-2880 08/17/2017
1H. HUD-50070 08/17/2017
1I. Cert. Lobbying 08/17/2017
1J. SF-LLL 08/17/2017
2A. Subrecipients 08/17/2017
2B. Recipient Performance 08/17/2017
3A. Project Detail 08/17/2017
3B. Description 08/17/2017
4A. Services 08/17/2017
4B. Housing Type 09/21/2017
5A. Households 09/21/2017
5B. Subpopulations No Input Required
5C. Outreach 08/17/2017
6A. Funding Request 08/17/2017
6C. Rental Assistance 08/17/2017
6D. Match 08/17/2017
6E. Summary Budget No Input Required
7A. Attachment(s) 08/17/2017
7B. Certification 08/17/2017
Submission Without Changes 09/21/2017
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Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
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1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/17/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0516
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
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1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: Young Women's Christian Association of Canton
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-0714799
c. Organizational DUNS: 123409864 PLUS 4 0000
d. Address
Street 1: YWCA of Canton
Street 2: 231 6th Street NE
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702-1092
e. Organizational Unit (optional)
Department Name: YWCA of Canton
Division Name: Housing
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Ms.
First Name: Linda
Middle Name: Louise
Last Name: Angelo
Suffix:
Title: Chief Financial Officer
Organizational Affiliation: Young Women's Christian Association of Canton
Telephone Number: (330) 453-7644
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 3 09/22/2017
Extension:
Fax Number: (330) 453-2735
Email: [email protected]
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1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: New Beginnings PSH
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
17. Proposed Project
a. Start Date: 11/01/2018
b. End Date: 10/31/2019
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Ms.
First Name: Cathy
Middle Name:
Last Name: Jennings
Suffix:
Title: Chief Executive Officer
Telephone Number:(Format: 123-456-7890)
(330) 453-7644
Fax Number:(Format: 123-456-7890)
(330) 453-2735
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/17/2017
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1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: Young Women's Christian Association of Canton
Prefix: Ms.
First Name: Cathy
Middle Name:
Last Name: Jennings
Suffix:
Title: Chief Executive Officer
Organizational Affiliation: Young Women's Christian Association of Canton
Telephone Number: (330) 453-7644
Extension:
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44702-1092
2. Employer ID Number (EIN): 34-0714799
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$33,688.00
(Requested amounts will be automatically entered within applications)
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Renewal Project Application FY2017 Page 9 09/22/2017
5. State the name and location (streetaddress, city and state) of the project or
activity:
New Beginnings PSH YWCA of Canton CantonOhio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
Yes
Part II Other Government Assistance Provided or Requested/ExpectedSources and Use of Funds
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance,payment, credit, or tax benefit.
Department/Local Agency Name and Address Type of Assistance AmountRequested /
Provided
Expected Uses of the Funds
Ohio Development Services Agency Housing Trust Fund Grant $8,422.00 New Beginnings PSH ProgramOperating Costs
Stark County Community Planning (ODSA Grant) HPRP 24150.0 Rapid Re-Housing RentalAssistance/Case Management
Part III Interested Parties
You must disclose:1. All developers, contractors, or consultants involved in the application for the assistance or inthe planning, development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which theassistance is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower).
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Alphabetical list of all persons with areportable financial interest in the
project or activity (For individuals, give the last name
first)
Social Security No.or Employee ID No.
Type ofParticipation
Financial Interestin Project/Activity
($)
Financial Interestin Project/Activity
(%)
NA NA NA $0.00 0%
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Cathy Jennings, Chief Executive Officer
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/07/2017
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: Young Women's Christian Association of Canton
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
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accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Ms.
First Name: Cathy
Middle Name
Last Name: Jennings
Suffix:
Title: Chief Executive Officer
Telephone Number:(Format: 123-456-7890)
(330) 453-7644
Fax Number:(Format: 123-456-7890)
(330) 453-2735
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/17/2017
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CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
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the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: Young Women's Christian Association of Canton
Name / Title of Authorized Official: Cathy Jennings, Chief Executive Officer
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/17/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: Young Women's Christian Association of Canton
Street 1: YWCA of Canton
Street 2: 231 6th Street NE
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702-1092
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
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Authorized Representative
Prefix: Ms.
First Name: Cathy
Middle Name:
Last Name: Jennings
Suffix:
Title: Chief Executive Officer
Telephone Number: (Format: 123-456-7890)
(330) 453-7644
Fax Number: (Format: 123-456-7890)
(330) 453-2735
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/17/2017
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Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
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2A. Project Subrecipients
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
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2B. Recipient Performance
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
Yes
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
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3A. Project Detail
1. Expiring Grant Number: OH0516(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: New Beginnings PSH
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Provide a description that addresses the entire scope of the proposedproject.
New Beginnings is a housing facility that serves homeless individuals andfamilies. Presently there are 26 apartments and we are in the beginning stagesof seeking funding to increase that number to 34. Units are private apartmentswith a kitchen area and private bathroom.Client profiles include persons with substance abuse issues, persons withmental health issues, domestic violence victims, and persons with physicaldisabilities.All of the apartments have now been converted to PSH. There are currently 6family units and 20 single units. After renovations there will be 6 family units and28 single units.Specific Services and Housing Activities:There will be one full time staff on site to provide case coordination that willsupport clients in maintaining their housing. Services will not be mandatory butwill be made available to all tenants. Services have been adapted to theHousing First model that will allow participants to chart a successful path tomaintaining stable housing. Regular office hours will be kept so tenants haveaccess to the coordinator. If the hours are not conducive for a clientarrangement will be made to meet when the client is available. Tenants willhave the opportunity to create a housing stability plan to identify clientdetermined barriers to maintaining housing.The case coordinator will work actively with each client to ensure that theidentified barriers do not endanger their housing. The housing stability plan willbe reviewed regularly and can be adapted to meet the changing needs andbarriers of the client. Referrals will be made by the case coordinator toappropriate services based on the housing stability plan. While participation inservices is not a requirement clients will be encouraged to attend. There willalso be a part time on site Housing Assistant that will provide propertymanagement services.
2. Does your project have a specificpopulation focus?
Yes
2a. Please identify the specific population focus. (Select ALL that apply)
Chronic Homeless Domestic Violence
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X X
Veterans Substance AbuseX
Youth (under 25)X
Mental IllnessX
Families with Children HIV/AIDS
Other(Click 'Save' to update)
Other:
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
3d. Does the project follow a "Housing First"approach?
Yes
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 23 09/22/2017
4. Does the PH project provide PSH or RRH? PSH
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 24 09/22/2017
3C. Dedicated Plus
Dedicated and DedicatedPLUS
A “100% Dedicated” project is a permanent supportive housing projectthat commits 100% of its beds to chronically homeless individuals andfamilies, according to NOFA Section III.3.b.
A “DedicatedPLUS” project is a permanent supportive housing projectwhere 100% of the beds are dedicated to serve individuals with disabilitiesand families in which one adult or child has a disability, includingunaccompanied homeless youth, that at a minimum, meet ONE of thefollowing criteria according to NOFA Section III.3.d:
(1) experiencing chronic homelessness as defined in 24 CFR 578.3; (2) residing in a transitional housing project that will be eliminated and meets the definition ofchronically homeless in effect at the time in which the individual or family entered the transitionalhousing project; (3) residing in a place not meant for human habitation, emergency shelter, or safe haven; butthe individuals or families experiencing chronic homelessness as defined at 24 CFR 578.3 hadbeen admitted and enrolled in a permanent housing project within the last year and were unableto maintain a housing placement; (4) residing in transitional housing funded by a joint TH and PH-RRH component project andwho were experiencing chronic homelessness as defined at 24 CFR 578.3 prior to entering theproject; (5)residing and has resided in a place not meant for human habitation, a safe haven, oremergency shelter for at least 12 months in the last three years, but has not done so on fourseparate occasions; or (6) receiving assistance through a Department of Veterans Affairs(VA)-funded homelessassistance program and met one of the above criteria at initial intake to the VA's homelessassistance system.
A renewal project where 100 percent of the beds are dedicated in their current grant asdescribed in NOFA Section III.A.3.b. must either become DedicatedPLUS or remain 100%Dedicated. If a renewal project currently has 100 percent of its beds dedicated to chronicallyhomeless individuals and families and elects to become a DedicatedPLUS project, the projectwill be required to adhere to all fair housing requirements at 24 CFR 578.93. Any beds that theapplicant identifies in this application as being dedicated to chronically homeless individuals andfamilies in a DedicatedPLUS project must continue to operate in accordance with SectionIII.A.3.b. Beds are identified on Screen 4B.
1. Indicate whether the project is "100%Dedicated", "DedicatedPLUS", or "N/A",
according to the information provided above.
100% Dedicated
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 25 09/22/2017
4A. Supportive Services for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Applicant Monthly
Assistance with Moving Costs Partner As needed
Case Management Applicant Weekly
Child Care Partner As needed
Education Services Non-Partner As needed
Employment Assistance and Job Training Non-Partner As needed
Food Applicant As needed
Housing Search and Counseling Services Applicant As needed
Legal Services Non-Partner As needed
Life Skills Training Non-Partner As needed
Mental Health Services Non-Partner As needed
Outpatient Health Services Non-Partner As needed
Outreach Services Non-Partner As needed
Substance Abuse Treatment Services Non-Partner As needed
Transportation Non-Partner As needed
Utility Deposits Partner As needed
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
No
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
Yes
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 26 09/22/2017
are received and renewed?
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partneragency?
Yes
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
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4B. Housing Type and Location
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 8
Total Beds: 8
Total Dedicated CH Beds: 8Housing Type Units Beds
Dormitory, shared or privat... 8 8
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 28 09/22/2017
4B. Housing Type and Location Detail
1. Housing Type: Dormitory, shared or private rooms
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 8
b. Beds: 8
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
8
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Street 1: 800 West Tuscarawas St.
Street 2:
City: Canton
State: Ohio
ZIP Code: 44702
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
399151 Stark County
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 29 09/22/2017
5A. Project Participants - Households
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 0 8 0 8
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 0 4 4
Adults ages 18-24 0 4 4
Accompanied Children under age 18 0 0 0
Unaccompanied Children under age 18 0 0
Total Persons 0 8 0 8
Click Save to automatically calculate totals
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
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5B. Project Participants - Subpopulations
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Children under age 18
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 4 0 0 2 0 3 2 1 0 0
Adults ages 18-24 4 0 0 2 0 3 2 0 0 0
Total Persons 8 0 0 4 0 6 4 1 0 0
Click Save to automatically calculate totals
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 31 09/22/2017
5C. Outreach for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
10% Directly from the street or other locations not meant for human habitation.
90% Directly from emergency shelters.
0% Directly from safe havens.
0% Persons fleeing domestic violence.
100% Total of above percentages
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
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6A. Funding Request
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Do any of the properties in this projecthave an active restrictive covenant?
No
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
No
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Leased Units
Leased Structures
Rental Assistance
Supportive Services X
Operating X
HMIS
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 33 09/22/2017
6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $8,422
Total Value of In-Kind Commitments: $0
Total Value of All Commitments: $8,422
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Match Type Source Contributor Date ofCommitment
Value ofCommitments
Yes Cash Government Ohio Development...
08/15/2017 $8,422
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 34 09/22/2017
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Government
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Ohio Development Services Agency
5. Date of Written Commitment: 08/15/2017
6. Value of Written Commitment: $8,422
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 35 09/22/2017
6E. Summary Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $0
1b. Leased Structures $0
2. Rental Assistance $0
3. Supportive Services $14,025
4. Operating $17,470
5. HMIS $0
6. Sub-total Costs Requested $31,495
7. Admin (Up to 10%)
$2,193
8. Total Assistanceplus Admin Requested
$33,688
9. Cash Match $8,422
10. In-Kind Match $0
11. Total Match $8,422
12. Total Budget $42,110
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No
3) Other Attachment No
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 37 09/22/2017
Attachment Details
Document Description:
Attachment Details
Document Description:
Attachment Details
Document Description:
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 38 09/22/2017
7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 39 09/22/2017
It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Cathy Jennings
Date: 08/17/2017
Title: Chief Executive Officer
Applicant Organization: Young Women's Christian Association of Canton
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 40 09/22/2017
Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 41 09/22/2017
Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Make changes
3. Specify which screens require changes by clicking the checkbox next tothe name and then clicking the Save button.
Part 2- Recipient and Subrecipient Information
2A. Subrecipients
2B. Recipient Performance
Part 3 - Project Information
3A. Project DetailX
3B. Description
3C. Dedicated PlusX
Part 4 - Housing Services and HMIS
4A. Services
4B. Housing Type
Part 5 - Participants and Outreach Information
5A. Households
5B. Subpopulations
5C. Outreach
Part 6 - Budget Information
6A. Funding Request
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 42 09/22/2017
6D. MatchX
6E. Summary Budget
Part 7 - Attachment(s) & Certification
7A. Attachment(s)X
7B. CertificationX
The applicant has selected "Make Changes" to Question 2 above. Pleaseprovide a brief description of the changes that will be made to the projectinformation screens (bullets are appropriate):
3a. - No Changes were made to this section3b. - Updated descriptive narrative3c. - Completed Dedicated Plus page4a. - Changes technical assistance with SSD/SSDI to "Yes" and chose "Yes" forSOAR CertifiedNote: Above boxes were changed as noted although not all of them areshowing as being checked4b. - Changed number of beds from 9 to 8. The number of units remains thesame at 8.5 a and b. - Changed total served from 9 to 8.5c. Changed percentages from last application.
The applicant has selected "Make Changes". Once this screen is saved,the applicant will be prohibited from "unchecking" any box that has been
checked regardless of whether a change to data on the correspondingscreen will be made.
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 43 09/22/2017
8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/16/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 08/16/2017
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 44 09/22/2017
1E. SF-424 Compliance 08/16/2017
1F. SF-424 Declaration 08/16/2017
1G. HUD-2880 08/16/2017
1H. HUD-50070 08/16/2017
1I. Cert. Lobbying 08/16/2017
1J. SF-LLL 08/16/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/16/2017
3A. Project Detail 08/16/2017
3B. Description 08/16/2017
3C. Dedicated Plus 08/16/2017
4A. Services 08/16/2017
4B. Housing Type 08/16/2017
5A. Households 08/16/2017
5B. Subpopulations No Input Required
5C. Outreach 08/16/2017
6A. Funding Request 08/16/2017
6D. Match 08/16/2017
6E. Summary Budget No Input Required
7A. Attachment(s) No Input Required
7B. Certification 08/17/2017
Submission Without Changes 08/16/2017
Applicant: YWCA of Canton 340714799Project: New Beginnings PSH 153007
Renewal Project Application FY2017 Page 45 09/22/2017
Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 1 09/22/2017
1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 09/21/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0323
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 2 09/22/2017
1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: Stark Metropolitan Housing Authority
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-6000508
c. Organizational DUNS: 010831279 PLUS 4 1111
d. Address
Street 1: 400 East Tuscarawas Street
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702
e. Organizational Unit (optional)
Department Name: Freed Housing
Division Name:
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Mr.
First Name: Martin
Middle Name: J
Last Name: Chumney
Suffix:
Title: HCV Program Director
Organizational Affiliation: Stark Metropolitan Housing Authority
Telephone Number: (330) 454-8051
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 3 09/22/2017
Extension: 312
Fax Number: (330) 580-9000
Email: [email protected]
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 4 09/22/2017
1C. SF-424 Application Details
9. Type of Applicant: La. Public Housing Authority
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 5 09/22/2017
1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: Gateway House II SPC Phase II
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-007
b. Project:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
17. Proposed Project
a. Start Date: 11/01/2017
b. End Date: 10/31/2018
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Mr.
First Name: Herman
Middle Name: L
Last Name: Hill
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 454-8051
Fax Number:(Format: 123-456-7890)
(330) 454-8065
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 09/21/2017
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
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1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: Stark Metropolitan Housing Authority
Prefix: Mr.
First Name: Herman
Middle Name: L
Last Name: Hill
Suffix:
Title: Executive Director
Organizational Affiliation: Stark Metropolitan Housing Authority
Telephone Number: (330) 454-8051
Extension: 332
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44702
2. Employer ID Number (EIN): 34-6000508
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$144,643.00
(Requested amounts will be automatically entered within applications)
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5. State the name and location (streetaddress, city and state) of the project or
activity:
Gateway House II SPC Phase II 400 EastTuscarawas Street Canton Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
Yes
Part II Other Government Assistance Provided or Requested/ExpectedSources and Use of Funds
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance,payment, credit, or tax benefit.
Department/Local Agency Name and Address Type of Assistance AmountRequested /
Provided
Expected Uses of the Funds
NA NA $0.00 NA
Part III Interested Parties
You must disclose:1. All developers, contractors, or consultants involved in the application for the assistance or inthe planning, development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which theassistance is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower).
Alphabetical list of all persons with a Social Security No. Type of Financial Interest Financial Interest
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 10 09/22/2017
reportable financial interest in theproject or activity
(For individuals, give the last namefirst)
or Employee ID No. Participation in Project/Activity($)
in Project/Activity(%)
NA NA NA $0.00 0%
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Herman Hill, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 07/18/2017
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: Stark Metropolitan Housing Authority
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 12 09/22/2017
accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Mr.
First Name: Herman
Middle Name L
Last Name: Hill
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 454-8051
Fax Number:(Format: 123-456-7890)
(330) 454-8065
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 09/21/2017
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CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 14 09/22/2017
the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: Stark Metropolitan Housing Authority
Name / Title of Authorized Official: Herman Hill, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 09/21/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: Stark Metropolitan Housing Authority
Street 1: 400 East Tuscarawas Street
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 16 09/22/2017
Authorized Representative
Prefix: Mr.
First Name: Herman
Middle Name: L
Last Name: Hill
Suffix:
Title: Executive Director
Telephone Number: (Format: 123-456-7890)
(330) 454-8051
Fax Number: (Format: 123-456-7890)
(330) 454-8065
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 09/21/2017
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
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Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
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2A. Project Subrecipients
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
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2B. Recipient Performance
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
No
Explain why the APR for the most recently expired grant term related tothis renewal project request has not been submitted.
This grant period most recently ended on 10/31/15 and the annual APR was notentered by the previous program administrators at SMHA. The APR for thisgrant was completed and entered on 8/9/2016.
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
Yes
Explain the circumstances that led HUD to recapture funds from the mostrecently expired grant term related to this renewal project request.
Grant OH0323C5E080900 expired 10/31/2015 with a balance of $75,266.80.As of this date, the funds have not been recaptured however it is understoodthat recapture is imminent. The balance of funds is a direct result of the delayin the construction of the Permanent Supportive Housing project. The projectwas scheduled to open in 2010 however, the construction was not completeuntil 10/2011. Since this is project-based assistance, we did not have anopportunity to over-lease to utilize additional funding.
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3A. Project Detail
1. Expiring Grant Number: OH0323(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: Gateway House II SPC Phase II
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Provide a description that addresses the entire scope of the proposedproject.
The SPC PRA program strictly adheres to the Housing First philosophy & isdesigned to provide project-based rental assistance to 6 homeless, disabledindividuals at Gateway II, a 40 unit PSH program in Canton. The programtargets disabled individuals targeting those who are chronically homeless whohave zero to low incomes; who are seriously mentally ill and/or who havechronic drug or alcohol addictions.
Regardless of poor financial or rental history, minor criminal convictions, orbehaviors that indicate a lack of housing readiness, eligible participants haveincomes at or below 50% of AMI & are living in streets, shelters, or displaced bydomestic violence at program entrance. Referrals are accepted regardless oftheir sobriety, use of substances or completion of treatment.
SMHA is an active participant in the Homeless Continuum of Care of Stark(HCCSC). HCCSC has established a central intake & coordinated assessment,& referral system (CIAPRS). All homeless service providers in Stark County thatare receiving Continuum of Care, are required to participate in the CIAPRS.
The County’s Homeless Hotline & HMIS staff is responsible for managing theCIAPRS, maintaining a central waiting list of clients for all program categories,& referring clients to providers for housing. All persons seeking housingassistance must be referred initially to the Homeless Hotline. Hotline staff isresponsible for collecting information about clients; conducting an initialevaluation of their housing status, needs, & resources. The Hotline maintains acentral register of clients awaiting housing & assign places on that waiting list toregistered clients for shelter or housing in the order of priority.
First priority is placed on chronically homeless (CH) individuals & families withthe longest history of homelessness & with the most severe service needs,followed by CH Individuals & families with the longest history of homelessness,CH individuals & families with the most severe service needs, then all other CHindividuals & families.
Continuum of Care-funded providers of permanent supportive housing must fillvacancies from the central waiting list, offering available units to clients on thatlist in the order of priority assigned to them by the Hotline. Before admitting anyclients to a program, SMHA will meet the client to conduct a personal interview,verify basic facts, & review the documentation required to certify their eligibility
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
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for the Program.
Participants are offered both on-site and community based services. Supportservices are voluntary & emphasize engagement & problem-solving overtherapeutic goals. Services plans are highly tenant-driven withoutpredetermined goals. Participation in services or program compliance is not acondition of tenancy. Participants receive an ongoing assessment of needs.
2. Does your project have a specificpopulation focus?
Yes
2a. Please identify the specific population focus. (Select ALL that apply)
Chronic HomelessX
Domestic Violence
Veterans Substance AbuseX
Youth (under 25) Mental IllnessX
Families with Children HIV/AIDS
Other(Click 'Save' to update)
Other:
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
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Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
3d. Does the project follow a "Housing First"approach?
Yes
4. Does the PH project provide PSH or RRH? PSH
Is this an SHP Project that had been approvedby HUD to change the renewal project budget
from leasing to rental assistance?
No
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3C. Dedicated Plus
Dedicated and DedicatedPLUS
A “100% Dedicated” project is a permanent supportive housing projectthat commits 100% of its beds to chronically homeless individuals andfamilies, according to NOFA Section III.3.b.
A “DedicatedPLUS” project is a permanent supportive housing projectwhere 100% of the beds are dedicated to serve individuals with disabilitiesand families in which one adult or child has a disability, includingunaccompanied homeless youth, that at a minimum, meet ONE of thefollowing criteria according to NOFA Section III.3.d:
(1) experiencing chronic homelessness as defined in 24 CFR 578.3; (2) residing in a transitional housing project that will be eliminated and meets the definition ofchronically homeless in effect at the time in which the individual or family entered the transitionalhousing project; (3) residing in a place not meant for human habitation, emergency shelter, or safe haven; butthe individuals or families experiencing chronic homelessness as defined at 24 CFR 578.3 hadbeen admitted and enrolled in a permanent housing project within the last year and were unableto maintain a housing placement; (4) residing in transitional housing funded by a joint TH and PH-RRH component project andwho were experiencing chronic homelessness as defined at 24 CFR 578.3 prior to entering theproject; (5)residing and has resided in a place not meant for human habitation, a safe haven, oremergency shelter for at least 12 months in the last three years, but has not done so on fourseparate occasions; or (6) receiving assistance through a Department of Veterans Affairs(VA)-funded homelessassistance program and met one of the above criteria at initial intake to the VA's homelessassistance system.
A renewal project where 100 percent of the beds are dedicated in their current grant asdescribed in NOFA Section III.A.3.b. must either become DedicatedPLUS or remain 100%Dedicated. If a renewal project currently has 100 percent of its beds dedicated to chronicallyhomeless individuals and families and elects to become a DedicatedPLUS project, the projectwill be required to adhere to all fair housing requirements at 24 CFR 578.93. Any beds that theapplicant identifies in this application as being dedicated to chronically homeless individuals andfamilies in a DedicatedPLUS project must continue to operate in accordance with SectionIII.A.3.b. Beds are identified on Screen 4B.
1. Indicate whether the project is "100%Dedicated", "DedicatedPLUS", or "N/A",
according to the information provided above.
DedicatedPLUS
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4A. Supportive Services for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Partner As needed
Assistance with Moving Costs
Case Management Partner Monthly
Child Care Non-Partner As needed
Education Services Non-Partner As needed
Employment Assistance and Job Training Non-Partner As needed
Food Non-Partner As needed
Housing Search and Counseling Services Partner As needed
Legal Services Non-Partner As needed
Life Skills Training Partner As needed
Mental Health Services Partner Monthly
Outpatient Health Services Non-Partner As needed
Outreach Services Partner As needed
Substance Abuse Treatment Services Partner Monthly
Transportation Non-Partner As needed
Utility Deposits
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
Yes
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are received and renewed?
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partneragency?
Yes
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
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4B. Housing Type and Location
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 25
Total Beds: 27
Total Dedicated CH Beds: 17Housing Type Units Beds
Clustered apartments 25 27
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4B. Housing Type and Location Detail
1. Housing Type: Clustered apartments
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 25
b. Beds: 27
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
17
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Street 1: 626 Walnut Avenue NE
Street 2:
City: Canton
State: Ohio
ZIP Code: 44702
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
399151 Stark County
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5A. Project Participants - Households
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 0 25 0 25
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 0 25 25
Adults ages 18-24 0 0 0
Accompanied Children under age 18 0 0 0
Unaccompanied Children under age 18 0 0
Total Persons 0 25 0 25
Click Save to automatically calculate totals
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 30 09/22/2017
5B. Project Participants - Subpopulations
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Children under age 18
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 25 0 0 3 0 3 0 0 0 0
Adults ages 18-24 0 0 0 0 0 0 0 0 0 0
Total Persons 25 0 0 3 0 3 0 0 0 0
Click Save to automatically calculate totals
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 31 09/22/2017
5C. Outreach for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
50% Directly from the street or other locations not meant for human habitation.
50% Directly from emergency shelters.
Directly from safe havens.
0% Persons fleeing domestic violence.
Directly from transitional housing eliminated in the FY 2017 CoC Program Competition.
Directly from the TH Portion of a Joint TH and PH-RRH Component project.
Persons receiving services through a Department of Veterans Affairs(VA)-funded homeless assistance program.
100% Total of above percentages
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 32 09/22/2017
6A. Funding Request
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Do any of the properties in this projecthave an active restrictive covenant?
No
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
Yes
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Leased Units
Leased Structures
Rental Assistance X
Supportive Services
Operating
HMIS
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 33 09/22/2017
6C. Rental Assistance Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes the rental assistance funding request for thetotal term of the project. To add information to the list, select the icon. Toview or update information already listed, select the icon.
Total Request for Grant Term: $137,400
Total Units: 25
Type of RentalAssistance
FMR Area Total UnitsRequested
Total Request
PRA OH - Canton-Massillon, OH MSA (390199... 25 $137,400
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 34 09/22/2017
Rental Assistance Budget Detail
Type of Rental Assistance: PRA
Metropolitan or non-metropolitanfair market rent area:
OH - Canton-Massillon, OH MSA (3901999999)
Does the applicant request rental assistancefunding for less than the area's per unit size
fair market rents?
No
Size of Units # of Units(Applicant)
FMR Area(Applicant)
HUD PaidRent
(Applicant)
12 Months TotalRequest
(Applicant)
SRO x $317 $317 x = $0
0 Bedroom 19 x $422 $422 x = $96,216
1 Bedroom 4 x $516 $516 x = $24,768
2 Bedrooms 2 x $684 $684 x = $16,416
3 Bedrooms x $873 $873 x = $0
4 Bedrooms x $938 $938 x = $0
5 Bedrooms x $1,079 $1,079 x = $0
6 Bedrooms x $1,219 $1,219 x = $0
7 Bedrooms x $1,360 $1,360 x = $0
8 Bedrooms x $1,501 $1,501 x = $0
9 Bedrooms x $1,642 $1,642 x = $0
Total Units and Annual AssistanceRequested
25 $137,400
Grant Term 1 Year
Total Request for Grant Term $137,400
Click the 'Save' button to automatically calculate totals.
Are you requesting a 15 year renewal persection IV.B.3.b. This request is only
available for PRA rental assistance projectsand 1 year of funding according to the
relevant section of the FY 2015 CoC ProgramCompetition NOFA.
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 35 09/22/2017
6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $0
Total Value of In-Kind Commitments: $36,161
Total Value of All Commitments: $36,161
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.Match Type Source Contributor Date of
CommitmentValue ofCommitments
Yes In-Kind Private Stark CountyMent...
08/17/2016 $36,161
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 36 09/22/2017
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Stark County Mental Health and RecoveryServices Board
5. Date of Written Commitment: 08/17/2016
6. Value of Written Commitment: $36,161
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 37 09/22/2017
6E. Summary Budget
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $0
1b. Leased Structures $0
2. Rental Assistance $137,400
3. Supportive Services $0
4. Operating $0
5. HMIS $0
6. Sub-total Costs Requested $137,400
7. Admin (Up to 10%)
$7,243
8. Total Assistanceplus Admin Requested
$144,643
9. Cash Match $0
10. In-Kind Match $36,161
11. Total Match $36,161
12. Total Budget $180,804
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 38 09/22/2017
7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No
3) Other Attachment No
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 39 09/22/2017
Attachment Details
Document Description:
Attachment Details
Document Description:
Attachment Details
Document Description:
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 40 09/22/2017
7A. In-Kind Match MOU Attachment
Document Type Required? Document Description Date Attached
In-Kind Match MOU No
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 41 09/22/2017
Attachment Details
Document Description:
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 42 09/22/2017
7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 43 09/22/2017
It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Herman Hill
Date: 09/21/2017
Title: Executive Director
Applicant Organization: Stark Metropolitan Housing Authority
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 44 09/22/2017
Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 45 09/22/2017
Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Make changes
3. Specify which screens require changes by clicking the checkbox next tothe name and then clicking the Save button.
Part 2- Recipient and Subrecipient Information
2A. Subrecipients
2B. Recipient Performance
Part 3 - Project Information
3A. Project DetailX
3B. Description
3C. Dedicated PlusX
Part 4 - Housing Services and HMIS
4A. Services
4B. Housing Type
Part 5 - Participants and Outreach Information
5A. Households
5B. Subpopulations
5C. Outreach
Part 6 - Budget Information
6A. Funding Request
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 46 09/22/2017
6C. Rental Assistance
6D. MatchX
6E. Summary BudgetX
Part 7 - Attachment(s) & Certification
7A. Attachment(s)X
7A. In-Kind Match MOU AttachmentX
7B. CertificationX
The applicant has selected "Make Changes" to Question 2 above. Pleaseprovide a brief description of the changes that will be made to the projectinformation screens (bullets are appropriate):
This is now a consolidated grant. We want to make a change to the fundingrequest. The new amount being requested is $144,643.00. The new Matchrequirement will be $36,161. Since this is now a consolidated grant, we will nowbe serving a total of 25 households in this grant.
The applicant has selected "Make Changes". Once this screen is saved,the applicant will be prohibited from "unchecking" any box that has been
checked regardless of whether a change to data on the correspondingscreen will be made.
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 47 09/22/2017
8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/16/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 48 09/22/2017
1D. SF-424 Congressional District(s) 08/16/2017
1E. SF-424 Compliance 08/16/2017
1F. SF-424 Declaration 08/16/2017
1G. HUD-2880 08/16/2017
1H. HUD-50070 08/16/2017
1I. Cert. Lobbying 08/16/2017
1J. SF-LLL 08/16/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/16/2017
3A. Project Detail 08/16/2017
3B. Description 08/16/2017
3C. Dedicated Plus 08/16/2017
4A. Services 08/16/2017
4B. Housing Type 08/16/2017
5A. Households 08/16/2017
5B. Subpopulations No Input Required
5C. Outreach 08/16/2017
6A. Funding Request 08/16/2017
6C. Rental Assistance 08/16/2017
6D. Match 08/16/2017
6E. Summary Budget No Input Required
7A. Attachment(s) No Input Required
7A. In-Kind Match MOU Attachment No Input Required
7B. Certification 08/16/2017
Submission Without Changes 08/16/2017
Applicant: Stark Metropolitan Housing Authority OH018Project: Gateway House II SPC Phase II 153985
Renewal Project Application FY2017 Page 49 09/22/2017
Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 1 09/22/2017
1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/15/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0296
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 2 09/22/2017
1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: ICAN Inc.
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-1575839
c. Organizational DUNS: 189042914 PLUS 4
d. Address
Street 1: 1214 Market Ave N
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44714
e. Organizational Unit (optional)
Department Name:
Division Name:
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Mrs.
First Name: Natalie
Middle Name:
Last Name: McCleskey
Suffix:
Title: Development Director
Organizational Affiliation: ICAN Inc.
Telephone Number: (330) 455-9100
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 3 09/22/2017
Extension: 150
Fax Number: (330) 455-4702
Email: [email protected]
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 4 09/22/2017
1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 5 09/22/2017
1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: Cherry Grove
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-007
17. Proposed Project
a. Start Date: 03/01/2017
b. End Date: 02/28/2018
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 6 09/22/2017
1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 7 09/22/2017
1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-9100
Fax Number:(Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 8 09/22/2017
1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: ICAN Inc.
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Organizational Affiliation: ICAN Inc.
Telephone Number: (330) 455-9100
Extension:
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44714
2. Employer ID Number (EIN): 34-1575839
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$136,092.00
(Requested amounts will be automatically entered within applications)
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 9 09/22/2017
5. State the name and location (streetaddress, city and state) of the project or
activity:
Cherry Grove 1214 Market Ave N Canton Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
Yes
Part II Other Government Assistance Provided or Requested/ExpectedSources and Use of Funds
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance,payment, credit, or tax benefit.
Department/Local Agency Name and Address Type of Assistance AmountRequested /
Provided
Expected Uses of the Funds
Ohio Development Services Agency, 77 S. HighStreet, Columbus, OH 43215
Grant $19,851.00 Cherry Grove - Maintainance, Utilitiesand Insurance
Ohio Development Services Agency, 77 S. HighStreet, Columbus, OH 43215
Grant 37834.0 Rapid Re-Housing - Salaries andBenefits
Stark Mental Health & Addiction Recovery, 121Cleveland Ave SW, Canton, OH 44702
Grant $45,389.00 Shelter Plus Care and West Park -Supportive Services; Peer Support;Employment; Critical TimeInterventionist Salary; Benefits andTravel
Part III Interested Parties
You must disclose:1. All developers, contractors, or consultants involved in the application for the assistance or in
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 10 09/22/2017
the planning, development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which theassistance is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower).
Alphabetical list of all persons with areportable financial interest in the
project or activity (For individuals, give the last name
first)
Social Security No.or Employee ID No.
Type ofParticipation
Financial Interestin Project/Activity
($)
Financial Interestin Project/Activity
(%)
NA NA NA $0.00 0%
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Julie Sparks, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/14/2017
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 11 09/22/2017
1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: ICAN Inc.
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 12 09/22/2017
accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-9100
Fax Number:(Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 13 09/22/2017
CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 14 09/22/2017
the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: ICAN Inc.
Name / Title of Authorized Official: Julie Sparks, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 15 09/22/2017
1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: ICAN Inc.
Street 1: 1214 Market Ave N
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44714
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 16 09/22/2017
Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number: (Format: 123-456-7890)
(330) 455-9100
Fax Number: (Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/15/2017
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 17 09/22/2017
Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 18 09/22/2017
2A. Project Subrecipients
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
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Renewal Project Application FY2017 Page 19 09/22/2017
2B. Recipient Performance
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
Yes
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
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Renewal Project Application FY2017 Page 20 09/22/2017
3A. Project Detail
1. Expiring Grant Number: OH0296(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: Cherry Grove
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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Renewal Project Application FY2017 Page 21 09/22/2017
3B. Project Description
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Provide a description that addresses the entire scope of the proposedproject.
Our community needs housing for homeless persons with severe mental illnesswho have been unable or unwilling to participate in housing or supportiveservices. Cherry Grove provides permanent housing and supportive services tothat target population. Eligible applicants must have incomes at/below 35% AMIand come from places not meant for habitation, “the street,” or emergencyshelter. Centralized intake and assessment is conducted by HMIS HomelessHotline. ICAN is on the CoC Centralized Intake and Assessment Committeeand utilizes the central process approved by the CoC to fill vacant units. Incompliance with the local CoC Central Intake and Assessment policies,chronically homeless persons with the most severe need will be placed higheron the wait list. First priority will be given to chronically homeless persons withthe longest history of homelessness and with the most severe service needs.Consistent with the Housing First approach, ICAN overlooks history of evictions,poor financial history, minor criminal convictions, substance abuse issues, clientbehaviors caused by symptoms of mental illness, and other traditional barriersto house clients quickly.
Cherry Grove serves 20 residents at one location. Each resident has anindividual bedroom and bathroom. Every two residents share kitchens andsitting rooms in 10 suites. Two common rooms and two patios providecommunity space. ICAN Housing contracts for third-party security services.Stark Mental Health and Addiction Recovery (SMHAR) Board contracts withColeman Professional Services (CPS) to provide 24-hour staffing and services.CPS on-site recovery coaches encourage residents to link to mainstreamservices. CPS provides a Site Supervisor to coordinate services with casemanagers from several mental health agencies to complete and implementhousing plans that promote housing stability. Residents work with CPS andICAN staff to correct lease violations. ICAN Housing requires CoC funding topay for building operating expenses, program operations and on-site security.
CPS staff and mental health case managers facilitate connection to benefits.New residents at Cherry Grove generally do not have income. ICAN willcontinue to develop plans to assist residents in accessing income and benefitsearlier in their tenancy at Cherry Grove.
2. Does your project have a specific Yes
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 22 09/22/2017
population focus?
2a. Please identify the specific population focus. (Select ALL that apply)
Chronic Homeless Domestic Violence
Veterans Substance Abuse
Youth (under 25) Mental IllnessX
Families with Children HIV/AIDS
Other(Click 'Save' to update) X
Other: None
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 23 09/22/2017
None of the above
3d. Does the project follow a "Housing First"approach?
Yes
4. Does the PH project provide PSH or RRH? PSH
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Renewal Project Application FY2017 Page 24 09/22/2017
3C. Dedicated Plus
Dedicated and DedicatedPLUS
A “100% Dedicated” project is a permanent supportive housing projectthat commits 100% of its beds to chronically homeless individuals andfamilies, according to NOFA Section III.3.b.
A “DedicatedPLUS” project is a permanent supportive housing projectwhere 100% of the beds are dedicated to serve individuals with disabilitiesand families in which one adult or child has a disability, includingunaccompanied homeless youth, that at a minimum, meet ONE of thefollowing criteria according to NOFA Section III.3.d:
(1) experiencing chronic homelessness as defined in 24 CFR 578.3; (2) residing in a transitional housing project that will be eliminated and meets the definition ofchronically homeless in effect at the time in which the individual or family entered the transitionalhousing project; (3) residing in a place not meant for human habitation, emergency shelter, or safe haven; butthe individuals or families experiencing chronic homelessness as defined at 24 CFR 578.3 hadbeen admitted and enrolled in a permanent housing project within the last year and were unableto maintain a housing placement; (4) residing in transitional housing funded by a joint TH and PH-RRH component project andwho were experiencing chronic homelessness as defined at 24 CFR 578.3 prior to entering theproject; (5)residing and has resided in a place not meant for human habitation, a safe haven, oremergency shelter for at least 12 months in the last three years, but has not done so on fourseparate occasions; or (6) receiving assistance through a Department of Veterans Affairs(VA)-funded homelessassistance program and met one of the above criteria at initial intake to the VA's homelessassistance system.
A renewal project where 100 percent of the beds are dedicated in their current grant asdescribed in NOFA Section III.A.3.b. must either become DedicatedPLUS or remain 100%Dedicated. If a renewal project currently has 100 percent of its beds dedicated to chronicallyhomeless individuals and families and elects to become a DedicatedPLUS project, the projectwill be required to adhere to all fair housing requirements at 24 CFR 578.93. Any beds that theapplicant identifies in this application as being dedicated to chronically homeless individuals andfamilies in a DedicatedPLUS project must continue to operate in accordance with SectionIII.A.3.b. Beds are identified on Screen 4B.
1. Indicate whether the project is "100%Dedicated", "DedicatedPLUS", or "N/A",
according to the information provided above.
N/A
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Renewal Project Application FY2017 Page 25 09/22/2017
4A. Supportive Services for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Partner Monthly
Assistance with Moving Costs
Case Management Partner Weekly
Child Care
Education Services
Employment Assistance and Job Training Non-Partner As needed
Food Non-Partner As needed
Housing Search and Counseling Services Applicant Quarterly
Legal Services
Life Skills Training Partner Weekly
Mental Health Services Partner Monthly
Outpatient Health Services Non-Partner As needed
Outreach Services Applicant As needed
Substance Abuse Treatment Services Partner Monthly
Transportation Partner Weekly
Utility Deposits
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
Yes
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 26 09/22/2017
are received and renewed?
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partneragency?
Yes
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 27 09/22/2017
4B. Housing Type and Location
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 20
Total Beds: 20
Total Dedicated CH Beds: 0Housing Type Units Beds
Shared housing 20 20
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Renewal Project Application FY2017 Page 28 09/22/2017
4B. Housing Type and Location Detail
1. Housing Type: Shared housing
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 20
b. Beds: 20
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
0
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Street 1: 830 Cherry Ave.NE
Street 2:
City: Canton
State: Ohio
ZIP Code: 44702
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
390858 Canton, 399151 Stark County
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5A. Project Participants - Households
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 0 20 0 20
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 0 18 18
Adults ages 18-24 0 2 2
Accompanied Children under age 18 0 0 0
Unaccompanied Children under age 18 0 0
Total Persons 0 20 0 20
Click Save to automatically calculate totals
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Renewal Project Application FY2017 Page 30 09/22/2017
5B. Project Participants - Subpopulations
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Children under age 18
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 17 0 1 11 1 18 0 0 0 0
Adults ages 18-24 2 0 0 0 0 2 0 0 0 0
Total Persons 19 0 1 11 1 20 0 0 0 0
Click Save to automatically calculate totals
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
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5C. Outreach for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
43% Directly from the street or other locations not meant for human habitation.
57% Directly from emergency shelters.
0% Directly from safe havens.
0% Persons fleeing domestic violence.
0% Directly from transitional housing.
Directly from the TH Portion of a Joint TH and PH-RRH Component project.
Persons receiving services through a Department of Veterans Affairs(VA)-funded homeless assistance program.
100% Total of above percentages
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6A. Funding Request
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Do any of the properties in this projecthave an active restrictive covenant?
Yes
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
No
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Leased Units
Leased Structures
Rental Assistance
Supportive Services X
Operating X
HMIS
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6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $34,024
Total Value of In-Kind Commitments: $0
Total Value of All Commitments: $34,024
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
Yes
1a. Briefly describe the source of the program income:
Program Income will be generated from occupancy charges paid to ICAN Inc.by the participants that does not exceed the highest of: a) 30% of the family'smonthly adjusted income; or b) 10% of the family's monthly gross income.
1b. Estimate the amount of program income that will be used as Match for this project:
$34,024
Match Type Source Contributor Date ofCommitment
Value ofCommitments
Yes Cash Private ICAN, Inc. rental... 08/12/2017 $34,024
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 34 09/22/2017
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
ICAN, Inc. rental income.
5. Date of Written Commitment: 08/12/2017
6. Value of Written Commitment: $34,024
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 35 09/22/2017
6E. Summary Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $0
1b. Leased Structures $0
2. Rental Assistance $0
3. Supportive Services $40,035
4. Operating $87,154
5. HMIS $0
6. Sub-total Costs Requested $127,189
7. Admin (Up to 10%)
$8,903
8. Total Assistanceplus Admin Requested
$136,092
9. Cash Match $34,024
10. In-Kind Match $0
11. Total Match $34,024
12. Total Budget $170,116
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 36 09/22/2017
7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No Match Commitment ... 08/09/2017
3) Other Attachment No
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 37 09/22/2017
Attachment Details
Document Description:
Attachment Details
Document Description: Match Commitment Letter - Cherry Grove
Attachment Details
Document Description:
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 38 09/22/2017
7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 39 09/22/2017
It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Julie Sparks
Date: 08/15/2017
Title: Executive Director
Applicant Organization: ICAN Inc.
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 40 09/22/2017
Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 41 09/22/2017
Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Make changes
3. Specify which screens require changes by clicking the checkbox next tothe name and then clicking the Save button.
Part 2- Recipient and Subrecipient Information
2A. Subrecipients
2B. Recipient Performance
Part 3 - Project Information
3A. Project DetailX
3B. Description
3C. Dedicated PlusX
Part 4 - Housing Services and HMIS
4A. Services
4B. Housing Type
Part 5 - Participants and Outreach Information
5A. Households
5B. Subpopulations
5C. Outreach
Part 6 - Budget Information
6A. Funding Request
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 42 09/22/2017
6D. MatchX
6E. Summary Budget
Part 7 - Attachment(s) & Certification
7A. Attachment(s)X
7B. CertificationX
The applicant has selected "Make Changes" to Question 2 above. Pleaseprovide a brief description of the changes that will be made to the projectinformation screens (bullets are appropriate):
* 3B. Project Description - Revising final paragraph in the narrative section, thatpreviously provided annual APR outcomes, in order to align with HUD'sInstructional Guidance regarding to desire for Applicants to avoid the need tomake annual updates in renewal project applications.* 2B. Recipient Performance - The FY2015 APR was submitted on timetherefore this response was updated to a "YES".
The applicant has selected "Make Changes". Once this screen is saved,the applicant will be prohibited from "unchecking" any box that has been
checked regardless of whether a change to data on the correspondingscreen will be made.
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 43 09/22/2017
8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/03/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 08/03/2017
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 44 09/22/2017
1E. SF-424 Compliance 08/03/2017
1F. SF-424 Declaration 08/03/2017
1G. HUD-2880 08/03/2017
1H. HUD-50070 08/03/2017
1I. Cert. Lobbying 08/03/2017
1J. SF-LLL 08/03/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/08/2017
3A. Project Detail 08/03/2017
3B. Description 08/03/2017
3C. Dedicated Plus 08/03/2017
4A. Services 08/03/2017
4B. Housing Type 08/03/2017
5A. Households 08/03/2017
5B. Subpopulations No Input Required
5C. Outreach 08/03/2017
6A. Funding Request 08/03/2017
6D. Match 08/09/2017
6E. Summary Budget No Input Required
7A. Attachment(s) 08/09/2017
7B. Certification 08/15/2017
Submission Without Changes 08/08/2017
Applicant: ICAN Inc. 189042914Project: Cherry Grove 152198
Renewal Project Application FY2017 Page 45 09/22/2017
Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 1 09/22/2017
1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/16/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0386
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 2 09/22/2017
1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: Stark Metropolitan Housing Authority
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-6000508
c. Organizational DUNS: 010831279 PLUS 4 1111
d. Address
Street 1: 400 East Tuscarawas Street
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702
e. Organizational Unit (optional)
Department Name: Freed Housing
Division Name:
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Mr.
First Name: Martin
Middle Name: J
Last Name: Chumney
Suffix:
Title: HCV Program Director
Organizational Affiliation: Stark Metropolitan Housing Authority
Telephone Number: (330) 454-8051
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 3 09/22/2017
Extension: 312
Fax Number: (330) 580-9000
Email: [email protected]
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 4 09/22/2017
1C. SF-424 Application Details
9. Type of Applicant: La. Public Housing Authority
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 5 09/22/2017
1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: Shelter Plus Care TRA MHRSB
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-007
b. Project:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
17. Proposed Project
a. Start Date: 10/01/2017
b. End Date: 09/30/2018
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 6 09/22/2017
1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 7 09/22/2017
1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Mr.
First Name: Herman
Middle Name: L
Last Name: Hill
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 454-8051
Fax Number:(Format: 123-456-7890)
(330) 454-8065
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/16/2017
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 8 09/22/2017
1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: Stark Metropolitan Housing Authority
Prefix: Mr.
First Name: Herman
Middle Name: L
Last Name: Hill
Suffix:
Title: Executive Director
Organizational Affiliation: Stark Metropolitan Housing Authority
Telephone Number: (330) 454-8051
Extension: 332
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44702
2. Employer ID Number (EIN): 34-6000508
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$39,767.00
(Requested amounts will be automatically entered within applications)
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 9 09/22/2017
5. State the name and location (streetaddress, city and state) of the project or
activity:
Shelter Plus Care TRA MHRSB 400 EastTuscarawas Street Canton Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
Yes
Part II Other Government Assistance Provided or Requested/ExpectedSources and Use of Funds
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance,payment, credit, or tax benefit.
Department/Local Agency Name and Address Type of Assistance AmountRequested /
Provided
Expected Uses of the Funds
NA NA $0.00 NA
Part III Interested Parties
You must disclose:1. All developers, contractors, or consultants involved in the application for the assistance or inthe planning, development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which theassistance is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower).
Alphabetical list of all persons with a Social Security No. Type of Financial Interest Financial Interest
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 10 09/22/2017
reportable financial interest in theproject or activity
(For individuals, give the last namefirst)
or Employee ID No. Participation in Project/Activity($)
in Project/Activity(%)
NA NA NA $0.00 0%
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Herman Hill, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 07/18/2017
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 11 09/22/2017
1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: Stark Metropolitan Housing Authority
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 12 09/22/2017
accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Mr.
First Name: Herman
Middle Name L
Last Name: Hill
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 454-8051
Fax Number:(Format: 123-456-7890)
(330) 454-8065
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/16/2017
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 13 09/22/2017
CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 14 09/22/2017
the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: Stark Metropolitan Housing Authority
Name / Title of Authorized Official: Herman Hill, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/16/2017
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 15 09/22/2017
1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: Stark Metropolitan Housing Authority
Street 1: 400 East Tuscarawas Street
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 16 09/22/2017
Authorized Representative
Prefix: Mr.
First Name: Herman
Middle Name: L
Last Name: Hill
Suffix:
Title: Executive Director
Telephone Number: (Format: 123-456-7890)
(330) 454-8051
Fax Number: (Format: 123-456-7890)
(330) 454-8065
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/16/2017
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 17 09/22/2017
Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
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2A. Project Subrecipients
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
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2B. Recipient Performance
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
No
Explain why the APR for the most recently expired grant term related tothis renewal project request has not been submitted.
The APR on this most recently completed grant period was due in December,2015 but was not completed and submitted until February, 2016 by the previousoperators of the program at Stark MHA.
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
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3A. Project Detail
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Expiring Grant Number: OH0386(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: Shelter Plus Care TRA MHRSB
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Provide a description that addresses the entire scope of the proposedproject.
The Program strictly adheres to the Housing First philosophy & is designed toprovide rental assistance to 6 homeless, disabled individuals targeting thosewith with MI, or dually diagnosed (MI & AoD) & adult serial inebriates.
Regardless of poor financial or rental history, minor criminal convictions, orbehaviors that indicate a lack of housing readiness, eligible participants haveincomes at or below 50% of AMI & are living in streets, shelters or displaced bydomestic violence at program entrance. Referrals are accepted regardless oftheir sobriety, use of substances or completion of treatment.
SMHA is an active participant in the Homeless Continuum of Care(HCCSC).HCCSC has established a central intake & coordinated assessment,prioritization, & referral system (CIAPRS). All homeless service providers inStark County that are receiving Continuum of Care, are required to participate inthe CIAPRS.
The County’s Homeless Hotline & HMIS staff is responsible for managing theCIAPRS, prioritizing applications for assistance, maintaining a central waitinglist of clients for all program categories, & referring clients to providers forhousing. All persons seeking housing assistance must be referred initially to theHomeless Hotline. Hotline staff is responsible for collecting information aboutclients; conducting an initial evaluation of their housing status, needs, &resources. The Hotline maintains a central register of clients awaiting housing &assign places on that waiting list to registered clients for shelter or housing inthe order of priority.
First priority is placed on chronically homeless (CH) individuals & families withthe longest history of homelessness & with the most severe service needs,followed by CH Individuals & families with the longest history of homelessness,CH individuals & families with the most severe service needs, then all other CHindividuals & families.
Continuum of Care-funded providers of permanent supportive housing must fillvacancies from the central waiting list, offering available units to clients on thatlist in the order of priority assigned to them by the Hotline. Before admitting anyclients to a program, SMHA will meet the client to conduct a personal interview,verify basic facts, & review the documentation required to certify their eligibilityfor the Program.
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Participants are offered support services through contract agencies of theMHRSB that are voluntary & emphasize engagement & problem-solving overtherapeutic goals. Services plans are highly tenant-driven withoutpredetermined goals. Participation in services or program compliance is not acondition of tenancy. Participants receive an ongoing assessment of needs.
Funds will provide 6 affordable housing units. Housing includes any availablerental housing in Stark County chosen by the participant that meets programrequirements & owners are willing to participate in the program.
2. Does your project have a specificpopulation focus?
Yes
2a. Please identify the specific population focus. (Select ALL that apply)
Chronic HomelessX
Domestic Violence
Veterans Substance AbuseX
Youth (under 25) Mental IllnessX
Families with Children HIV/AIDS
Other(Click 'Save' to update)
Other:
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
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None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
3d. Does the project follow a "Housing First"approach?
Yes
4. Does the PH project provide PSH or RRH? PSH
Is this an SHP Project that had been approvedby HUD to change the renewal project budget
from leasing to rental assistance?
No
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3C. Dedicated Plus
Dedicated and DedicatedPLUS
A “100% Dedicated” project is a permanent supportive housing projectthat commits 100% of its beds to chronically homeless individuals andfamilies, according to NOFA Section III.3.b.
A “DedicatedPLUS” project is a permanent supportive housing projectwhere 100% of the beds are dedicated to serve individuals with disabilitiesand families in which one adult or child has a disability, includingunaccompanied homeless youth, that at a minimum, meet ONE of thefollowing criteria according to NOFA Section III.3.d:
(1) experiencing chronic homelessness as defined in 24 CFR 578.3; (2) residing in a transitional housing project that will be eliminated and meets the definition ofchronically homeless in effect at the time in which the individual or family entered the transitionalhousing project; (3) residing in a place not meant for human habitation, emergency shelter, or safe haven; butthe individuals or families experiencing chronic homelessness as defined at 24 CFR 578.3 hadbeen admitted and enrolled in a permanent housing project within the last year and were unableto maintain a housing placement; (4) residing in transitional housing funded by a joint TH and PH-RRH component project andwho were experiencing chronic homelessness as defined at 24 CFR 578.3 prior to entering theproject; (5)residing and has resided in a place not meant for human habitation, a safe haven, oremergency shelter for at least 12 months in the last three years, but has not done so on fourseparate occasions; or (6) receiving assistance through a Department of Veterans Affairs(VA)-funded homelessassistance program and met one of the above criteria at initial intake to the VA's homelessassistance system.
A renewal project where 100 percent of the beds are dedicated in their current grant asdescribed in NOFA Section III.A.3.b. must either become DedicatedPLUS or remain 100%Dedicated. If a renewal project currently has 100 percent of its beds dedicated to chronicallyhomeless individuals and families and elects to become a DedicatedPLUS project, the projectwill be required to adhere to all fair housing requirements at 24 CFR 578.93. Any beds that theapplicant identifies in this application as being dedicated to chronically homeless individuals andfamilies in a DedicatedPLUS project must continue to operate in accordance with SectionIII.A.3.b. Beds are identified on Screen 4B.
1. Indicate whether the project is "100%Dedicated", "DedicatedPLUS", or "N/A",
according to the information provided above.
100% Dedicated
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4A. Supportive Services for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Partner As needed
Assistance with Moving Costs
Case Management Partner Monthly
Child Care Non-Partner As needed
Education Services Non-Partner As needed
Employment Assistance and Job Training Non-Partner As needed
Food Non-Partner As needed
Housing Search and Counseling Services Partner As needed
Legal Services Non-Partner As needed
Life Skills Training Partner As needed
Mental Health Services Partner Monthly
Outpatient Health Services Non-Partner As needed
Outreach Services Partner As needed
Substance Abuse Treatment Services Partner Monthly
Transportation Non-Partner As needed
Utility Deposits
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
Yes
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are received and renewed?
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partneragency?
Yes
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
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4B. Housing Type and Location
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 6
Total Beds: 6
Total Dedicated CH Beds: 6Housing Type Units Beds
Scattered-site apartments (... 6 6
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4B. Housing Type and Location Detail
1. Housing Type: Scattered-site apartments (including efficiencies)
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 6
b. Beds: 6
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
6
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Street 1: Scattered Sites
Street 2:
City: Canton, Massillon, Alliance
State: Ohio
ZIP Code: 44702
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
399151 Stark County
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5A. Project Participants - Households
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 0 6 0 6
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 0 6 6
Adults ages 18-24 0 0 0
Accompanied Children under age 18 0 0 0
Unaccompanied Children under age 18 0 0
Total Persons 0 6 0 6
Click Save to automatically calculate totals
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5B. Project Participants - Subpopulations
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Children under age 18
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 6 0 0 3 0 3 0 0 0 0
Adults ages 18-24 0 0 0 0 0 0 0 0 0 0
Total Persons 6 0 0 3 0 3 0 0 0 0
Click Save to automatically calculate totals
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
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5C. Outreach for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
50% Directly from the street or other locations not meant for human habitation.
50% Directly from emergency shelters.
Directly from safe havens.
0% Persons fleeing domestic violence.
100% Total of above percentages
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6A. Funding Request
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Do any of the properties in this projecthave an active restrictive covenant?
Yes
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
Yes
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Leased Units
Leased Structures
Rental Assistance X
Supportive Services
Operating
HMIS
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6C. Rental Assistance Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes the rental assistance funding request for thetotal term of the project. To add information to the list, select the icon. Toview or update information already listed, select the icon.
Total Request for Grant Term: $37,152
Total Units: 6
Type of RentalAssistance
FMR Area Total UnitsRequested
Total Request
TRA OH - Canton-Massillon, OH MSA (390199... 6 $37,152
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Rental Assistance Budget Detail
Type of Rental Assistance: TRA
Metropolitan or non-metropolitanfair market rent area:
OH - Canton-Massillon, OH MSA (3901999999)
Does the applicant request rental assistancefunding for less than the area's per unit size
fair market rents?
No
Size of Units # of Units(Applicant)
FMR Area(Applicant)
HUD PaidRent
(Applicant)
12 Months TotalRequest
(Applicant)
SRO 0 x $317 $317 x = $0
0 Bedroom 0 x $422 $422 x = $0
1 Bedroom 6 x $516 $516 x = $37,152
2 Bedrooms 0 x $684 $684 x = $0
3 Bedrooms 0 x $873 $873 x = $0
4 Bedrooms 0 x $938 $938 x = $0
5 Bedrooms 0 x $1,079 $1,079 x = $0
6 Bedrooms 0 x $1,219 $1,219 x = $0
7 Bedrooms 0 x $1,360 $1,360 x = $0
8 Bedrooms 0 x $1,501 $1,501 x = $0
9 Bedrooms 0 x $1,642 $1,642 x = $0
Total Units and Annual AssistanceRequested
6 $37,152
Grant Term 1 Year
Total Request for Grant Term $37,152
Click the 'Save' button to automatically calculate totals.
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6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $0
Total Value of In-Kind Commitments: $9,996
Total Value of All Commitments: $9,996
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.Match Type Source Contributor Date of
CommitmentValue ofCommitments
Yes In-Kind Private Stark CountyMent...
08/17/2016 $9,996
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Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Stark County Mental Health and RecoveryServices Board
5. Date of Written Commitment: 08/17/2016
6. Value of Written Commitment: $9,996
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
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6E. Summary Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $0
1b. Leased Structures $0
2. Rental Assistance $37,152
3. Supportive Services $0
4. Operating $0
5. HMIS $0
6. Sub-total Costs Requested $37,152
7. Admin (Up to 10%)
$2,615
8. Total Assistanceplus Admin Requested
$39,767
9. Cash Match $0
10. In-Kind Match $9,996
11. Total Match $9,996
12. Total Budget $49,763
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No
3) Other Attachment No
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Attachment Details
Document Description:
Attachment Details
Document Description:
Attachment Details
Document Description:
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
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7A. In-Kind Match MOU Attachment
Document Type Required? Document Description Date Attached
In-Kind Match MOU No
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Attachment Details
Document Description:
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7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 43 09/22/2017
It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Herman Hill
Date: 08/16/2017
Title: Executive Director
Applicant Organization: Stark Metropolitan Housing Authority
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 44 09/22/2017
Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 45 09/22/2017
Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Submit without changes
The applicant has selected “Submit without changes” to Question 2above. If the applicant has identified project information on the precedingscreens that does not match the current contract, select “Make changes”above and update the relevant project information.
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
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8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/16/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 47 09/22/2017
1D. SF-424 Congressional District(s) 08/16/2017
1E. SF-424 Compliance 08/16/2017
1F. SF-424 Declaration 08/16/2017
1G. HUD-2880 08/16/2017
1H. HUD-50070 08/16/2017
1I. Cert. Lobbying 08/16/2017
1J. SF-LLL 08/16/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/16/2017
3A. Project Detail 08/16/2017
3B. Description 08/16/2017
3C. Dedicated Plus 08/16/2017
4A. Services 08/16/2017
4B. Housing Type 08/16/2017
5A. Households 08/16/2017
5B. Subpopulations No Input Required
5C. Outreach 08/16/2017
6A. Funding Request 08/16/2017
6C. Rental Assistance 08/16/2017
6D. Match 08/16/2017
6E. Summary Budget No Input Required
7A. Attachment(s) No Input Required
7A. In-Kind Match MOU Attachment No Input Required
7B. Certification 08/16/2017
Submission Without Changes 08/16/2017
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA MHRSB 153977
Renewal Project Application FY2017 Page 48 09/22/2017
Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
Applicant: YWCA of Canton 340714799Project: STARR 153005
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1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 09/21/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0422
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
Applicant: YWCA of Canton 340714799Project: STARR 153005
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1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: Young Women's Christian Association of Canton
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-0714799
c. Organizational DUNS: 123409864 PLUS 4 0000
d. Address
Street 1: YWCA of Canton
Street 2: 231 6th Street NE
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702-1092
e. Organizational Unit (optional)
Department Name: YWCA of Canton
Division Name: Housing
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Ms.
First Name: Linda
Middle Name: Louise
Last Name: Angelo
Suffix:
Title: Chief Financial Officer
Organizational Affiliation: Young Women's Christian Association of Canton
Telephone Number: (330) 453-7644
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 3 09/22/2017
Extension:
Fax Number: (330) 453-2735
Email: [email protected]
Applicant: YWCA of Canton 340714799Project: STARR 153005
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1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 5 09/22/2017
1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: STARR
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
17. Proposed Project
a. Start Date: 10/01/2018
b. End Date: 09/30/2019
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
Applicant: YWCA of Canton 340714799Project: STARR 153005
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
Applicant: YWCA of Canton 340714799Project: STARR 153005
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Ms.
First Name: Cathy
Middle Name:
Last Name: Jennings
Suffix:
Title: Chief Executive Officer
Telephone Number:(Format: 123-456-7890)
(330) 453-7644
Fax Number:(Format: 123-456-7890)
(330) 453-2735
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 09/21/2017
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Renewal Project Application FY2017 Page 8 09/22/2017
1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: Young Women's Christian Association of Canton
Prefix: Ms.
First Name: Cathy
Middle Name:
Last Name: Jennings
Suffix:
Title: Chief Executive Officer
Organizational Affiliation: Young Women's Christian Association of Canton
Telephone Number: (330) 453-7644
Extension:
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44702-1092
2. Employer ID Number (EIN): 34-0714799
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$215,960.00
(Requested amounts will be automatically entered within applications)
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 9 09/22/2017
5. State the name and location (streetaddress, city and state) of the project or
activity:
STARR YWCA of Canton Canton Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
Yes
Part II Other Government Assistance Provided or Requested/ExpectedSources and Use of Funds
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance,payment, credit, or tax benefit.
Department/Local Agency Name and Address Type of Assistance AmountRequested /
Provided
Expected Uses of the Funds
Ohio Development Services Agency Housing Trust Fund Grant $8,422.00 New Beginnings PSH ProgramOperating Costs
Stark County Community Planning (ODSA Grant) HPRP 24150.0 Rapid Re-Housing RentalAssistance/Case Management
Part III Interested Parties
You must disclose:1. All developers, contractors, or consultants involved in the application for the assistance or inthe planning, development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which theassistance is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower).
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 10 09/22/2017
Alphabetical list of all persons with areportable financial interest in the
project or activity (For individuals, give the last name
first)
Social Security No.or Employee ID No.
Type ofParticipation
Financial Interestin Project/Activity
($)
Financial Interestin Project/Activity
(%)
NA NA NA $0.00 0%
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Cathy Jennings, Chief Executive Officer
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/07/2017
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 11 09/22/2017
1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: Young Women's Christian Association of Canton
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 12 09/22/2017
accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Ms.
First Name: Cathy
Middle Name
Last Name: Jennings
Suffix:
Title: Chief Executive Officer
Telephone Number:(Format: 123-456-7890)
(330) 453-7644
Fax Number:(Format: 123-456-7890)
(330) 453-2735
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 09/21/2017
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Renewal Project Application FY2017 Page 13 09/22/2017
CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 14 09/22/2017
the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: Young Women's Christian Association of Canton
Name / Title of Authorized Official: Cathy Jennings, Chief Executive Officer
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 09/21/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: Young Women's Christian Association of Canton
Street 1: YWCA of Canton
Street 2: 231 6th Street NE
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702-1092
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 16 09/22/2017
Authorized Representative
Prefix: Ms.
First Name: Cathy
Middle Name:
Last Name: Jennings
Suffix:
Title: Chief Executive Officer
Telephone Number: (Format: 123-456-7890)
(330) 453-7644
Fax Number: (Format: 123-456-7890)
(330) 453-2735
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 09/21/2017
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Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
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2A. Project Subrecipients
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
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2B. Recipient Performance
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
Yes
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
No
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 20 09/22/2017
3A. Project Detail
1. Expiring Grant Number: OH0422(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: STARR
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
1. Provide a description that addresses the entire scope of the proposedproject.
Stark Area Rapid Rehousing (STARR) assists households living in emergencyshelter,on the streets, or fleeing domestic violence situations. STARR assiststhose who are facing housing barriers. Services following housingsearch/placement are focused on rental assistance, lease compliance andhousing stability. STARR services can go up to 18 months. The Housing Firstmodel has been adopted,and is being utilized by the STARR program. Theprogram has a specific focus on chronically homeless individuals, however ininstances of inability to demonstrate chronicity the program may servehomeless individuals. The goal is to rapidly rehouse individuals within 30 days.Research has shown this type of project to be effective when barriers tohousing are eliminated. Being able to provide longer term rental assistance willcontribute to housing sustainability.Intake: The Homeless Hotline will use the intake and assessment form todetermine eligibility for referral to the programs. The Hotline uses intake data todetermine which program is the best fit for clients andrefers clients to the appropriate program.Assessment: After client is referred from the Hotline they will be contacted toset-up a face-to-face intake with a Case Coordinator. At this time theCentralized Intake and Assessment Committee has formulated anintake/assessment form that has integrated SPDAT characteristics. The agencyis also utilizing a program (AES Basic System). This program is also inconjunction with the Homeless Hotline. It will allow the agency to better track,store, and document services rendered to clients, as well as give more detailedreports.This will be initiated at the Hotline and then completed by the Case Coordinator.This will assist in determining the level of support services and rental assistancepotentially needed for each client.Stabilization: Upon acceptance the Case Coordinator develops a service planand provides landlord liaison services. Assistance is given in accessingpermanent,affordable housing though a housing search process, assisting withrent over a designated period of time, negotiating with the landlord; assistingwith bus passes and educating the participant on the irresponsibilities andrights. STARR will also assist with utility deposits and applying for PIPP. Afterplacement into housing, participants are linked to mainstream benefits:Medicaid, household and money management, parenting classes, and supportfor mental health and substance abuse issues. Clients will be referred to theOhio Means Jobs Program and the job readiness program at Goodwill Campusto gain or increase overall income. Home visits are conducted to assist thehousehold with budgeting,lease compliance, and connection to mainstreamservices. Home visiting is provided for an optimum goal of 3-12 months but cancontinue up to 18 months if needed. STARR will offer assistance with obtainingbasic furnishings, and delivery of those items.
2. Does your project have a specificpopulation focus?
Yes
Applicant: YWCA of Canton 340714799Project: STARR 153005
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2a. Please identify the specific population focus. (Select ALL that apply)
Chronic HomelessX
Domestic ViolenceX
Veterans Substance Abuse
Youth (under 25) Mental Illness
Families with Children HIV/AIDS
Other(Click 'Save' to update) X
Other: Individuals
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
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3d. Does the project follow a "Housing First"approach?
Yes
4. Does the PH project provide PSH or RRH? RRH
Is this an SHP Project that had been approvedby HUD to change the renewal project budget
from leasing to rental assistance?
No
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4A. Supportive Services for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Applicant Monthly
Assistance with Moving Costs Applicant As needed
Case Management Applicant Monthly
Child Care Applicant As needed
Education Services Partner As needed
Employment Assistance and Job Training Partner As needed
Food Applicant As needed
Housing Search and Counseling Services Applicant Monthly
Legal Services Non-Partner As needed
Life Skills Training Applicant As needed
Mental Health Services Partner As needed
Outpatient Health Services Non-Partner As needed
Outreach Services Applicant As needed
Substance Abuse Treatment Services Non-Partner As needed
Transportation Applicant As needed
Utility Deposits Applicant As needed
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
Yes
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 25 09/22/2017
are received and renewed?
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partneragency?
Yes
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
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4B. Housing Type and Location
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 57
Total Beds: 57Housing Type Units Beds
Scattered-site apartments (... 57 57
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4B. Housing Type and Location Detail
1. Housing Type: Scattered-site apartments (including efficiencies)
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 57
b. Beds: 57
3. Address
Street 1: Various street addresses
Street 2:
City: Various through out the county
State: Ohio
ZIP Code:
4. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
390066 Alliance, 390858 Canton, 399151 StarkCounty, 393114 Massillon
Applicant: YWCA of Canton 340714799Project: STARR 153005
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5A. Project Participants - Households
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 0 57 0 57
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 0 47 47
Adults ages 18-24 0 10 10
Accompanied Children under age 18 0 0 0
Unaccompanied Children under age 18 0 0
Total Persons 0 57 0 57
Click Save to automatically calculate totals
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5B. Project Participants - Subpopulations
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Children under age 18
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 47 0 0 4 2 2 8 3 5 0
Adults ages 18-24 10 0 0 1 1 1 2 3 2 0
Total Persons 57 0 0 5 3 3 10 6 7 0
Click Save to automatically calculate totals
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
Applicant: YWCA of Canton 340714799Project: STARR 153005
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5C. Outreach for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
30% Directly from the street or other locations not meant for human habitation.
60% Directly from emergency shelters.
Directly from safe havens.
0% Persons fleeing domestic violence.
10% Directly from transitional housing eliminated in the FY 2017 CoC Program Competition.
Directly from the TH Portion of a Joint TH and PH-RRH Component project.
Persons receiving services through a Department of Veterans Affairs(VA)-funded homeless assistance program.
100% Total of above percentages
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6A. Funding Request
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Do any of the properties in this projecthave an active restrictive covenant?
No
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
No
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Rental Assistance X
Supportive Services X
HMIS
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Renewal Project Application FY2017 Page 32 09/22/2017
6C. Rental Assistance Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes the rental assistance funding request for thetotal term of the project. To add information to the list, select the icon. Toview or update information already listed, select the icon.
Total Request for Grant Term: $105,264
Total Units: 17
Type of RentalAssistance
FMR Area Total UnitsRequested
Total Request
TRA OH - Canton-Massillon, OH MSA (390199... 17 $105,264
Applicant: YWCA of Canton 340714799Project: STARR 153005
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Rental Assistance Budget Detail
Type of Rental Assistance: TRA
Metropolitan or non-metropolitanfair market rent area:
OH - Canton-Massillon, OH MSA (3901999999)
Does the applicant request rental assistancefunding for less than the area's per unit size
fair market rents?
No
Size of Units # of Units(Applicant)
FMR Area(Applicant)
HUD PaidRent
(Applicant)
12 Months TotalRequest
(Applicant)
SRO x $317 $317 x = $0
0 Bedroom x $422 $422 x = $0
1 Bedroom 17 x $516 $516 x = $105,264
2 Bedrooms x $684 $684 x = $0
3 Bedrooms x $873 $873 x = $0
4 Bedrooms x $938 $938 x = $0
5 Bedrooms x $1,079 $1,079 x = $0
6 Bedrooms x $1,219 $1,219 x = $0
7 Bedrooms x $1,360 $1,360 x = $0
8 Bedrooms x $1,501 $1,501 x = $0
9 Bedrooms x $1,642 $1,642 x = $0
Total Units and Annual AssistanceRequested
17 $105,264
Grant Term 1 Year
Total Request for Grant Term $105,264
Click the 'Save' button to automatically calculate totals.
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6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $53,990
Total Value of In-Kind Commitments: $0
Total Value of All Commitments: $53,990
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Match Type Source Contributor Date ofCommitment
Value ofCommitments
Yes Cash Private YWCA CantonDonat...
07/29/2016 $15,840
Yes Cash Private Sisters of Charit... 08/12/2016 $14,000
Yes Cash Government ODSA CountyHPRP ...
03/15/2017 $24,150
Applicant: YWCA of Canton 340714799Project: STARR 153005
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Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
YWCA Canton Donations
5. Date of Written Commitment: 07/29/2016
6. Value of Written Commitment: $15,840
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Sisters of Charity Foundation
5. Date of Written Commitment: 08/12/2016
6. Value of Written Commitment: $14,000
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: Cash
3. Type of Source: Government
4. Name the Source of the Commitment: (Be as specific as possible and include the
ODSA County HPRP Grant
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 36 09/22/2017
office or grant program as applicable)
5. Date of Written Commitment: 03/15/2017
6. Value of Written Commitment: $24,150
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6E. Summary Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $0
1b. Leased Structures $0
2. Rental Assistance $105,264
3. Supportive Services $96,814
4. Operating $0
5. HMIS $0
6. Sub-total Costs Requested $202,078
7. Admin (Up to 10%)
$13,882
8. Total Assistanceplus Admin Requested
$215,960
9. Cash Match $53,990
10. In-Kind Match $0
11. Total Match $53,990
12. Total Budget $269,950
Applicant: YWCA of Canton 340714799Project: STARR 153005
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No
3) Other Attachment No
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 39 09/22/2017
Attachment Details
Document Description:
Attachment Details
Document Description:
Attachment Details
Document Description:
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 40 09/22/2017
7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 41 09/22/2017
It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Cathy Jennings
Date: 09/21/2017
Title: Chief Executive Officer
Applicant Organization: Young Women's Christian Association of Canton
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 42 09/22/2017
Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 43 09/22/2017
Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Make changes
3. Specify which screens require changes by clicking the checkbox next tothe name and then clicking the Save button.
Part 2- Recipient and Subrecipient Information
2A. Subrecipients
2B. Recipient Performance
Part 3 - Project Information
3A. Project DetailX
3B. DescriptionX
Part 4 - Housing Services and HMIS
4A. Services
4B. Housing TypeX
Part 5 - Participants and Outreach Information
5A. HouseholdsX
5B. SubpopulationsX
5C. Outreach
Part 6 - Budget Information
6A. Funding Request
6C. Rental Assistance
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 44 09/22/2017
6D. MatchX
6E. Summary Budget
Part 7 - Attachment(s) & Certification
7A. Attachment(s)X
7B. CertificationX
The applicant has selected "Make Changes" to Question 2 above. Pleaseprovide a brief description of the changes that will be made to the projectinformation screens (bullets are appropriate):
6C&6E application was amended after submission in 2016.Amendmentchanged the allocation of the funds between supportive services and rentalassistance.Boxes not saving as checked on the above screen.-Serving familiesw/children changed to individuals/singles-Providing furniture and delivery offurniture. 4b.Housing type,uncheck the families w/children box,STARRI's targetaudience is Singles/individuals. Increase households based on previous yr.median.
The applicant has selected "Make Changes". Once this screen is saved,the applicant will be prohibited from "unchecking" any box that has been
checked regardless of whether a change to data on the correspondingscreen will be made.
Applicant: YWCA of Canton 340714799Project: STARR 153005
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8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/17/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 08/17/2017
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Renewal Project Application FY2017 Page 46 09/22/2017
1E. SF-424 Compliance 08/17/2017
1F. SF-424 Declaration 08/17/2017
1G. HUD-2880 08/17/2017
1H. HUD-50070 08/17/2017
1I. Cert. Lobbying 08/17/2017
1J. SF-LLL 08/17/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/17/2017
3A. Project Detail 08/17/2017
3B. Description 09/18/2017
4A. Services 08/17/2017
4B. Housing Type 09/18/2017
5A. Households 09/18/2017
5B. Subpopulations No Input Required
5C. Outreach 08/17/2017
6A. Funding Request 08/17/2017
6C. Rental Assistance 08/17/2017
6D. Match 08/17/2017
6E. Summary Budget No Input Required
7A. Attachment(s) No Input Required
7B. Certification 08/17/2017
Submission Without Changes 09/18/2017
Applicant: YWCA of Canton 340714799Project: STARR 153005
Renewal Project Application FY2017 Page 47 09/22/2017
Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources/ - Programpolicy questions and problems related to completing the application in e-snaps may be directedto HUD via the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS)number and an active registration in the Central Contractor Registration (CCR)/System forAward Management (SAM) in order to apply for funding under the Fiscal Year (FY) 2017Continuum of Care (CoC) Program Competition. For more information see FY 2017 CoCProgram Competition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2016 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - Before starting the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - Carefully review each question in the Project Application. Questions from previouscompetitions may have been changed or removed, or new questions may have been added, andinformation previously submitted may or may not be relevant. Data from the FY 2016 ProjectApplication will be imported into the FY 2017 Project Application; however, applicants will berequired to review all fields for accuracy and to update information that may have been adjustedthrough the FY 2016 post award process or a grant agreement amendment. Data entered in thepost award and amendment forms in e-snaps will not be imported into the project application. - Expiring Shelter Plus Care projects requesting renewal funding for the first time under 24CFR part 578, and rental assistance projects can only request the number of units and unit sizeas approved in the final HUD-approved Grant Inventory Worksheet (GIW). - Expiring Supportive Housing Projects requesting renewal funding for the first time under 24CFR part 578, transitional housing, permanent supportive housing with leasing, rapid re-housing,supportive services only, renewing safe havens, and HMIS can only request the Annual RenewalAmount (ARA) that appears on the CoC’s HUD-approved GIW. If the ARA is reduced throughthe CoC’s reallocation process, the final project funding request must reflect the reduced amountlisted on the CoC’s reallocation forms. - HUD reserves the right to reduce or reject any renewal project that fails to adhere to 24 CFRpart 578 and the application requirements set forth in the FY 2017 CoC Program CompetitionNOFA.
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1A. SF-424 Application Type
1. Type of Submission: Application
2. Type of Application: Renewal Project Application
If "Revision", select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/16/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier: This is the first 6 digits of the Grant Number,known as the PIN, that will also be indicated
on Screen 3A Project Detail. This numbermust match the first 6 digits of the grant
number on the HUD approved Grant InventoryWorksheet (GIW).
OH0240
Check to confrim that the Federal AwardIdentifier has been updated to reflect the
most recently awarded grant number
X
6. Date Received by State:
7. State Application Identifier:
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1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: Stark Metropolitan Housing Authority
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-6000508
c. Organizational DUNS: 010831279 PLUS 4 1111
d. Address
Street 1: 400 East Tuscarawas Street
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702
e. Organizational Unit (optional)
Department Name: Freed Housing
Division Name:
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Mr.
First Name: Martin
Middle Name: J
Last Name: Chumney
Suffix:
Title: HCV Program Director
Organizational Affiliation: Stark Metropolitan Housing Authority
Telephone Number: (330) 454-8051
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Extension: 312
Fax Number: (330) 580-9000
Email: [email protected]
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1C. SF-424 Application Details
9. Type of Applicant: La. Public Housing Authority
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (State(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: Shelter Plus Care TRA
16. Congressional District(s):
a. Applicant:(for multiple selections hold CTRL key)
OH-007
b. Project:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
17. Proposed Project
a. Start Date: 06/01/2017
b. End Date: 05/31/2018
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Mr.
First Name: Herman
Middle Name: L
Last Name: Hill
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 454-8051
Fax Number:(Format: 123-456-7890)
(330) 454-8065
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/16/2017
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1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: Stark Metropolitan Housing Authority
Prefix: Mr.
First Name: Herman
Middle Name: L
Last Name: Hill
Suffix:
Title: Executive Director
Organizational Affiliation: Stark Metropolitan Housing Authority
Telephone Number: (330) 454-8051
Extension: 332
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44702
2. Employer ID Number (EIN): 34-6000508
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$378,289.00
(Requested amounts will be automatically entered within applications)
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5. State the name and location (streetaddress, city and state) of the project or
activity:
Shelter Plus Care TRA 400 East TuscarawasStreet Canton Ohio
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
Yes
Part II Other Government Assistance Provided or Requested/ExpectedSources and Use of Funds
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance,payment, credit, or tax benefit.
Department/Local Agency Name and Address Type of Assistance AmountRequested /
Provided
Expected Uses of the Funds
NA NA $0.00 NA
Part III Interested Parties
You must disclose:1. All developers, contractors, or consultants involved in the application for the assistance or inthe planning, development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which theassistance is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower).
Alphabetical list of all persons with a Social Security No. Type of Financial Interest Financial Interest
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reportable financial interest in theproject or activity
(For individuals, give the last namefirst)
or Employee ID No. Participation in Project/Activity($)
in Project/Activity(%)
NA NA NA $0.00 0%
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Herman Hill, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 07/18/2017
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: Stark Metropolitan Housing Authority
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:
I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application. Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true and
X
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accurate.Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Mr.
First Name: Herman
Middle Name L
Last Name: Hill
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 454-8051
Fax Number:(Format: 123-456-7890)
(330) 454-8065
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/16/2017
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CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
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the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: Stark Metropolitan Housing Authority
Name / Title of Authorized Official: Herman Hill, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/16/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: Stark Metropolitan Housing Authority
Street 1: 400 East Tuscarawas Street
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44702
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier abovewhen this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be available forpublic inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not morethan $100,000 for each such failure.
I certify that this information is true andcomplete.
X
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Authorized Representative
Prefix: Mr.
First Name: Herman
Middle Name: L
Last Name: Hill
Suffix:
Title: Executive Director
Telephone Number: (Format: 123-456-7890)
(330) 454-8051
Fax Number: (Format: 123-456-7890)
(330) 454-8065
Email: [email protected]
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/16/2017
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Additional Information
Now that you have completed Part 1 of the application, please review Parts2-7, which are in Read Only mode. Screen 3C, which is mandatory for allPH-PSH projects and screens 6D, 7A and 7B which are mandatory for allprojects will be editable and must be answered prior to submission.
Once you are done reviewing, you will be guided to a "Submissionswithout Changes" screen. At this screen if you decide no edits or updatesare required to any screens other than the mandatory questions for 3Cand/or 6D,7A and 7B, you are allowed to submit the application withoutever needing to edit the rest of the application. However, if you determinethat changes need to be made to the application, we have given you theability to open up individual screens for edit, instead of the entireapplication.
Once you select the screens you want to edit via checkboxes, you willclick "Save", and those screens will be available for edit. An importantreminder, once you make those selections and click "Save", you cannotuncheck those boxes. You are allowed to select additional boxes evenafter saving your initial selections. Again, you must click "Save" for thosenewly selected screens to be available for edit.
If your project is a First Time Renewal, your project will not be able toutilize the "Submit Without Changes" function. The Submissions WithoutChanges page will be automatically set to "Make Changes" and you will berequired to input data into the application for all required fields relevant tothe component type.
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2A. Project Subrecipients
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards: $0Organization Type Type Sub-
AwardAmount
This list contains no items
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2B. Recipient Performance
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Has the recipient successfully submittedthe APR on time for the most recently expired
grant term related to this renewal projectrequest?
No
Explain why the APR for the most recently expired grant term related tothis renewal project request has not been submitted.
The APR on the most recently completed grant was due in August, 2015 butwas not completed and submitted until 10/19/2015.
2. Does the recipient have any unresolvedHUD Monitoring and/or OIG Audit findings
concerning any previous grant term related tothis renewal project request?
No
3. Has the recipient maintained consistentQuarterly Drawdowns for the most recentgrant term related to this renewal project
request?
Yes
4. Have any Funds been recaptured by HUDfor the most recently expired grant termrelated to this renewal project request?
Yes
Explain the circumstances that led HUD to recapture funds from the mostrecently expired grant term related to this renewal project request.
Grant OH240L5E081306 expired 5/31/2015 with an balance of $87,912.61. Asof this date, HUD has not recaptured funds but will do so in the near future.Although the grant was over-leased; serving more participants that projected;the balance is a direct result of participants working toward their goal of self-sufficiency by obtaining income and contributing toward a portion of rent.Because participants pay a portion of rent, the amount of rent assistancedisbursed is reduced. The current grant will not have a large balancerecaptured as we are now permitted to use a portion of the rent assistance lineitem for direct service administrative costs to the project.
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3A. Project Detail
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Expiring Grant Number: OH0240(e.g., the "Federal Award Identifier" indicated on form 1A. Application Type)
2a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
2b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
3. Project Name: Shelter Plus Care TRA
4. Project Status: Standard
5. Component Type: PH
6. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Provide a description that addresses the entire scope of the proposedproject.
The SPC TRA program strictly adheres to the Housing First philosophy & isdesigned to provide rental assistance to 65 units for homeless, disabledindividuals & their families targeting those with MI, AoD & AIDS.
Regardless of poor financial or rental history, minor criminal convictions, orbehaviors that indicate a lack of housing readiness, eligible participants haveincomes at or below 50% of AMI & are living in streets, shelters or transitionalhousing, or displaced by domestic violence at program entrance. Referrals areaccepted regardless of their sobriety, use of substances or completion oftreatment.
SMHA is an active participant in the Homeless Continuum of Care of Stark(HCCSC). HCCSC has established a central intake & coordinated assessment,prioritization, & referral system (CIAPRS). All homeless service providers inStark County that are receiving Continuum of Care, are required to participate inthe CIAPRS.
The County’s Homeless Hotline & HMIS staff is responsible for managing theCIAPRS, prioritizing applications for assistance, maintaining a central waitinglist of clients for all program categories, & referring clients to providers forhousing. All persons seeking housing assistance must be referred initially to theHomeless Hotline. Hotline staff is responsible for collecting information aboutclients; conducting an initial evaluation of their housing status, needs, &resources. The Hotline maintains a central register of clients awaiting housing &assign places on that waiting list to registered clients for shelter or housing inthe order of priority.
First priority is placed on chronically homeless (CH) individuals & families withthe longest history of homelessness & with the most severe service needs,followed by CH Individuals & families with the longest history of homelessness,CH individuals & families with the most severe service needs, then all other CHindividuals & families.
Continuum of Care-funded providers of permanent supportive housing must fillvacancies from the central waiting list, offering available units to clients on thatlist in the order of priority assigned to them by the Hotline. Before admitting anyclients to a program, SMHA will meet the client to conduct a personal interview,verify basic facts, & review the documentation required to certify their eligibility
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for the Program.
Participants are offered support services through contract agencies of theMHRSB that are voluntary & emphasize engagement & problem-solving overtherapeutic goals. Services plans are highly tenant-driven withoutpredetermined goals. Participation in services or program compliance is not acondition of tenancy. Participants receive an ongoing assessment of needs.
Funds will provide 65 affordable housing units. Housing includes any availablerental housing in Stark County chosen by the participant that meets programrequirements & owners are willing to participate in the program.
2. Does your project have a specificpopulation focus?
Yes
2a. Please identify the specific population focus. (Select ALL that apply)
Chronic HomelessX
Domestic Violence
Veterans Substance AbuseX
Youth (under 25) Mental IllnessX
Families with Children HIV/AIDSX
Other(Click 'Save' to update)
Other:
3. Housing First
3a. Does the project quickly moveparticipants into permanent housing
Yes
3b. Does the project ensure that participants are not screened out basedon the following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictions X
History of victimization(e.g. domestic violence, sexual assault, childhood abuse) X
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None of the above
3c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
3d. Does the project follow a "Housing First"approach?
Yes
4. Does the PH project provide PSH or RRH? PSH
Is this an SHP Project that had been approvedby HUD to change the renewal project budget
from leasing to rental assistance?
No
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3C. Dedicated Plus
Dedicated and DedicatedPLUS
A “100% Dedicated” project is a permanent supportive housing projectthat commits 100% of its beds to chronically homeless individuals andfamilies, according to NOFA Section III.3.b.
A “DedicatedPLUS” project is a permanent supportive housing projectwhere 100% of the beds are dedicated to serve individuals with disabilitiesand families in which one adult or child has a disability, includingunaccompanied homeless youth, that at a minimum, meet ONE of thefollowing criteria according to NOFA Section III.3.d:
(1) experiencing chronic homelessness as defined in 24 CFR 578.3; (2) residing in a transitional housing project that will be eliminated and meets the definition ofchronically homeless in effect at the time in which the individual or family entered the transitionalhousing project; (3) residing in a place not meant for human habitation, emergency shelter, or safe haven; butthe individuals or families experiencing chronic homelessness as defined at 24 CFR 578.3 hadbeen admitted and enrolled in a permanent housing project within the last year and were unableto maintain a housing placement; (4) residing in transitional housing funded by a joint TH and PH-RRH component project andwho were experiencing chronic homelessness as defined at 24 CFR 578.3 prior to entering theproject; (5)residing and has resided in a place not meant for human habitation, a safe haven, oremergency shelter for at least 12 months in the last three years, but has not done so on fourseparate occasions; or (6) receiving assistance through a Department of Veterans Affairs(VA)-funded homelessassistance program and met one of the above criteria at initial intake to the VA's homelessassistance system.
A renewal project where 100 percent of the beds are dedicated in their current grant asdescribed in NOFA Section III.A.3.b. must either become DedicatedPLUS or remain 100%Dedicated. If a renewal project currently has 100 percent of its beds dedicated to chronicallyhomeless individuals and families and elects to become a DedicatedPLUS project, the projectwill be required to adhere to all fair housing requirements at 24 CFR 578.93. Any beds that theapplicant identifies in this application as being dedicated to chronically homeless individuals andfamilies in a DedicatedPLUS project must continue to operate in accordance with SectionIII.A.3.b. Beds are identified on Screen 4B.
1. Indicate whether the project is "100%Dedicated", "DedicatedPLUS", or "N/A",
according to the information provided above.
DedicatedPLUS
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4A. Supportive Services for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Partner As needed
Assistance with Moving Costs
Case Management Partner Monthly
Child Care Non-Partner As needed
Education Services Non-Partner As needed
Employment Assistance and Job Training Non-Partner As needed
Food Non-Partner As needed
Housing Search and Counseling Services Partner As needed
Legal Services Non-Partner As needed
Life Skills Training Partner As needed
Mental Health Services Partner Monthly
Outpatient Health Services Non-Partner As needed
Outreach Services Partner As needed
Substance Abuse Treatment Services Partner Monthly
Transportation Non-Partner As needed
Utility Deposits
2. Please identify whether the projectincludes the following activities:
2a. Transportation assistance to clients toattend mainstream benefit appointments,
employment training, or jobs?
Yes
2b. Use of a single application form for fouror more mainstream programs?
Yes
2c. At least annual follow-ups withparticipants to ensure mainstream benefits
Yes
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are received and renewed?
3. Do project participants have access toSSI/SSDI technical assistance provided by
the applicant, a subrecipient, or partneragency?
Yes
3a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
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4B. Housing Type and Location
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 65
Total Beds: 85
Total Dedicated CH Beds: 56Housing Type Units Beds
Scattered-site apartments (... 65 85
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4B. Housing Type and Location Detail
1. Housing Type: Scattered-site apartments (including efficiencies)
2. Indicate the maximum number of units and beds available for project participants at the selected housing site.
a. Units: 65
b. Beds: 85
3. How many beds of the total beds in "2b.Beds" are dedicated to the chronically
homeless?
56
This includes both the “dedicated” and “prioritized” beds from previouscompetitions.
4. Address:
Street 1: Scattered Sites
Street 2:
City: Canton, Massillon, Alliance
State: Ohio
ZIP Code: 44702
5. Select the geographic area(s) associated with the address:(for multiple selections hold CTRL Key)
399151 Stark County
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5A. Project Participants - Households
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Households Households with atLeast One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Total Number of Households 9 56 0 65
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 9 56 65
Adults ages 18-24 0 0 0
Accompanied Children under age 18 20 0 20
Unaccompanied Children under age 18 0 0
Total Persons 29 56 0 85
Click Save to automatically calculate totals
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5B. Project Participants - Subpopulations
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 9 0 4 1 4 0 0 0 0
Adults ages 18-24 0 0 0 0 0 0 0 0 0
Children under age 18 0 0 0 0 0 0 0 20
Total Persons 9 0 0 4 1 4 0 0 0 20
Click Save to automatically calculate totals
Persons in Households without Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 56 0 0 25 2 29 0 0 0 0
Adults ages 18-24 0 0 0 0 0 0 0 0 0 0
Total Persons 56 0 0 25 2 29 0 0 0 0
Click Save to automatically calculate totals
Persons in Households with Only Children
Characteristics
Chronically
Homeless Non-
Veterans
Chronically
Homeless
Veterans
Non-Chronic
allyHomeles
sVeterans
ChronicSubstan
ceAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victimsof
Domestic
Violence
PhysicalDisabilit
y
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Children under age 18
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Unaccompanied Children under age 18
Total Persons 0 0 0 0 0 0 0 0
Describe the unlisted subpopulations referred to above:
Table: Persons in Households with at Least One Adult and One Child; Column:Persons not represented by listed sub-populations; Row: Children under age18; 13 represent children of participants being served by the program.
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5C. Outreach for Participants
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
45% Directly from the street or other locations not meant for human habitation.
45% Directly from emergency shelters.
10% Directly from safe havens.
0% Persons fleeing domestic violence.
Directly from transitional housing eliminated in the FY 2017 CoC Program Competition.
Directly from the TH Portion of a Joint TH and PH-RRH Component project.
Persons receiving services through a Department of Veterans Affairs(VA)-funded homeless assistance program.
100% Total of above percentages
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6A. Funding Request
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
1. Do any of the properties in this projecthave an active restrictive covenant?
No
2. Was the original project awarded as eithera Samaritan Bonus or Permanent Housing
Bonus project?
No
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Renewal Grant Term: 1 Year
5. Select the costs for which funding is beingrequested:
Leased Units
Leased Structures
Rental Assistance X
Supportive Services
Operating
HMIS
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6C. Rental Assistance Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following list summarizes the rental assistance funding request for thetotal term of the project. To add information to the list, select the icon. Toview or update information already listed, select the icon.
Total Request for Grant Term: $351,840
Total Units: 65
Type of RentalAssistance
FMR Area Total UnitsRequested
Total Request
TRA OH - Canton-Massillon, OH MSA (390199... 65 $351,840
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA 153978
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Rental Assistance Budget Detail
Type of Rental Assistance: TRA
Metropolitan or non-metropolitanfair market rent area:
OH - Canton-Massillon, OH MSA (3901999999)
Does the applicant request rental assistancefunding for less than the area's per unit size
fair market rents?
Yes
Size of Units # of Units(Applicant)
FMR Area(Applicant)
HUD PaidRent
(Applicant)
12 Months TotalRequest
(Applicant)
SRO x $317 $317 x = $0
0 Bedroom x $422 $422 x = $0
1 Bedroom 56 x $516 $410 x = $275,520
2 Bedrooms 3 x $684 $580 x = $20,880
3 Bedrooms 6 x $873 $770 x = $55,440
4 Bedrooms x $938 $938 x = $0
5 Bedrooms x $1,079 $1,079 x = $0
6 Bedrooms x $1,219 $1,219 x = $0
7 Bedrooms x $1,360 $1,360 x = $0
8 Bedrooms x $1,501 $1,501 x = $0
9 Bedrooms x $1,642 $1,642 x = $0
Total Units and Annual AssistanceRequested
65 $351,840
Grant Term 1 Year
Total Request for Grant Term $351,840
Click the 'Save' button to automatically calculate totals.
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6D. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $0
Total Value of In-Kind Commitments: $94,573
Total Value of All Commitments: $94,573
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.Match Type Source Contributor Date of
CommitmentValue ofCommitments
Yes In-Kind Private Mental Healthand...
08/17/2016 $53,937
Yes In-Kind Private Crisis Interventi... 08/15/2016 $28,749
Yes In-Kind Private CommQuest 08/12/2016 $11,887
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Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Mental Health and Recovery Services Board ofStark County
5. Date of Written Commitment: 08/17/2016
6. Value of Written Commitment: $53,937
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
Sources of Match Detail
1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
Crisis Intervention and Recovery
5. Date of Written Commitment: 08/15/2016
6. Value of Written Commitment: $28,749
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
Sources of Match Detail
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA 153978
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1. Will this commitment be used towardsMatch?
Yes
2. Type of Commitment: In-Kind
3. Type of Source: Private
4. Name the Source of the Commitment: (Be as specific as possible and include the
office or grant program as applicable)
CommQuest
5. Date of Written Commitment: 08/12/2016
6. Value of Written Commitment: $11,887
Before grant execution, services to be provided by a third party must bedocumented by a memorandum of understanding (MOU) between the
recipient or subrecipient and the third party that will provide the services.
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6E. Summary Budget
This screen is currently read only and only includes data from theprevious grant. To make changes to this information, navigate to the
Submission without Changes screen, select "Make Changes" in responseto Question 2, and then check the box next each screen that requires a
change to match the current grant agreement, as amended, or to accountfor a reallocation of funds.
The following information summarizes the funding request for the totalterm of the project. Budget amounts from the Leased Units, RentalAssistance, and Match screens have been automatically imported andcannot be edited. However, applicants must confirm and correct, ifnecessary, the total budget amounts for Leased Structures, SupportiveServices, Operating, HMIS, and Admin. Budget amounts must reflect themost accurate project information according to the most recent projectgrant agreement or project grant agreement amendment, the CoC’s finalHUD-approved FY 2017 GIW or the project budget as reduced due to CoCreallocation. Please note that, new for FY 2017, there are no detailedbudget screens for Leased Structures, Supportive Services, Operating, orHMIS costs. HUD expects the original details of past approved budgets forthese costs to be the basis for future expenses. However, any reasonableand eligible costs within each CoC cost category can be expended and willbe verified during a HUD monitoring.
Eligible Costs Total Assistance Requestedfor 1 year
Grant Term(Applicant)
1a. Leased Units $0
1b. Leased Structures $0
2. Rental Assistance $351,840
3. Supportive Services $0
4. Operating $0
5. HMIS $0
6. Sub-total Costs Requested $351,840
7. Admin (Up to 10%)
$26,449
8. Total Assistanceplus Admin Requested
$378,289
9. Cash Match $0
10. In-Kind Match $94,573
11. Total Match $94,573
12. Total Budget $472,862
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachmenbt No
3) Other Attachment No
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Attachment Details
Document Description:
Attachment Details
Document Description:
Attachment Details
Document Description:
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7A. In-Kind Match MOU Attachment
Document Type Required? Document Description Date Attached
In-Kind Match MOU No
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Attachment Details
Document Description:
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7B. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
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It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
20-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 20 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
C. Explanation.Where the applicant is unable to certify to any of the statements in this certification, suchapplicant shall provide an explanation.
Name of Authorized Certifying Official Herman Hill
Date: 08/16/2017
Title: Executive Director
Applicant Organization: Stark Metropolitan Housing Authority
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
X
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Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA 153978
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Submission Without Changes
1. Are the requested renewal funds reducedfrom the previous award as a result of
reallocation?
No
2. Do you wish to submit this applicationwithout making changes? Please refer to the
guidelines below to inform you of therequirements.
Submit without changes
The applicant has selected “Submit without changes” to Question 2above. If the applicant has identified project information on the precedingscreens that does not match the current contract, select “Make changes”above and update the relevant project information.
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA 153978
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8B Submission Summary
Page Last Updated
1A. SF-424 Application Type 08/16/2017
1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
Applicant: Stark Metropolitan Housing Authority OH018Project: Shelter Plus Care TRA 153978
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1D. SF-424 Congressional District(s) 08/16/2017
1E. SF-424 Compliance 08/16/2017
1F. SF-424 Declaration 08/16/2017
1G. HUD-2880 08/16/2017
1H. HUD-50070 08/16/2017
1I. Cert. Lobbying 08/16/2017
1J. SF-LLL 08/16/2017
2A. Subrecipients No Input Required
2B. Recipient Performance 08/16/2017
3A. Project Detail 08/16/2017
3B. Description 08/16/2017
3C. Dedicated Plus 08/16/2017
4A. Services 08/16/2017
4B. Housing Type 08/16/2017
5A. Households 08/16/2017
5B. Subpopulations 08/16/2017
5C. Outreach 08/16/2017
6A. Funding Request 08/16/2017
6C. Rental Assistance 08/16/2017
6D. Match 08/16/2017
6E. Summary Budget No Input Required
7A. Attachment(s) No Input Required
7A. In-Kind Match MOU Attachment No Input Required
7B. Certification 08/16/2017
Submission Without Changes 08/16/2017
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Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember:
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources. - Program policy questions and problems related to completing the application in e-snaps maybe directed to HUD the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS) numberand an active registration in the Central Contractor Registration (CCR)/System for AwardManagement (SAM) in order to apply for funding under the Fiscal Year (FY) 2017 Continuum ofCare (CoC) Program Competition. For more information see FY 2017 CoC ProgramCompetition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2017 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - New projects may only be submitted as either Reallocated or Permanent Supportive HousingBonus Projects. These funding methods are determined in collaboration with local CoC and it iscritical that applicants indicate the correct funding method. Project applicants mustcommunicate with their CoC to make sure that the CoC submissions reflect the same fundingmethod. - Before completing the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - HUD reserves the right to reduce or reject any new project that fails to adhere to (24 CFR part578 and application requirements set forth in FY 2017 CoC Program Competition NOFA.
Applicant: ICAN Inc. 189042914Project: ICAN CoC Rapid Re-Housing I Expansion 154283
New Project Application FY2017 Page 1 09/22/2017
1A. SF-424 Application Type
1. Type of Submission:
2. Type of Application: New Project Application
If Revision, select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/28/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
6. Date Received by State:
7. State Application Identifier:
Applicant: ICAN Inc. 189042914Project: ICAN CoC Rapid Re-Housing I Expansion 154283
New Project Application FY2017 Page 2 09/22/2017
1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: ICAN Inc.
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-1575839
c. Organizational DUNS: 189042914 PLUS 4:
d. Address
Street 1: 1214 Market Ave N
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44714
e. Organizational Unit (optional)
Department Name:
Division Name:
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Mrs.
First Name: Natalie
Middle Name:
Last Name: McCleskey
Suffix:
Title: Development Director
Organizational Affiliation: ICAN Inc.
Telephone Number: (330) 455-9100
Applicant: ICAN Inc. 189042914Project: ICAN CoC Rapid Re-Housing I Expansion 154283
New Project Application FY2017 Page 3 09/22/2017
Extension: 150
Fax Number: (330) 455-4702
Email: [email protected]
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1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (state(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: ICAN CoC Rapid Re-Housing I Expansion
16. Congressional District(s):
a. Applicant: OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-013, OH-016, OH-007
17. Proposed Project
a. Start Date: 10/01/2018
b. End Date: 09/30/2019
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-9100
Fax Number:(Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/28/2017
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1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: ICAN Inc.
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Organizational Affiliation: ICAN Inc.
Telephone Number: (330) 455-9100
Extension:
Email: [email protected]
City: Canton
County: Stark
State: Ohio
Country: United States
Zip/Postal Code: 44714
2. Employer ID Number (EIN): 34-1575839
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$53,620.00
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(Requested amounts will be automatically entered within applications)
5. State the name and location (street address, City and State) of theproject or activity.
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
Yes
Part II Other Government Assistance Provided or Requested/ExpectedSources and Use of Funds
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance,payment, credit, or tax benefit.
Department/Local Agency Name and Address Type of Assistance AmountRequested /
Provided
Expected Uses of the Funds
Ohio Development Services Agency, 77 S. HighStreet, Columbus, OH 43215
Grant $19,851.00 Cherry Grove - Maintainance, Utilitiesand Insurance
Ohio Development Services Agency, 77 S. HighStreet, Columbus, OH 43215
Grant $37,834.00 Rapid Re-Housing - Salaries andBenefits
Stark Mental Health & Addiction Recovery, 121Cleveland Ave SW, Canton, OH 44702
Grant $45,389.00 Shelter Plus Care and West Park -Supportive Services; Peer Support;Employment; Critical TimeInterventionist Salary; Benefits andTravel
Note: If additional sources of Government Assistance, please use the"Other Attachments" screen of the project applicant profile.
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Part III Interested Parties
You must disclose:1. All developers, contractors, or consultants involved in the application for the assistance or inthe planning, development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which theassistance is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower).
Alphabetical list of all persons with areportable financial interest in the project or
activity (For individuals, give the last name first)
Social Security No.or Employee ID No.
Type ofParticipation
Financial Interestin Project/Activity
($)
Financial Interestin Project/Activity
(%)
NA NA NA $0.00 0%
Note: If there are no other people included, write NA in the boxes.
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Julie Sparks, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/14/2017
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: ICAN Inc.
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
2. Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application.Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
X
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the accompaniment herewith, is true andaccurate.
Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-9100
Fax Number:(Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/28/2017
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CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
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the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: ICAN Inc.
Name / Title of Authorized Official: Julie Sparks, Executive Director
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/28/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: ICAN Inc.
Street 1: 1214 Market Ave N
Street 2:
City: Canton
County: Stark
State: Ohio
Country: United States
Zip / Postal Code: 44714
11. Information requested through this form is authorized by title 31U.S.C. section 1352. This disclosure of lobbying activities is a materialrepresentation of fact upon which reliance was placed by the tier above
when this transaction was made or entered into. This disclosure isrequired pursuant to 31 U.S.C. 1352. This information will be available for
public inspection. Any person who fails to file the required disclosureshall be subject to a civil penalty of not less than $10,000 and not more
than $100,000 for each such failure.
I certify that this information is true andcomplete.
X
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Authorized Representative
Prefix: Ms.
First Name: Julie
Middle Name:
Last Name: Sparks
Suffix:
Title: Executive Director
Telephone Number:(Format: 123-456-7890)
(330) 455-9100
Fax Number:(Format: 123-456-7890)
(330) 455-4702
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/28/2017
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2A. Project Subrecipients
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards:Organization Type Sub-
AwardAmount
This list contains no items
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2B. Experience of Applicant, Subrecipient(s), andOther Partners
1. Describe the experience of the applicant and potential subrecipients (ifany), in effectively utilizing federal funds and performing the activitiesproposed in the application, given funding and time limitations.
ICAN Housing has successfully managed Rapid Re-Housing (RRH) Programsusing City of Canton, Ohio ESG funds and Ohio Development Services Agency(ODSA) Homeless Crisis Response Program (HCRP) funds. ICAN hasadministered the ODSA HCRP RRH program for over 3 years. According to themost recent performance report, the number of households served was 30.They were families with children, so the number of persons served was 51. Theaverage length of time to get a family housed was 30 days. The average lengthof stay in the program was 9 months.
CAN’s Rapid Re-Housing Coordinator provides security deposits and rentalassistance. Households must pay 30% of the monthly adjusted income for rent.The Coordinator provides housing search and placement assistance andhousing stability case management to help participants retain their housing,Participants attend at least one case management meeting per month. Themeetings may be held more frequently as needed.
ICAN maintains successful collaborative relationships with providers in theStark County Mental Health and Addiction Recovery system, homeless serviceproviders, Stark County Department of Jobs and Family Services and the SocialSecurity Administration. ICAN staff provides information and referrals to clientsto attend mainstream benefit appointments, employment training, and jobs.Staff uses Motivational Interviewing to help participants address ambivalenceand navigate through the stages of change. These collaborative efforts enableICAN to provide clients with access to social, employment, and mental healthservices crucial to their success in retaining permanent housing and findingemployment.
2. Describe the experience of the applicant and potential subrecipients (ifany) in leveraging other Federal, State, local, and private sector funds.
* HUD CoC – annually since 1997, $811,914 in PY 2016 for PSH and RRH;* County HOME – in various years and varying amounts since 1997, $23,000 inPY 2015 for a Capital Improvement Program (CIP) project;* OMHAS – annually since 1997, $574,000 in PY 2017 for Outreach/PATH andPSH; $500,000 in PY 2016 for a Community Capital Project; $495,000 in PY2016 for Cooperative Agreement to Benefit Homeless Individuals (CABHI)* ODSA – every two years since 1997, $236,000 in PY 2016 SupportiveHousing Program funds;* OHFA - since 2012, $75,000 in PY 2014 for a CIP project;* City of Canton HOME CHDO & ESG – $570,000 in PY2017 for Arbor RidgePSH project and $39,066 in PY2015 for RRH
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3. Describe the basic organization and management structure of theapplicant and subrecipients (if any). Include evidence of internal andexternal coordination and an adequate financial accounting system.
ICAN Housing has had successful experience developing, owning, operating,and managing permanent supportive housing since 1988. ICAN owns andoperates 25 scattered-site buildings containing 135 apartments for residentswho have severe mental illness and may also battle substance use disorders.ICAN also manages 80 subsidy vouchers to benefit the same population thatcan be used for privately owned apartments; six of those vouchers arededicated to homeless veterans.
The Agency has a board of directors, and the Executive Director leads a highlycapable staff with vast experience and expertise in homeless outreach, housingsupports, permanent supportive housing, property management, programoperations, general administration, and grants management. ICAN alsopartners with a wide array of community organizations that deliver services andsupports designed to end homelessness in our community. ICAN Housingmeasures success by each client who achieves stability and self-reliance. TheAgency has a strong fiscal department and manages funds efficiently. Smith,Barta & Company auditors rate ICAN Housing as a low-risk agency andconsistently give the agency clean A 133 audits.
4a. Are there any unresolved monitoring oraudit findings for any HUD grants(includingESG) operated by the applicant or potential
subrecipients (if any)?
No
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3A. Project Detail
1a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
1b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
2. Project Name: ICAN CoC Rapid Re-Housing I Expansion
3. Project Status: Standard
4. Component Type: PH
5. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
1. Provide a description that addresses the entire scope of the proposedproject.
Housing Stability: ICAN Housing’s Rapid Re-Housing Coordinator will providefinancial assistance for security deposits, utility deposits and rental assistanceas needed. Households must pay 30% of the monthly adjusted income for rent.The Coordinator will provide housing search and placement assistance andhousing stability case management to help participants retain their housing,thereby reducing the number of homeless episodes. Participants will attend atleast one case management session per month. The sessions will be held morefrequently as needed.
Assistance with increasing Employment Income: ICAN Housing maintainslongstanding and successful collaborative relationships with providers in theStark Mental Health and Addiction Recovery (SMHAR) system, homelessservice providers, and Stark County Department of Jobs and Family Services(DJFS). ICAN staff will provide information and referrals to clients to attendtraining and employment appointments. Staff will use Motivational Interviewingto help participants address ambivalence and navigate through the stages ofchange.
Linking to Mainstream Services: ICAN staff will provide detailed information andreferrals to clients regarding mainstream services and financial assistance, andwill follow up with clients regarding utilization via phone and in casemanagement sessions. The Agency conducts follow-ups with participants toensure mainstream benefits are received and renewed. ICAN Housingmaintains longstanding and successful collaborative relationships with Stark Co.Department of Jobs and Family Services & the Social Security Administration.
ICAN provides tenants access to SSI/SSDI technical assistance through referralto a SOAR-trained case manager. Referrals for move in items, furniture and buspasses provide additional relief.
2. Describe the estimated schedule for the proposed activities, themanagement plan, and the method for assuring effective and timelycompletion of all work.
ICAN Housing currently has staff in place who are administering a Rapid Re-Housing Program. Potential participants are readily available through the centralintake and assessment prioritized waiting list. Over the one-year term for thisCoC RRH project, ICAN will be able to gear up quickly for projectimplementation. ICAN's Operations Director works closely with the RRHCoordinator to address challenges, concerns, and progress toward reachingproject goals. These factors will help ensure effective and timely projectcompletion.
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ICAN will provide: 1) housing search and placement assistance; 2) financialassistance for moving costs, security & utility deposits, and rental assistance fora max of 12 months; 3) information and referrals to help clients accessmainstream benefits, employment and other resources; and 4) casemanagement to help clients retain housing & benefits. ICAN will target literallyhomeless families with mental illness, but not exclude other eligible households.Households must pay 30% of monthly adjusted income for rent.
3. Will your project participate in a CoCCoordinated Entry Process?
Yes
* 4. Please identify the project's specific population focus.
(Select ALL that apply)Chronic Homeless Domestic Violence
Veterans Substance Abuse
Youth (under 25) Mental Illness
FamiliesX
HIV/AIDS
Other(Click 'Save' to update)
5. Housing First
a. Will the project quickly move participantsinto permanent housing
Yes
b. Does the project ensure that participants are not screened out based onthe following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictionsX
History of victimization (e.g. domestic violence, sexual assault, childhood abuse)X
None of the above
c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
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Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
d. Will the project follow a "Housing First"approach?
(Click 'Save' to update)
Yes
6. If applicable, describe the proposed development activities and theresponsibilities that the applicant and potential subrecipients (if any) willhave in developing, operating, and maintaining the property.
Not applicable.
7. Will the PH project provide PSH or RRH? RRH
8. Will participants be required to live in aparticular structure, unit, or locality, at some
point during the period of participation?
No
9. Will more than 16 persons live in onestructure?
No
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3C. Project Expansion Information
1. Will the project use an existing homelessfacility or incorporate activities provided by
an existing project?
Yes
2. Is this New project application requesting a“Project Expansion” of an eligible renewal
project of the same component type?
Yes
Enter the PIN number (first 6 numbers of the grant number) and ProjectName for the CoC funded grant that is applying for renewal in FY 2017
upon which this project proposes to expand.
Eligible Renewal Grant PIN Number: OH0569
Eligible Renewal Grant Project Name: ICAN CoC Rapid Re-Housing I
3. Select the activities below that describe theexpansion project, and click on the "Save"button below to provide additional details.
Increase the number of homeless personsserved
Increase number of homeless persons served
Indicate how the project is proposing to "increase the number of homelesspersons served."
Current level of effort
# of persons served at a point-in-time 22
# of units 9
# of beds 22
New effort
# of additional persons served at a point in time that this project will provide 14
# of additional units this project will provide 5
# of additional beds this project will provide 14
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4A. Supportive Services for Participants
1a. Are the proposed project policies andpractices consistent with the laws related toproviding education services to individuals
and families?
Yes
1b. Will the proposed project have adesignated staff person to ensure that the
children are enrolled in school and receiveeducational services, as appropriate?
Yes
2. Describe how participants will be assisted to obtain and remain inpermanent housing.
ICAN Housing’s Rapid Re-Housing Coordinator will provide financial assistancefor moving costs, security deposits, utility deposits and rental assistance asneeded. Households must pay 30% of the monthly adjusted income for rent.The Coordinator will provide housing search and placement assistance andhousing stability case management to help participants retain their housing,thereby reducing the number of homeless episodes. Participants will attend atleast one case management session per month. The sessions will be held morefrequently as needed.
3. Describe specifically how participants will be assisted both to increasetheir employment and/or income and to maximize their ability to liveindependently.
ICAN Housing maintains longstanding and successful collaborativerelationships with providers in the Stark County Mental Health and AddictionRecovery (SCMHAR) system, homeless service providers, EmploymentAgencies and Employers. ICAN staff will provide information and referrals toclients to attend training and employment appointments. Staff will useMotivational Interviewing to help participants address ambivalence and navigatethrough the stages of change.
ICAN staff will provide detailed information and referrals to clients regardingmainstream services and financial assistance, and will follow up with clientsregarding utilization via phone and in case management sessions. The Agencyconducts follow-ups with participants to ensure mainstream benefits arereceived and renewed. ICAN Housing maintains longstanding and successfulcollaborative relationships with Stark County Department of Jobs and FamilyServices & the Social Security Administration.
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ICAN provides tenants access to SSI/SSDI technical assistance through referralto a SOAR-trained case manager. Referrals for move in items, furniture and buspasses provide additional relief.
4. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Partner As needed
Assistance with Moving Costs Applicant As needed
Case Management Applicant Monthly
Child Care Non-Partner As needed
Education Services Non-Partner As needed
Employment Assistance and Job Training Partner As needed
Food Non-Partner As needed
Housing Search and Counseling Services Applicant As needed
Legal Services
Life Skills Training Non-Partner As needed
Mental Health Services Partner As needed
Outpatient Health Services Non-Partner As needed
Outreach Services Applicant As needed
Substance Abuse Treatment Services Partner As needed
Transportation Applicant As needed
Utility Deposits Applicant As needed
5. Please identify whether the project will include the following activities:
5a. Transportation assistance to clients toattend mainstream
benefit appointments, employment training,or jobs?
Yes
5b. Use of a single application form for fouror more mainstream
programs?
Yes
5c. Regular follow-ups with participants toensure mainstream
benefits are received and renewed?
Yes
6. Will project participants have access toSSI/SSDI technical assistance
Yes
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provided by the applicant, a subrecipient, orpartner agency?
6a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
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4B. Housing Type and Location
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 5
Total Beds: 14Housing Type Units Beds
Scattered-site apartments (... 5 14
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4B. Housing Type and Location Detail
1. Housing Type: Scattered-site apartments (including efficiencies)
2. Indicate the maximum number of units and beds available for projectparticipants at the selected housing site.
a. Units: 5
b. Beds: 14
3. Address
Street 1: 1214 Market Ave N
Street 2:
City: Canton
State: Ohio
ZIP Code: 44714
*4. Select the geographic area(s) associated with the address. For newprojects, select the area(s) expected to be covered.
(for multiple selections hold CTRL key)
399151 Stark County
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5A. Project Participants - Households
Households TableHouseholds with at
Least One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Number of Households 5 5
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 5 5
Adults ages 18-24 0
Accompanied Children under age 18 9 9
Unaccompanied Children under age 18 0
Total Persons 14 0 0 14
Click Save to automatically calculate totals
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5B. Project Participants - Subpopulations
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
HomelessNon-
Veterans
Chronically
HomelessVeterans
Non-Chronicall
yHomelessVeterans
ChronicSubstanc
eAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victims ofDomesticViolence
PhysicalDisability
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24 1 1 1 2
Adults ages 18-24
Children under age 18 9
Total Persons 1 0 0 0 0 1 1 0 0 11
Click Save to automatically calculate totals
Persons in Households without Children
Characteristics
Chronically
HomelessNon-
Veterans
Chronically
HomelessVeterans
Non-Chronicall
yHomelessVeterans
ChronicSubstanc
eAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victims ofDomesticViolence
PhysicalDisability
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households with Only Children
Characteristics
Chronically
HomelessNon-
Veterans
Chronically
HomelessVeterans
Non-Chronicall
yHomelessVeterans
ChronicSubstanc
eAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victims ofDomesticViolence
PhysicalDisability
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Childrenunder age 18
Unaccompanied Childrenunder age 18
Total Persons 0 0 0 0 0 0 0
Describe the unlisted subpopulations referred to above:
Children of participants. Participants who are literally homeless, with highneeds and score for needing Rapid Re-Housing, according to local assessmenttool (SPDAT) during Centralized and Coordinated Intake and Assessment
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System process, but who do not fit into any of the subpopulations listed above.
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5C. Outreach for Participants
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
20% Directly from the street or other locations not meant for human habitation.
80% Directly from emergency shelters.
Directly from safe havens.
Persons fleeing domestic violence.
Directly from transitional housing that was eliminated in the FY 2017 CoC Program Competition.
Directly from the TH Portion of a Joint TH and PH-RRH Component project.
Persons receiving services through a Department of Veterans Affairs(VA)-funded homeless assistance program (Eligiblefor JOINT projects if from TH or Emergency Shelters).
100% Total of above percentages
2. Describe the outreach plan to bring these homeless participants intothe project.
ICAN's RRH Coordinator identifies eligible families through the centralizedintake and assessment prioritization list. The Agency's PATH Outreach team isalso available to provide additional assistance in attempting to contact andreach families identified through the centralized intake and assessment system.
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6A. Funding Request
1. Will it be feasible for the project to beunder grant agreement by September 30,
2019?
Yes
2. Is the project proposing to using fundsreallocated from the CoCs annual renewal
demand OR
is the project applying for funding throughthe permanent housing bonus?
Permanent Housing Bonus
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Select a grant term: 1 Year
* 5. Select the costs for which funding isbeing requested:
Acquisition/Rehabilitation/New Construction
Rental Assistance X
Supportive Services
HMIS
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6E. Rental Assistance Budget
The following list summarizes the rental assistance funding request for thetotal term of the project. To add information to the list, select the icon. Toview or update information already listed, select the icon.
Total Request for Grant Term: $50,112
Total Units: 5
Type of RentalAssistance
FMR Area Total UnitsRequested
Total Request
TRA OH - Canton-Massillon, OH MSA (390199... 5 $50,112
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Rental Assistance Budget Detail
Instructions: Type of Rental Assistance: Select the applicable type of rental assistance from the dropdownmenu. Options include tenant-based (TRA), sponsor-based (SRA), and project-based assistance(PRA). Each type has unique requirements and applicants should refer to the 24 CFR 578.51before making a selection.
Metropolitan or non-metropolitan fair market rent area: This is a required field. Select the FY2016 FMR area in which the project is located. The list is sorted by state abbreviation. Theselected FMR area will be used to populate the rents in the chart below.
Size of Units: These options are system generated. Unit size is defined by the number ofdistinct bedrooms and not by the number of distinct beds.
# of units: This is a required field. For each unit size, enter the number of units for whichfunding is being requested.
FMR: These fields are populated with the FY 2016 FMR amounts based on the FMR areaselected by the applicant. The FMRs are available online athttp://www.huduser.org/portal/datasets/fmr.html.
12 Months: These fields are populated with the value 12 to calculate the annual rent request.
Total Request: This column populates with the total calculated amount from each row basedon the number of units multiplied by the corresponding FMR and by 12 months.
Total Units and Annual Assistance Requested: The fields in this row are automaticallycalculated based on the total number of units and the sum of the total requests per unit size peryear.
Grant Term: This field is populated based on the grant term selected on Screen “6A. FundingRequest" and will be read only.
Total Request for Grant Term: This field is automatically calculated based on the total annualassistance requested multiplied by the grant term.
All total fields will be calculated once the required field has been completed and saved.
Additional Resources can be found at the HUD Exchange: https://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources
Type of Rental Assistance: TRA
Metropolitan or non-metropolitanfair market rent area:
OH - Canton-Massillon, OH MSA (3901999999)
Size of Units # of Units(Applicant)
FMR Area(Applicant)
12 Months TotalRequest
(Applicant)
SRO x $317 x 12 = $0
0 Bedroom x $422 x 12 = $0
1 Bedroom x $516 x 12 = $0
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2 Bedrooms 1 x $684 x 12 = $8,208
3 Bedrooms 4 x $873 x 12 = $41,904
4 Bedrooms x $938 x 12 = $0
5 Bedrooms x $1,079 x 12 = $0
6 Bedrooms x $1,219 x 12 = $0
7 Bedrooms x $1,360 x 12 = $0
8 Bedrooms x $1,501 x 12 = $0
9 Bedrooms x $1,642 x 12 = $0
Total Units and Annual AssistanceRequested
5 $50,112
Grant Term 1 Year
Total Request for Grant Term $50,112
Click the 'Save' button to automatically calculate totals.
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6I. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $13,405
Total Value of In-Kind Commitments: $0
Total Value of All Commitments: $13,405
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Match Type Source Contributor Date ofCommitment
Value ofCommitments
Yes Cash Private ICAN Inc. 08/25/2017 $13,405
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Sources of Match Detail
1. Will this commitment be used towardsmatch ?
Yes
2. Type of commitment: Cash
3. Type of source: Private
4. Name the source of the commitment:(Be as specific as possible and include the
office or grant program as applicable)
ICAN Inc.
5. Date of Written Commitment: 08/25/2017
6. Value of Written Commitment: $13,405
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6J. Summary Budget
The following information summarizes the funding request for the totalterm of the project. However, administrative costs can be entered in 8.Admin field below.
Eligible Costs Annual AssistanceRequested(Applicant)
Grant Term(Applicant)
Total AssistanceRequested
for Grant Term(Applicant)
1a. Acquisition $0
1b. Rehabilitation $0
1c. New Construction $0
2a. Leased Units $0 1 Year $0
2b. Leased Structures $0 1 Year $0
3. Rental Assistance $50,112 1 Year $50,112
4. Supportive Services $0 1 Year $0
5. Operating $0 1 Year $0
6. HMIS $0 1 Year $0
7. Sub-total Costs Requested $50,112
8. Admin (Up to 10%)
$3,508
9. Total AssistancePlus Admin Requested
$53,620
10. Cash Match $13,405
11. In-Kind Match $0
12. Total Match $13,405
13. Total Budget $67,025
Click the 'Save' button to automatically calculate totals.
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachment(s) No Match Documentati... 08/28/2017
3) Other Attachment(s) No
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Attachment Details
Document Description:
Attachment Details
Document Description: Match Documentation - RRH I Expansion
Attachment Details
Document Description:
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7D. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
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It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
15-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 15 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
Where the applicant is unable to certify to any of the statements in thiscertification, such applicant shall provide an explanation.
Name of Authorized Certifying Official: Julie Sparks
Date: 08/28/2017
Title: Executive Director
Applicant Organization: ICAN Inc.
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
X
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statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
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8B. Submission Summary
Applicant must click the submit button once all forms have a status ofComplete.
Page Last Updated
1A. SF-424 Application Type No Input Required
1B. SF-424 Legal Applicant No Input Required
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1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 08/10/2017
1E. SF-424 Compliance 08/10/2017
1F. SF-424 Declaration 08/10/2017
1G. HUD 2880 08/10/2017
1H. HUD 50070 08/10/2017
1I. Cert. Lobbying 08/10/2017
1J. SF-LLL 08/10/2017
2A. Subrecipients No Input Required
2B. Experience 08/15/2017
3A. Project Detail 08/10/2017
3B. Description 08/14/2017
3C. Expansion 08/14/2017
4A. Services 08/14/2017
4B. Housing Type 08/10/2017
5A. Households 08/10/2017
5B. Subpopulations 08/10/2017
5C. Outreach 08/14/2017
6A. Funding Request 08/10/2017
6E. Rental Assistance 08/10/2017
6I. Match 08/25/2017
6J. Summary Budget No Input Required
7A. Attachment(s) 08/28/2017
7D. Certification 08/15/2017
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Before Starting the Project Application
To ensure that the Project Application is completed accurately, ALLproject applicants should review the following information BEFOREbeginning the application.
Things to Remember:
- Additional training resources can be found on the HUD Exchange athttps://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources. - Program policy questions and problems related to completing the application in e-snaps maybe directed to HUD the HUD Exchange Ask A Question. - Project applicants are required to have a Data Universal Numbering System (DUNS) numberand an active registration in the Central Contractor Registration (CCR)/System for AwardManagement (SAM) in order to apply for funding under the Fiscal Year (FY) 2017 Continuum ofCare (CoC) Program Competition. For more information see FY 2017 CoC ProgramCompetition NOFA. - To ensure that applications are considered for funding, applicants should read all sections ofthe FY 2017 CoC Program NOFA and the FY 2017 General Section NOFA. - Detailed instructions can be found on the left menu within e-snaps. They contain morecomprehensive instructions and so should be used in tandem with onscreen text and thehide/show instructions found on each individual screen. - New projects may only be submitted as either Reallocated or Permanent Supportive HousingBonus Projects. These funding methods are determined in collaboration with local CoC and it iscritical that applicants indicate the correct funding method. Project applicants mustcommunicate with their CoC to make sure that the CoC submissions reflect the same fundingmethod. - Before completing the project application, all project applicants must complete or update (asapplicable) the Project Applicant Profile in e-snaps. - HUD reserves the right to reduce or reject any new project that fails to adhere to (24 CFR part578 and application requirements set forth in FY 2017 CoC Program Competition NOFA.
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1A. SF-424 Application Type
1. Type of Submission:
2. Type of Application: New Project Application
If Revision, select appropriate letter(s):
If "Other", specify:
3. Date Received: 08/17/2017
4. Applicant Identifier:
5a. Federal Entity Identifier:
6. Date Received by State:
7. State Application Identifier:
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1B. SF-424 Legal Applicant
8. Applicant
a. Legal Name: Coleman Professional Services
b. Employer/Taxpayer Identification Number(EIN/TIN):
34-1240178
c. Organizational DUNS: 089247571 PLUS 4:
d. Address
Street 1: 5982 Rhodes Road
Street 2:
City: Kent
County: Portage
State: Ohio
Country: United States
Zip / Postal Code: 44240
e. Organizational Unit (optional)
Department Name: Residential Services
Division Name:
f. Name and contact information of person tobe
contacted on matters involving thisapplication
Prefix: Ms.
First Name: Carol
Middle Name: J.
Last Name: McCullough
Suffix:
Title: Grant Writer
Organizational Affiliation: Coleman Professional Services
Telephone Number: (330) 676-6810
Applicant: Coleman Professional Services 089247571Project: Coleman Massillon PSH 155499
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Extension:
Fax Number: (330) 678-3677
Email: [email protected]
Applicant: Coleman Professional Services 089247571Project: Coleman Massillon PSH 155499
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1C. SF-424 Application Details
9. Type of Applicant: M. Nonprofit with 501C3 IRS Status
10. Name of Federal Agency: Department of Housing and Urban Development
11. Catalog of Federal Domestic AssistanceTitle:
CoC Program
CFDA Number: 14.267
12. Funding Opportunity Number: FR-6100-N-25
Title: Continuum of Care Homeless AssistanceCompetition
13. Competition Identification Number:
Title:
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1D. SF-424 Congressional District(s)
14. Area(s) affected by the project (state(s)only):
(for multiple selections hold CTRL key)
Ohio
15. Descriptive Title of Applicant's Project: Coleman Massillon PSH
16. Congressional District(s):
a. Applicant: OH-013, OH-016, OH-007
b. Project:(for multiple selections hold CTRL key)
OH-007
17. Proposed Project
a. Start Date: 12/01/2017
b. End Date: 11/30/2018
18. Estimated Funding ($)
a. Federal:
b. Applicant:
c. State:
d. Local:
e. Other:
f. Program Income:
g. Total:
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1E. SF-424 Compliance
19. Is the Application Subject to Review ByState Executive Order 12372 Process?
b. Program is subject to E.O. 12372 but has notbeen selected by the State for review.
If "YES", enter the date this application wasmade available to the State for review:
20. Is the Applicant delinquent on any Federaldebt?
No
If "YES," provide an explanation:
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1F. SF-424 Declaration
By signing and submitting this application, I certify (1) to the statementscontained in the list of certifications** and (2) that the statements hereinare true, complete, and accurate to the best of my knowledge. I alsoprovide the required assurances** and agree to comply with any resultingterms if I accept an award. I am aware that any false, fictitious, orfraudulent statements or claims may subject me to criminal, civil, oradministrative penalties. (U.S. Code, Title 218, Section 1001)
I AGREE: X
21. Authorized Representative
Prefix: Mr.
First Name: Nelson
Middle Name: W.
Last Name: Burns
Suffix:
Title: President & CEO
Telephone Number:(Format: 123-456-7890)
(330) 676-6801
Fax Number:(Format: 123-456-7890)
(330) 678-3677
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/17/2017
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1G. HUD 2880
Applicant/Recipient Disclosure/Update Report - Form 2880U.S. Department of Housing and Urban Development
OMB Approval No. 2510-0011 (exp.11/30/2018)
Applicant/Recipient Information
1. Applicant/Recipient Name, Address, and Phone
Agency Legal Name: Coleman Professional Services
Prefix: Mr.
First Name: Nelson
Middle Name: W.
Last Name: Burns
Suffix:
Title: President & CEO
Organizational Affiliation: Coleman Professional Services
Telephone Number: (330) 676-6801
Extension:
Email: [email protected]
City: Kent
County: Portage
State: Ohio
Country: United States
Zip/Postal Code: 44240
2. Employer ID Number (EIN): 34-1240178
3. HUD Program: Continuum of Care Program
4. Amount of HUD AssistanceRequested/Received:
$103,949.00
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(Requested amounts will be automatically entered within applications)
5. State the name and location (street address, City and State) of theproject or activity.
Refer to project name, addresses and CoC Project Identifying Number (PIN) entered into theattached project application.
Part I Threshold Determinations
1. Are you applying for assistance for aspecific project or activity?
(For further information, see 24 CFR Sec. 4.3).
Yes
2. Have you received or do you expect toreceive assistance within the jurisdiction ofthe Department (HUD), involving the project
or activity in this application, in excess of$200,000 during this fiscal year (Oct. 1 - Sep.
30)? For further information, see 24 CFR Sec.4.9.
Yes
Part II Other Government Assistance Provided or Requested/ExpectedSources and Use of Funds
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance,payment, credit, or tax benefit.
Department/Local Agency Name and Address Type of Assistance AmountRequested /
Provided
Expected Uses of the Funds
NA NA $0.00 NA
Note: If additional sources of Government Assistance, please use the"Other Attachments" screen of the project applicant profile.
Part III Interested Parties
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You must disclose:1. All developers, contractors, or consultants involved in the application for the assistance or inthe planning, development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which theassistance is sought that exceeds $50,000 or 10 percent of the assistance (whichever is lower).
Alphabetical list of all persons with areportable financial interest in the project or
activity (For individuals, give the last name first)
Social Security No.or Employee ID No.
Type ofParticipation
Financial Interestin Project/Activity
($)
Financial Interestin Project/Activity
(%)
NA NA NA $0.00 0%
Note: If there are no other people included, write NA in the boxes.
CertificationWarning: If you knowingly make a false statement on this form, you may be subject to civil orcriminal penalties under Section 1001 of Title 18 of the United States Code. In addition, anyperson who knowingly and materially violates any required disclosures of information, includingintentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for eachviolation.
I certify that this information is true and complete.
I AGREE: X
Name / Title of Authorized Official: Nelson Burns, President & CEO
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 07/18/2017
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1H. HUD 50070
HUD 50070 Certification for a Drug Free Workplace
Applicant Name: Coleman Professional Services
Program/Activity Receiving Federal GrantFunding:
CoC Program
Acting on behalf of the above named Applicant as its Authorized Official, Imake the following certifications and agreements to the Department of
Housing and Urban Development (HUD) regarding the sites listed below:I certify that the above named Applicant will or will continue toprovide a drug-free workplace by:
a. Publishing a statement notifying employees that the unlawfulmanufacture, distribution, dispensing, possession, or use of acontrolled substance is prohibited in the Applicant's workplaceand specifying the actions that will be taken against employeesfor violation of such prohibition.
e. Notifying the agency in writing, within ten calendar days afterreceiving notice under subparagraph d.(2) from an employee orotherwise receiving actual notice of such conviction. Employersof convicted employees must provide notice, including positiontitle, to every grant officer or other designee on whose grantactivity the convicted employee was working, unless theFederalagency has designated a central point for the receipt ofsuch notices. Notice shall include the identification number(s)of each affected grant;
b. Establishing an on-going drug-free awareness program toinform employees ---(1) The dangers of drug abuse in the workplace(2) The Applicant's policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation, and employeeassistance programs; and(4) The penalties that may be imposed upon employees for drugabuse violations occurring in the workplace.
f. Taking one of the following actions, within 30 calendar days ofreceiving notice under subparagraph d.(2), with respect to anyemployee who is so convicted ---(1) Taking appropriate personnel action against such anemployee, up to and including termination, consistent with therequirements of the Rehabilitation Act of 1973, as amended; or(2) Requiring such employee to participate satisfactorily in adrug abuse assistance or rehabilitation program approved forsuch purposes by a Federal, State, or local health, lawenforcement, or other appropriate agency;
c. Making it a requirement that each employee to be engaged inthe performance of the grant be given a copy of the statementrequired by paragraph a.;
g. Making a good faith effort to continue to maintain a drugfreeworkplace through implementation of paragraphs a. thru f.
d. Notifying the employee in the statement required by paragrapha. that, as a condition of employment under the grant, theemployee will ---(1) Abide by the terms of the statement; and(2) Notify the employer in writing of his or her conviction for aviolation of a criminal drug statute occurring in the workplaceno later than five calendar days after such conviction;
2. Sites for Work Performance.The Applicant shall list (on separate pages) the site(s) for the performance of work done inconnection with the HUD funding of the program/activity shown above: Place of Performanceshall include the street address, city, county, State, and zip code. Identify each sheet with theApplicant name and address and the program/activity receiving grant funding.) Workplaces, including addresses, entered in the attached project application.Refer to addresses entered into the attached project application.
I hereby certify that all the information statedherein, as well as any information provided in
X
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the accompaniment herewith, is true andaccurate.
Warning: HUD will prosecute false claims and statements. Conviction may result in criminaland/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Authorized Representative
Prefix: Mr.
First Name: Nelson
Middle Name W.
Last Name: Burns
Suffix:
Title: President & CEO
Telephone Number:(Format: 123-456-7890)
(330) 676-6801
Fax Number:(Format: 123-456-7890)
(330) 678-3677
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/17/2017
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CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or onbehalf of the undersigned, to any person for influencing or attempting toinfluence an officer or employee of an agency, a Member of Congress, anofficer or employee of Congress, or an employee of a Member of Congressin connection with the awarding of any Federal contract, the making of anyFederal grant, the making of any Federal loan, the entering into of anycooperative agreement, and the extension, continuation, renewal,amendment, or modification of any Federal contract, grant, loan, orcooperative agreement.
2) If any funds other than Federal appropriated funds have been paid orwill be paid to any person for influencing or attempting to influence anofficer or employee of any agency, a Member of Congress, an officer oremployee of Congress, or an employee of a Member of Congress inconnection with this Federal contract, grant, loan, or cooperativeagreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with itsinstructions.
(3) The undersigned shall require that the language of this certification beincluded in the award documents for all subawards at all tiers (includingsubcontracts, subgrants, and contracts under grants, loans, andcooperative agreements) and that all subrecipients shall certify anddisclose accordingly. This certification is a material representation of factupon which reliance was placed when this transaction was made orentered into. Submission of this certification is a prerequisite for makingor entering into this transaction imposed by section 1352, title 31, U.S.Code. Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief,that:
If any funds have been paid or will be paid to any person for influencingor attempting to influence an officer or employee of any agency, a Memberof Congress, an officer or employee of Congress, or an employee of aMember of Congress in connection with this commitment providing for theUnited States to insure or guarantee a loan, the undersigned shallcomplete and submit Standard Form-LLL, ''Disclosure of LobbyingActivities,'' in accordance with its instructions. Submission of thisstatement is a prerequisite for making or entering into this transactionimposed by section 1352, title 31, U.S. Code. Any person who fails to file
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the required statement shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each such failure.
I hereby certify that all the information statedherein, as well as any information provided in
the accompaniment herewith, is true andaccurate:
X
Warning: HUD will prosecute false claims and statements. Conviction mayresult in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31U.S.C. 3729, 3802)
Applicant’s Organization: Coleman Professional Services
Name / Title of Authorized Official: Nelson Burns, President & CEO
Signature of Authorized Official: Considered signed upon submission in e-snaps.
Date Signed: 08/17/2017
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1J. SF-LLL
DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C.
1352. Approved by OMB0348-0046
HUD requires a new SF-LLL submitted with each annual CoC competition and completing thisscreen fulfills this requirement.
Answer “Yes” if your organization is engaged in lobbying associated with the CoC Program andanswer the questions as they appear next on this screen. The requirement related to lobbyingas explained in the SF-LLL instructions states: “The filing of a form is required for each paymentor agreement to make payment to any lobbying entity for influencing or attempting to influencean officer or employee of any agency, a Member of Congress, an officer or employee ofCongress, or an employee of a Member of Congress in connection with a covered Federalaction.”
Answer “No” if your organization is NOT engaged in lobbying.
Does the recipient or subrecipient of this CoCgrant participate in federal lobbying activities
(lobbying a federal administration orcongress) in connection with the CoC
Program?
No
Legal Name: Coleman Professional Services
Street 1: 5982 Rhodes Road
Street 2:
City: Kent
County: Portage
State: Ohio
Country: United States
Zip / Postal Code: 44240
11. Information requested through this form is authorized by title 31U.S.C. section 1352. This disclosure of lobbying activities is a materialrepresentation of fact upon which reliance was placed by the tier above
when this transaction was made or entered into. This disclosure isrequired pursuant to 31 U.S.C. 1352. This information will be available for
public inspection. Any person who fails to file the required disclosureshall be subject to a civil penalty of not less than $10,000 and not more
than $100,000 for each such failure.
I certify that this information is true andcomplete.
X
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Authorized Representative
Prefix: Mr.
First Name: Nelson
Middle Name: W.
Last Name: Burns
Suffix:
Title: President & CEO
Telephone Number:(Format: 123-456-7890)
(330) 676-6801
Fax Number:(Format: 123-456-7890)
(330) 678-3677
Email: [email protected]
Signature of Authorized Representative: Considered signed upon submission in e-snaps.
Date Signed: 08/17/2017
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2A. Project Subrecipients
This form lists the subrecipient organization(s) for the project. To add asubrecipient, select the icon. To view or update subrecipient
information already listed, select the view option.
Total Expected Sub-Awards:Organization Type Sub-
AwardAmount
This list contains no items
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2B. Experience of Applicant, Subrecipient(s), andOther Partners
1. Describe the experience of the applicant and potential subrecipients (ifany), in effectively utilizing federal funds and performing the activitiesproposed in the application, given funding and time limitations.
A nonprofit provider of behavioral health and rehabilitative programs, Colemanhas been developing, operating, and managing permanent supportive housingto individuals experiencing homelessness for the past 25 years. Recognized bythe Department of Housing and Urban Development (HUD) as a leader inhousing development and operations for persons with mental illness, Colemanwas one of the first grantees in the nation to receive a HUD McKinney Grant forhomeless persons.
Coleman has been a HUD grantee in Portage for over 20 years. In StarkCounty, we sub-contract with YWCA for HUD-funded STARR II & III programsand partner with ICAN at HUD-funded projects (BASIC and James House)providing house staff, case management & other treatment programs. MentalHealth Boards in multiple counties rely on Coleman to administer funding fromHUD: Coleman coordinates 4 Shelter Plus Care (S+C) grants in Trumbull & 2S+C grants in Jefferson & we partner on 2 S+C grants in Portage and 1 S+Cgrant in Allen. We subcontract as a housing and service provider for 2 otherHUD grants in Trumbull & Jefferson. We receive PBV from Portage MHA. Wereceive a Returning Home Ohio grant from CSH in Stark.
Coleman has also benefitted from and efficiently used federal funding throughintermediaries. Over the past 3 years, we received funding from [1] HUDthrough Community Development Block grant funds for supportive housing,capital funds for housing repair and renovation, and mediation programs forresidents (in addition to HUD support for supportive housing through theBoSCoC) [2] US Dept of Interior for historic housing renovation; [3] US Dept ofHHS for re-entry services, first episode psychosis services, youth employment,child abuse hotline, adult protective services, homemaker help, and adult dayservices.
Coleman has policies and procedures that are followed to make sure thefinancial accounting system detail is accurate. The financial accounting systemconsists of the General Ledger, Accounts Payable and Accounts Receivablemodules. The General Ledger module contains the data from the AccountsPayable and the Accounts Receivable modules of the system; it also is themodule that produces the financial reporting for the organization. The accountspayable module pays the bills for the organization and the accounts receivablemodule bills for services and where payments are posted for services.
2. Describe the experience of the applicant and potential subrecipients (ifany) in leveraging other Federal, State, local, and private sector funds.
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Coleman receives HUD funds through the intermediary Ohio DevelopmentServices Agency, including Supportive Housing Program funds for 63 units inPortage and Trumbull Counties, and Homeless Crisis Response Program(HCRP) funds providing Rapid Rehousing services to 92 individuals in PortageCounty annually. Coleman is the lead agency for Region 5 and administratesthe HCRP application and funding for 5 counties.
Coleman has also successfully partnered with Stark County Mental Health &Addiction Recovery, Portage Metropolitan Housing Agency, Ohio Department ofDevelopment, Mental Health and Recovery Board of Trumbull County, and OhioDepartment of Mental Health and Recovery Services to develop housing andsupportive services projects.
3. Describe the basic organization and management structure of theapplicant and subrecipients (if any). Include evidence of internal andexternal coordination and an adequate financial accounting system.
Coleman provides supportive services to residents at over 260 units of housingthat we own and operate in 4 counties: Allen, Portage, Stark and Trumbull. Weprovide a diversity of settings, from group homes with intensive 24 hour supportto clustered and scattered site independent apartments that offer supportiveservices as needed/desired. Headquartered in Kent, OH, President and CEONelson Burns has served Coleman in this role for 30 years and overseensignificant growth while maintaining a healthy bottom line. Vice Presidentsoversee Finance, Human Resources, Information Technology and Operations,and Clinical Services. Directors, located onsite, oversee County operations andPrograms. Coleman has centralized Operations and Residential Directors thatidentify priorities, travel extensively, and direct staff in each of our Countylocations. We are active members of the local Continuum of Care and interactwith a variety of partners outlined in section 3B below.
The financial accounting system currently being used is a software program thatallows for and produces financial reporting, payments, statements, andinvoicing. This software has modules for the General Ledger, Accounts Payableand Accounts Receivable. All financial functions are centralized at theheadquarters in Kent, OH under the oversight of the Finance Vice President.
Coleman uses Lean Six Sigma quality processes across the organization. As acombined model, Lean and Six Sigma are used extensively across the globe asan evidence-based approach to change projects requiring cross-functionalteams and stringent use of deployment plans. Lean focuses on the eliminationof wasteful activities, including wait times and other delays. The use of data fordecision-making is stressed by Six Sigma. Six Sigma suggests a model ofDefine, Measure, Analyze, Improve and Control to change processes – whichrelies on process mapping, removing unnecessary steps, standardizingprocedures and maintaining gains from functioning processes. Bothcomponents require commitment to identified goals which is driven throughteam leadership that can eliminate barriers encountered by the team.
Coleman uses High Performance Teams to develop and manage continuousimprovement projects, which typically follow the Lean Six Sigma model. Inrecent years, the organization has used at least 4 such teams to develop andimplement recommendations about the diagnostic assessment and prescreen
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process, as well as housing, billing processes and implementing Zero Suicideprocesses.
4a. Are there any unresolved monitoring oraudit findings for any HUD grants(includingESG) operated by the applicant or potential
subrecipients (if any)?
No
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3A. Project Detail
1a. CoC Number and Name: OH-508 - Canton, Massillon, Alliance/StarkCounty CoC
1b. CoC Collaborative Applicant Name: Stark County Regional Planning Commission
2. Project Name: Coleman Massillon PSH
3. Project Status: Standard
4. Component Type: PH
5. Does this project use one or moreproperties that have been conveyed through
the Title V process?
No
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3B. Project Description
1. Provide a description that addresses the entire scope of the proposedproject.
Coleman Professional Services is currently developing Changing Destinies, a10-unit permanent, supportive housing facility for transition age young adults inMassillon (Stark County), slated for completion before the end of the calendaryear. The project will provide a safe place for young adults to stabilize, setgoals, and work towards independence. Young adults entering this program willbe those most in need (as previous users of high end, high cost services).
Units will be dedicated to chronically homeless individuals with a serious mentalillness and/or other disabling conditions such as substance abuse, health ordevelopmental disabilities who have been continuously homeless for a year ormore or have had at least four episodes of homelessness in the past threeyears.
Participants will be provided with safe, decent, permanent housing, employmentservices, and an array of mental health services such as case management,psychiatry, counseling and group therapy. A Resident Manager will live onsite inan eleventh unit and serve as a support, alerter, motivator, and reporter. TheResident Manager will also collaborate with any treatment providers toencourage treatment adherence, ongoing assessment, and goal attainment.
Using a Housing First approach, Coleman will provide participants with thetools, support, and resources needed to maintain permanent housing as a partof the Changing Destinies program for as long as they wish to participate. Inaddition, if and when it is appropriate, we will work with the participant onindividual goals related to income through employment, SSI/SSDI income, or apermanent rental subsidy such as Section 8. All residential staff and casemanagers have been trained in Motivational Interviewing and Trauma InformedCare.
The Changing Destinies permanent supportive housing program will utilize theCentralized Intake and Assessment System approved by the HomelessContinuum of Care Stark County (HCCSC) to place participants in the program.We anticipate serving 10 to 12 individuals annually. See Part 5 below for moreon who we serve.
Participant outcomes: 91% will remain in or exit to permanent housing as of theend of the operating year and 82% will maintain/increase their total income asof the end of the operating year or project exit.
2. Describe the estimated schedule for the proposed activities, themanagement plan, and the method for assuring effective and timelycompletion of all work.
We anticipate that the facility will be move-in ready in November of 2017. ThisPSH program will provide education, socialization, recreation, skill training,
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employment, & mental health/recovery services for homeless young adults.Staffed by a live-in, peer mental health tech (to be hired) who provides supportto residents and collaborates with treatment providers, the program will bemanaged by the Director of Residential, Jackie McDougle, who has a diversecrisis and direct service experience (9yrs) including Hospital Liaison and CaseManager. Those referred will complete an assessment as described on page12. Staff will provide regular check-ins daily, paying special attention to tenantswho have identified stressors. Residents will be encouraged to participate inregular onsite meetings and voluntary living area activities. Coleman will workwith StarkMHAR & Homeless Hotline to identify a process for referral ofhomeless TAY with the appropriate SPDAT score & eligibility criteria forassessment to the program. All participants will be entered into HMIS.
Coleman follows Housing First practices. The only requirements are that theapplicants provide verification of disability and verification of homelessness.Income, sobriety, drug testing, or employment are not required upon entry.
For individuals active in case management, onsite staff will continually assessand collaborate with case manager for purposes of further assessment, linkage,follow-up, and progress on mainstream services. For individuals not in casemanagement, other providers, including counselors, psychiatry, and supportiveliving staff, as applicable, will assist as well. Continual efforts will be made toengage clients in services for which a need has been assessed. All providerswill work in a person-centered way using motivational interviewing to establishand work towards goals of independence and recovery, which include benefits,education, employment, and environmental support.
Applicants are encouraged to obtain or maintain supportive services but this isnot a requirement for program entry. If the applicant wishes to participate insupportive services to promote housing stability and well-being, we will linkthem with community resources to do so. We can provide participantsemployment resources for increasing their income and/or skill.
3. Will your project participate in a CoCCoordinated Entry Process?
Yes
* 4. Please identify the project's specific population focus.
(Select ALL that apply)Chronic Homeless
XDomestic Violence
Veterans Substance Abuse
Youth (under 25)X
Mental IllnessX
Families HIV/AIDS
Other(Click 'Save' to update)
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5. Housing First
a. Will the project quickly move participantsinto permanent housing
Yes
b. Does the project ensure that participants are not screened out based onthe following items? Select all that apply.
Having too little or little incomeX
Active or history of substance useX
Having a criminal record with exceptions for state-mandated restrictionsX
History of victimization (e.g. domestic violence, sexual assault, childhood abuse)X
None of the above
c. Does the project ensure that participants are not terminated from theprogram for the following reasons? Select all that apply.
Failure to participate in supportive servicesX
Failure to make progress on a service planX
Loss of income or failure to improve incomeX
Any other activity not covered in a lease agreement typically found for unassisted persons in the project’s geographic areaX
None of the above
d. Will the project follow a "Housing First"approach?
(Click 'Save' to update)
Yes
6. If applicable, describe the proposed development activities and theresponsibilities that the applicant and potential subrecipients (if any) willhave in developing, operating, and maintaining the property.
n/a
7. Will the PH project provide PSH or RRH? PSH
8. Will participants be required to live in aparticular structure, unit, or locality, at some
point during the period of participation?
Yes
Explain how and why the project will implement this requirement.
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This is a site based project rather than a tenant selected scattered site unit, soparticipants will be required to live in the structure to be a part of this program.
9. Will more than 16 persons live in onestructure?
No
Dedicated and DedicatedPLUS
A “100% Dedicated” project is a permanent supportive housing projectthat commits 100% of its beds to chronically homeless individuals andfamilies, according to NOFA Section III.3.b.
A “DedicatedPLUS” project is a permanent supportive housing projectwhere 100% of the beds are dedicated to serve individuals with disabilitiesand families in which one adult or child has a disability, includingunaccompanied homeless youth, that at a minimum, meet ONE of thefollowing criteria according to NOFA Section III.3.d:(1) experiencing chronic homelessness as defined in 24 CFR 578.3; (2) residing in a transitional housing project that will be eliminated and meets the definition ofchronically homeless in effect at the time in which the individual or family entered the transitionalhousing project; (3) residing in a place not meant for human habitation, emergency shelter, or safe haven; butthe individuals or families experiencing chronic homelessness as defined at 24 CFR 578.3 hadbeen admitted and enrolled in a permanent housing project within the last year and were unableto maintain a housing placement; (4) residing in transitional housing funded by a joint TH and PH-RRH component project andwho were experiencing chronic homelessness as defined at 24 CFR 578.3 prior to entering theproject; (5)residing and has resided in a place not meant for human habitation, a safe haven, oremergency shelter for at least 12 months in the last three years, but has not done so on fourseparate occasions; or (6) receiving assistance through a Department of Veterans Affairs(VA)-funded homelessassistance program and met one of the above criteria at initial intake to the VA's homelessassistance system.
10. Indicate whether the project is “100%Dedicated,” or “DedicatedPLUS,” according
to the information provided above.
100% Dedicated
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3C. Project Expansion Information
1. Will the project use an existing homelessfacility or incorporate activities provided by
an existing project?
No
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4A. Supportive Services for Participants
1a. Are the proposed project policies andpractices consistent with the laws related toproviding education services to individuals
and families?
Yes
1b. Will the proposed project have adesignated staff person to ensure that the
children are enrolled in school and receiveeducational services, as appropriate?
Yes
2. Describe how participants will be assisted to obtain and remain inpermanent housing.
With 26 years of experience providing housing & voluntary services toindividuals experiencing homelessness, Coleman recognizes the importance ofbeing person-centered and trauma-informed in our approach with residents. Ourproject will be staffed by a live-in, peer supporter mental health tech whoprovides support & collaborates with treatment providers to encourageadherence, ongoing assessment and goal attainment. Individuals will completea Diagnostic Assessment including a specific TAY housing assessment to helpidentify any specific TAY-related supportive housing needs. Staff will providecheck-ins daily, paying special attention to attend to tenants who have identifiedstressors.
3. Describe specifically how participants will be assisted both to increasetheir employment and/or income and to maximize their ability to liveindependently.
In FY16, Coleman increased job placements to 401 individuals, 119 in StarkCounty. TAY housing staff will encourage residents to move toward incomeindependence and gainful employment using Motivational Interviewingtechniques and will assist individuals in identifying career goals and interests.Individuals who prefer career training instead of a rapid job search will bereferred to BVR. Coleman utilizes the evidence-based Supported Employment(SE) model & follows core concepts including: zero exclusion, rapid job search,ongoing benefits consultation, integrated employment & treatment services,competitive jobs, consumer choice, and ongoing retention services as needed,up to 180 days.
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4. For all supportive services available to participants, indicate who willprovide them and how often they will be provided.
Click 'Save' to update.Supportive Services Provider Frequency
Assessment of Service Needs Applicant Bi-weekly
Assistance with Moving Costs Non-Partner As needed
Case Management Applicant Weekly
Child Care Non-Partner As needed
Education Services Non-Partner As needed
Employment Assistance and Job Training Applicant As needed
Food Non-Partner As needed
Housing Search and Counseling Services Applicant As needed
Legal Services Non-Partner As needed
Life Skills Training Applicant Weekly
Mental Health Services Applicant Weekly
Outpatient Health Services Non-Partner As needed
Outreach Services Partner As needed
Substance Abuse Treatment Services Applicant As needed
Transportation Applicant As needed
Utility Deposits Non-Partner As needed
5. Please identify whether the project will include the following activities:
5a. Transportation assistance to clients toattend mainstream
benefit appointments, employment training,or jobs?
Yes
5b. Use of a single application form for fouror more mainstream
programs?
Yes
5c. Regular follow-ups with participants toensure mainstream
benefits are received and renewed?
Yes
6. Will project participants have access toSSI/SSDI technical assistance
provided by the applicant, a subrecipient, orpartner agency?
Yes
6a. Has the staff person providing thetechnical assistance completed SOAR
training in the past 24 months.
Yes
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4B. Housing Type and Location
The following list summarizes each housing site in the project. To add ahousing site to the list, select the icon. To view or update a housing sitealready listed, select the icon.
Total Units: 10
Total Beds: 10
Total Dedicated CH Beds: 10Housing Type Units Beds
Clustered apartments 10 10
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4B. Housing Type and Location Detail
1. Housing Type: Clustered apartments
2. Indicate the maximum number of units and beds available for projectparticipants at the selected housing site.
a. Units: 10
b. Beds: 10
3. How many beds of the total beds in “2b.Beds” are dedicated to the chronically
homeless?
10
This includes both the “dedicated” and “prioritized” beds.
4. Address:
Street 1: 2135 Harsh Avenue
Street 2:
City: Massillon
State: Ohio
ZIP Code: 44646
*5. Select the geographic area(s) associated with the address. For newprojects, select the area(s) expected to be covered.
(for multiple selections hold CTRL key)
399151 Stark County
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5A. Project Participants - Households
Households TableHouseholds with at
Least One Adultand One Child
Adult Householdswithout Children
Households withOnly Children
Total
Number of Households 0 10 0 10
Characteristics Persons inHouseholds with at
Least One Adultand One Child
Adult Persons inHouseholds without
Children
Persons inHouseholds with
Only Children
Total
Adults over age 24 0 0 0
Adults ages 18-24 0 10 10
Accompanied Children under age 18 0 0 0
Unaccompanied Children under age 18 0 0
Total Persons 0 10 0 10
Click Save to automatically calculate totals
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5B. Project Participants - Subpopulations
Persons in Households with at Least One Adult and One Child
Characteristics
Chronically
HomelessNon-
Veterans
Chronically
HomelessVeterans
Non-Chronicall
yHomelessVeterans
ChronicSubstanc
eAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victims ofDomesticViolence
PhysicalDisability
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24
Children under age 18
Total Persons 0 0 0 0 0 0 0 0 0 0
Persons in Households without Children
Characteristics
Chronically
HomelessNon-
Veterans
Chronically
HomelessVeterans
Non-Chronicall
yHomelessVeterans
ChronicSubstanc
eAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victims ofDomesticViolence
PhysicalDisability
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Adults over age 24
Adults ages 18-24 10 0 0 6 1 10 2 2 2 0
Total Persons 10 0 0 6 1 10 2 2 2 0
Click Save to automatically calculate totals
Persons in Households with Only Children
Characteristics
Chronically
HomelessNon-
Veterans
Chronically
HomelessVeterans
Non-Chronicall
yHomelessVeterans
ChronicSubstanc
eAbuse
Personswith
HIV/AIDS
SeverelyMentally
Ill
Victims ofDomesticViolence
PhysicalDisability
Developmental
Disability
Personsnot
represented bylisted
subpopulations
Accompanied Childrenunder age 18
Unaccompanied Childrenunder age 18
Total Persons 0 0 0 0 0 0 0
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5C. Outreach for Participants
1. Enter the percentage of project participants that will be coming fromeach of the following locations.
20% Directly from the street or other locations not meant for human habitation.
80% Directly from emergency shelters.
0% Directly from safe havens.
0% Persons fleeing domestic violence.
100% Total of above percentages
2. Describe the outreach plan to bring these homeless participants intothe project.
The Changing Destinies permanent supportive housing program will utilize theCentralized Intake and Assessment System approved by the HomelessContinuum of Care Stark County (HCCSC) to place participants in the program.Residential program staff participate in the HCCSC and have served on theSystem Performance and Planning Committee, Youth HomelessnessCommittee, Emergency Shelter Committee and Discharge Planning Committee.Staff also participate in Housing Promotion meetings in collaboration with theMHRSB and other area agencies as needed.
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6A. Funding Request
1. Will it be feasible for the project to beunder grant agreement by September 30,
2019?
Yes
2. Is the project proposing to using fundsreallocated from the CoCs annual renewal
demand OR
is the project applying for funding throughthe permanent housing bonus?
Permanent Housing Bonus
3. Does this project propose to allocate fundsaccording to an indirect cost rate?
No
4. Select a grant term: 1 Year
* 5. Select the costs for which funding isbeing requested:
Acquisition/Rehabilitation/New Construction
Leased Units
Leased Structures
Rental Assistance X
Supportive Services X
Operating
HMIS
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6E. Rental Assistance Budget
The following list summarizes the rental assistance funding request for thetotal term of the project. To add information to the list, select the icon. Toview or update information already listed, select the icon.
Total Request for Grant Term: $61,920
Total Units: 10
Type of RentalAssistance
FMR Area Total UnitsRequested
Total Request
PRA OH - Canton-Massillon, OH MSA (390199... 10 $61,920
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Rental Assistance Budget Detail
Instructions: Type of Rental Assistance: Select the applicable type of rental assistance from the dropdownmenu. Options include tenant-based (TRA), sponsor-based (SRA), and project-based assistance(PRA). Each type has unique requirements and applicants should refer to the 24 CFR 578.51before making a selection.
Metropolitan or non-metropolitan fair market rent area: This is a required field. Select the FY2016 FMR area in which the project is located. The list is sorted by state abbreviation. Theselected FMR area will be used to populate the rents in the chart below.
Size of Units: These options are system generated. Unit size is defined by the number ofdistinct bedrooms and not by the number of distinct beds.
# of units: This is a required field. For each unit size, enter the number of units for whichfunding is being requested.
FMR: These fields are populated with the FY 2016 FMR amounts based on the FMR areaselected by the applicant. The FMRs are available online athttp://www.huduser.org/portal/datasets/fmr.html.
12 Months: These fields are populated with the value 12 to calculate the annual rent request.
Total Request: This column populates with the total calculated amount from each row basedon the number of units multiplied by the corresponding FMR and by 12 months.
Total Units and Annual Assistance Requested: The fields in this row are automaticallycalculated based on the total number of units and the sum of the total requests per unit size peryear.
Grant Term: This field is populated based on the grant term selected on Screen “6A. FundingRequest" and will be read only.
Total Request for Grant Term: This field is automatically calculated based on the total annualassistance requested multiplied by the grant term.
All total fields will be calculated once the required field has been completed and saved.
Additional Resources can be found at the HUD Exchange: https://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources
Type of Rental Assistance: PRA
Metropolitan or non-metropolitanfair market rent area:
OH - Canton-Massillon, OH MSA (3901999999)
Size of Units # of Units(Applicant)
FMR Area(Applicant)
12 Months TotalRequest
(Applicant)
SRO x $317 x 12 = $0
0 Bedroom x $422 x 12 = $0
1 Bedroom 10 x $516 x 12 = $61,920
Applicant: Coleman Professional Services 089247571Project: Coleman Massillon PSH 155499
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2 Bedrooms x $684 x 12 = $0
3 Bedrooms x $873 x 12 = $0
4 Bedrooms x $938 x 12 = $0
5 Bedrooms x $1,079 x 12 = $0
6 Bedrooms x $1,219 x 12 = $0
7 Bedrooms x $1,360 x 12 = $0
8 Bedrooms x $1,501 x 12 = $0
9 Bedrooms x $1,642 x 12 = $0
Total Units and Annual AssistanceRequested
10 $61,920
Grant Term 1 Year
Total Request for Grant Term $61,920
Click the 'Save' button to automatically calculate totals.
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6F. Supportive Services Budget
Instructions: Enter the quantity and total budget request for each supportive services cost. The requestentered should be equivalent to the cost of one year of the relevant supportive service.
Eligible Costs: The system populates a list of eligible supportive services for which funds canbe requested. The costs listed are the only costs allowed under 24 CFR 578.53.
Quantity AND Description: This is a required field. A quantity AND description must beentered for each requested cost. Enter the quantity in detail (e.g. 1 FTE Case Manager Salary +benefits, or child care for 15 children) for each supportive service activity for which funding isbeing requested. Please note that simply stating “1FTE” is NOT providing “Quantity AND Detail”and limits HUD’s understanding of what is being requested. Failure to enter adequate ‘QuantityAND Detail’ may result in conditions being placed on an award and a delay of grant funding.
Annual Assistance Requested: This is a required field. For each grant year, enter the amountof funds requested for each activity. The amount entered must only be the amount that isDIRECTLY related to providing supportive services to homeless participants.
Total Annual Assistance Requested: This field is automatically calculated based on the sum ofthe annual assistance requests entered for each activity.
Grant Term: This field is populated based on the grant term selected on Screen "6A. FundingRequest" and will be read only.
Total Request for Grant Term: This field is automatically calculated based on the total amountrequested for each eligible cost multiplied by the grant term.
All total fields will be calculated once the required field has been completed and saved.
Additional Resources can be found at the HUD Exchange: https://www.hudexchange.info/e-snaps/guides/coc-program-competition-resources
A quantity AND description must be entered for each requested cost.Eligible Costs Quantity AND Description
(max 400 characters)Annual Assistance
Requested
1. Assessment of Service Needs .40 FTE Mental Health Tech/Peer Support (Salary + Benefits) for12 months. Position responsible for regularly assessing residents.Program includes multiple FTE total but funding comes from othersources.
$12,460
2. Assistance with Moving Costs
3. Case Management
4. Child Care
5. Education Services
6. Employment Assistance
7. Food
8. Housing/Counseling Services
9. Legal Services
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10. Life Skills .40 FTE Mental Health Tech/Peer Support (Salary + Benefits) for12 months. Position responsible for conducting inspectionsmonitoring for health, safety and security; coordinatingmaintenance; completing drills; and teaching life skills. Programincludes multiple FTE total but funding comes from other sources.
$12,460
11. Mental Health Services .20 FTE Mental Health Tech/Peer Support (Salary + Benefits) for12 months. Position responsible for coordinating external supportservices. Program includes multiple FTE total but funding comesfrom other sources.
$10,309
12. Outpatient Health Services
13. Outreach Services
14. Substance Abuse Treatment Services
15. Transportation
16. Utility Deposits
17. Operating Costs
Total Annual Assistance Requested $35,229
Grant Term 1 Year
Total Request for Grant Term $35,229
Click the 'Save' button to automatically calculate totals.
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6I. Sources of Match
The following list summarizes the funds that will be used as Match for theproject. To add a Matching source to the list, select the icon. To view orupdate a Matching source already listed, select the icon.
Summary for MatchTotal Value of Cash Commitments: $106,068
Total Value of In-Kind Commitments: $0
Total Value of All Commitments: $106,068
1. Does this project generate program incomeas described in 24 CFR 578.97 that will be
used as Match for this grant?
No
Match Type Source Contributor Date ofCommitment
Value ofCommitments
Yes Cash Private ColemanProfessio...
06/06/2017 $25,987
Yes Cash Government StarkMHAR 06/06/2017 $80,081
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Sources of Match Detail
1. Will this commitment be used towardsmatch ?
Yes
2. Type of commitment: Cash
3. Type of source: Private
4. Name the source of the commitment:(Be as specific as possible and include the
office or grant program as applicable)
Coleman Professional Services
5. Date of Written Commitment: 06/06/2017
6. Value of Written Commitment: $25,987
Sources of Match Detail
1. Will this commitment be used towardsmatch ?
Yes
2. Type of commitment: Cash
3. Type of source: Government
4. Name the source of the commitment:(Be as specific as possible and include the
office or grant program as applicable)
StarkMHAR
5. Date of Written Commitment: 06/06/2017
6. Value of Written Commitment: $80,081
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6J. Summary Budget
The following information summarizes the funding request for the totalterm of the project. However, administrative costs can be entered in 8.Admin field below.
Eligible Costs Annual AssistanceRequested(Applicant)
Grant Term(Applicant)
Total AssistanceRequested
for Grant Term(Applicant)
1a. Acquisition $0
1b. Rehabilitation $0
1c. New Construction $0
2a. Leased Units $0 1 Year $0
2b. Leased Structures $0 1 Year $0
3. Rental Assistance $61,920 1 Year $61,920
4. Supportive Services $35,229 1 Year $35,229
5. Operating $0 1 Year $0
6. HMIS $0 1 Year $0
7. Sub-total Costs Requested $97,149
8. Admin (Up to 10%)
$6,800
9. Total AssistancePlus Admin Requested
$103,949
10. Cash Match $106,068
11. In-Kind Match $0
12. Total Match $106,068
13. Total Budget $210,017
Click the 'Save' button to automatically calculate totals.
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7A. Attachment(s)
Document Type Required? Document Description Date Attached
1) Subrecipient NonprofitDocumentation
No
2) Other Attachment(s) No StarkMHAR Match C... 08/17/2017
3) Other Attachment(s) No Coleman Match Com... 08/17/2017
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Attachment Details
Document Description:
Attachment Details
Document Description: StarkMHAR Match Commitment Letter
Attachment Details
Document Description: Coleman Match Commitment Letter
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7D. Certification
A. For all projects:
Fair Housing and Equal Opportunity
It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulationspursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, onthe ground of race, color or national origin, be excluded from participation in, be denied thebenefits of, or be otherwise subjected to discrimination under any program or activity for whichthe applicant receives Federal financial assistance, and will immediately take any measuresnecessary to effectuate this agreement. With reference to the real property and structure(s)thereon which are provided or improved with the aid of Federal financial assistance extended tothe applicant, this assurance shall obligate the applicant, or in the case of any transfer,transferee, for the period during which the real property and structure(s) are used for a purposefor which the Federal financial assistance is extended or for another purpose involving theprovision of similar services or benefits.
It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and withimplementing regulations at 24 CFR part 100, which prohibit discrimination in housing on thebasis of race, color, religion, sex, disability, familial status or national origin.
It will comply with Executive Order 11063 on Equal Opportunity in Housing and withimplementing regulations at 24 CFR Part 107 which prohibit discrimination because of race,color, creed, sex or national origin in housing and related facilities provided with Federal financialassistance.
It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter60-1), which state that no person shall be discriminated against on the basis of race, color,religion, sex or national origin in all phases of employment during the performance of Federalcontracts and shall take affirmative action to ensure equal employment opportunity. Theapplicant will incorporate, or cause to be incorporated, into any contract for construction work asdefined in Section 130.5 of HUD regulations the equal opportunity clause required by Section130.15(b) of the HUD regulations.
It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended(12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that tothe greatest extent feasible opportunities for training and employment be given to lower-incomeresidents of the project and contracts for work in connection with the project be awarded insubstantial part to persons residing in the area of the project.
It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended,and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based ondisability in Federally-assisted and conducted programs and activities.
It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, andimplementing regulations at 24 CFR Part 146, which prohibit discrimination because of age inprojects and activities receiving Federal financial assistance.
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It will comply with Executive Orders 11625, 12432, and 12138, which state that programparticipants shall take affirmative action to encourage participation by businesses owned andoperated by members of minority groups and women.
If persons of any particular race, color, religion, sex, age, national origin, familial status, ordisability who may qualify for assistance are unlikely to be reached, it will establish additionalprocedures to ensure that interested persons can obtain information concerning the assistance.
It will comply with the reasonable modification and accommodation requirements and, asappropriate, the accessibility requirements of the Fair Housing Act and section 504 of theRehabilitation Act of 1973, as amended.
Additional for Rental Assistance Projects:
If applicant has established a preference for targeted populations of disabled persons pursuantto 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within thedesignated population.
B. For non-Rental Assistance Projects Only.
15-Year Operation Rule.
For applicants receiving assistance for acquisition, rehabilitation or new construction: The projectwill be operated for no less than 15 years from the date of initial occupancy or the date of initialservice provision for the purpose specified in the application.
1-Year Operation Rule.
For applicants receiving assistance for supportive services, leasing, or operating costs but notreceiving assistance for acquisition, rehabilitation, or new construction: The project will beoperated for the purpose specified in the application for any year for which such assistance isprovided.
Where the applicant is unable to certify to any of the statements in thiscertification, such applicant shall provide an explanation.
Name of Authorized Certifying Official: Nelson Burns
Date: 08/17/2017
Title: President & CEO
Applicant Organization: Coleman Professional Services
PHA Number (For PHA Applicants Only):
I certify that I have been duly authorized bythe applicant to submit this Applicant
Certification and to ensure compliance. I amaware that any false, ficticious, or fraudulent
X
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statements or claims may subject me tocriminal, civil, or administrative penalties .
(U.S. Code, Title 218, Section 1001).
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8B. Submission Summary
Applicant must click the submit button once all forms have a status ofComplete.
Page Last Updated
1A. SF-424 Application Type No Input Required
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1B. SF-424 Legal Applicant No Input Required
1C. SF-424 Application Details No Input Required
1D. SF-424 Congressional District(s) 08/16/2017
1E. SF-424 Compliance 08/16/2017
1F. SF-424 Declaration 08/16/2017
1G. HUD 2880 08/16/2017
1H. HUD 50070 08/16/2017
1I. Cert. Lobbying 08/16/2017
1J. SF-LLL 08/16/2017
2A. Subrecipients No Input Required
2B. Experience 08/16/2017
3A. Project Detail 08/16/2017
3B. Description 08/17/2017
3C. Expansion 08/16/2017
4A. Services 08/16/2017
4B. Housing Type 08/16/2017
5A. Households 08/17/2017
5B. Subpopulations No Input Required
5C. Outreach 08/17/2017
6A. Funding Request 08/17/2017
6E. Rental Assistance 08/17/2017
6F. Supp Srvcs Budget 08/17/2017
6I. Match 08/17/2017
6J. Summary Budget No Input Required
7A. Attachment(s) 08/17/2017
7D. Certification 08/17/2017
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