legal services for nhap - rfa - state funds grant.docxdhhs.ne.gov/grants and contract opportunity...
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Legal Services for NHAP - RFA - State Funds Grant.docx
REQUEST FOR APPLICATIONS – STATE FUNDS
The State of Nebraska, Department of Health and Human Services, Division of Children and Family Services (“DHHS”), is issuing this Request for Applications (“RFA”) for the purposes of entering into grant agreement(s) (“grant” or “grants”) and awarding state funds to an eligible and qualified entity to assist individuals and families at risk of or experiencing homelessness. A more detailed description may be found in Project Description, Section 2.
RFA #
RELEASE Date
3671
February 4, 2021
APPLICATION DUE DATE
POINT OF CONTACT
March 4, 2021
Keith Roland/Oyinda Oyetunde
INITIAL BUDGET period
total funding available
The Later of April 1, 2021 or the Date of the Execution of the Grant - December 2021
$75,000
Grantees receiving grants may only be paid up to the actual and allowable costs (as defined herein) of completing the Project Description, Section 2. No Grants resulting from this RFA will be fee-for-service contracts, regardless of the method of payment, and no Grantee may keep a profit from its grant. More detail about the terms of this funding is set forth in Terms, Section 5, below.
A copy of this RFA may be found online at DHHS’ website at www.dhhs.ne.gov. Until final Grants are signed, all other information pertinent to this RFA, including but not limited to any amendments or addenda, will be posted on the DHHS website.
Table of Contents
1.RFA OVERVIEW3
1.1.Background and Purpose3
1.2.Funding Information3
1.3.Budget Period3
1.4.Applicable Law3
1.5.Eligible Entities4
1.6.Award of Funding4
2.PROJECT DESCRIPTION5
2.1.Background and Purpose5
2.2.Scope of Work5
2.3.Performance Requirements6
2.4.Reporting Requirements6
2.5. Additional Requirements……………………………………………………………………………………………7
3.RFA PROCEDURE8
3.1.RFA Point of Contact (“POC”)8
3.2.Schedule of Events9
3.3. Pre-Applicant Information Session………………………………………………………………………………...9
3.4.Written Questions and Answers 9
3.5.Submission of Applications10
3.6.Evaluation Committee10
3.7.Evaluation of Applications11
3.8.Late Applications11
3.9.Corrections11
3.10.Grievance and Protest Procedures11
3.11.Competition / Joint Efforts12
3.12.DHHS Reservations of Authority During Application and Evaluation Process12
4.APPLICATION INSTRUCTIONS13
4.1.Application Contents13
4.2.Applicant’s Organization Overview13
4.3.Applicant’s Work Plan13
4.4.Applicant’s Budget13
4.5. Budget Changes14
4.6.Direct Costs14
4.7.Indirect Costs14
4.8.Program Income14
5.TERMS16
5.1.Addenda16
6.GLOSSARY OF TERMS17
RFA OVERVIEW
Funding Information
The total anticipated available funds for Grant(s) under this RFA is $75,000 (seventy-five thousand dollars). A total award of this amount of funds is not guaranteed, but is subject to the Applications received, to actual money appropriated to DHHS, and to DHHS’ discretion. DHHS may establish a cap on total amount of funds that any one Applicant, or Applicants acting jointly, may request. Any cap shall be set forth in the Applications Instructions, Section 4.4, below. The total funds may be split among multiple Grantees in the discretion of DHHS.
Budget Period
The Budget Period is the time during which a successful Applicant may incur costs and expend awarded funds to carry out the work authorized under this RFA and the resulting Grant. For purposes of this RFA and resulting Grant, DHHS will apply the definition of “budget period” in 2 CFR § 200.1, as that section was revised effective November 12, 2020. See 85 FR 49506. The initial Budget Period for this RFA is the later of April 1, 2021 or the Date of the Execution of the Grant to December 31, 2021. This period may be extended by DHHS.
For the initial Budget Period, all costs must be invoiced to DHHS by January 15, 2022 and liquidated (i.e., spent) by December 31, 2021. These dates are dependent on DHHS’ own ability to timely process payments. They may be subject to change; final dates will be included in the final Grant between the parties. If an Applicant believes it cannot meet these deadlines, it should not apply for funding under this RFA. Obligation and liquidation deadlines may be extended, but no extensions are guaranteed. Future Budget Periods, as allowed by DHHS, may have different obligation and liquidation deadlines.
Applicable Law
For purposes of this RFA and resulting Grant, DHHS will apply the Uniform Grant Guidance, in addition to all applicable state law. The Uniform Grant Guidance, 2 CFR §§ 200 et seq. (“UGG”) generally applies to grants funded from the United States Department of Agriculture (USDA), the Department of Housing and Urban Development (HUD), the Department of Labor (DOL), the Environmental Protection Agency (EPA) or other federal agencies.
Additional state statutes and regulations may apply to the funding contained herein. These may be included in Additional Program Requirements, Section 5.7, below, as well as in the Grant itself.
Further information about allowable costs and activities may be set forth herein.
Eligible Entities
Any Applicant for this RFA must be a “non-federal entity,” as defined 2 CFR § 200.1. A “non-federal entity” is limited to local governments, Indian tribes, institutions of higher education, or nonprofit organizations; further definitions in the UGG may apply. Any Application submitted by an Applicant who is ineligible will be rejected without scoring.
1.1.1. This RFA is only open to Applicants who were awarded funding by Nebraska Homeless Assistance Program (NHAP) in State Fiscal Year 2021 (July 1, 2020 to June 30, 2021).
1.1.2. To be eligible for this funding, entities must meet one of the following provisions:
1.1.2.1. Provide transitional living services for at least eight hours of every twentyfour hour period, as defined by the state and federal rules and regulations governing HUD’s Emergency Solutions Grant (ESG) program and/or Nebraska’s Homeless Shelter Assistance Trust Fund (HSATF).
1.1.2.2. Provide homelessness prevention, rapid rehousing, street outreach and/or shelter services for individuals and/or families who are homeless or at risk of homelessness in compliance with the state and federal rules and regulations governing HUD’s ESG program and/or Nebraska’s HSATF.
1.1.3. In order to be eligible for NHAP funding, entities must:
1.1.3.1. Provide documentation from one of the three Continuums of Care in the State of the need for the proposed services identified in their application.
1.1.3.2. Be exempt from taxation under section 501(c) 3 of the Internal Revenue of 1986 or represent a number of eligible applicants.
1.1.3.3. Not discriminate based on age, religion, sex, race, color, disability, sexual orientation, gender identity or national origin (24 CFR 5).
1.1.3.4. Operate a drug-free premises.
1.1.3.5. Conduct an annual, certified, external financial audit/financial report within the last 12 months.
1.1.4. To be eligible for funding for the emergency shelter component, entities must maintain shelter facilities in compliance with HUD’s minimum standards at 24 CFR 576.403, and entities must obtain approval by local governments for all cities or counties where shelter will occur. Local government approval is required even for entities providing motel/hotel vouchers via Form 6, attached.
Award of Funding
DHHS will evaluate Applications in the manner set forth herein. An Intent to Award will be posted on the DHHS Website with selected Applicants. Funds will be awarded through a written agreement, termed a Grant, which will incorporate this RFA by reference. No promise for funds is binding on DHHS, and no funds will be paid to any Applicant, until a Grant has been executed by both the Applicant and DHHS.
PROJECT DESCRIPTION
Background and Purpose
DHHS, Division of Children and Family Services Nebraska Homeless Assistance Program (NHAP) is issuing this RFA for the purposes of assisting individuals and families at risk of, or experiencing homelessness.
NHAP is authorized to release emergency funds from the Homeless Shelter Assistance Trust Fund (HSATF) by DHHS Program Regulations 462. 462 NAC 1-001.03 states “the Nebraska Department of Health and Human Services will set aside up to $75,000 of the Homeless Assistance Trust Fund to be used for emergency or for discretionary situations that occur outside of the annual Homeless Shelter Assistance Trust Fund program cycle, related to the support of homeless and near homeless populations.”
These emergency funds are to be used to help prepare for, respond to, and prevent the spread of COVID-19 among individuals and families at risk of and experiencing homelessness.
Scope of Work
Agencies awarded this funding will be responsible for providing homeless assistance services within their respective service areas for the purpose of preventing, preparing for, and responding to COVID-19. Agencies may apply for funding for the following service components: street outreach, emergency shelter, homeless prevention, and rapid rehousing. All Awardees are responsible for the following:
1.1.5. Complying with federal and state Emergency Solutions Grant (ESG), Emergency Solutions Grant – COVID 19 CARES Act Funding (ESG-CV), and Homeless Shelter Assistance Trust Fund requirements found in the Code of Federal Regulations Title 24 Part 576 (ESG), Notice CPD-20-08: Waivers and Alternative Requirements for the ESG Program Under the CARES Act, Nebraska Revised Statute §§ 68-1601 through 68-1608 and Nebraska Administrative Code Title 462 (HSATF).
1.1.6. Complying with the written ESG/NHAP standards approved by the relevant Continuum of Care, which can be found on the NHAP website at: http://dhhs.ne.gov/Pages/Nebraska-Homeless-Assistance-Program-Providers.aspx.
1.1.7. Assisting homeless individuals in obtaining permanent housing.
1.1.8. Assisting homeless individuals or individuals at risk of homelessness in accessing appropriate supportive services (including medical and mental health treatment, counseling, supervision, and other services essential for achieving independent living).
1.1.9. Assisting homeless individuals or individuals at risk of homelessness in accessing Federal, State, local assistance as needed to achieve stability.
1.1.10. Involving homeless individuals and families in constructing, renovating, maintaining, operating, and providing homeless assistance services. This involvement can be through employment or volunteer efforts.
1.1.11. Following the NHAP Homeless Management Information System (HMIS) workflow and participate in NHAP’s identified HMIS database by entering all required NHAP and HUD data elements on all persons served and all NHAP-funded activities, with the exception of victim or legal service providers who agree to collect all of required NHAP and HUD data elements on all persons served and all NHAP-funded activities and enter them into an electronic database system which is comparable to the HMIS.
1.1.12. Assessing client eligibility and obtaining the necessary documentation to verify the client, the payment/service provided and the housing unit meet HUD’s ESG requirements at 24 CFR 576:
http://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title24/24cfr576_main_02.tpl
1.1.13. Complying with the ESG program requirements identified in 24 CFR Part 576 , including, but not limited to the following:
1.1.13.1. Verification of participant eligibility for services and/or financial assistance;
1.1.13.2. Ensuring program participant housing and shelter facilities comply with HUD’s lead-based paint and ESG habitability standards;
1.1.13.3. Use of a centralized or coordinated program participant assessment, as developed by the relevant Continuum of Care. Awardees meeting HUD’s definition of a “victim service provider” may choose not to use the Continuum of Care’s centralized or coordinated assessment system; and
1.1.13.4. Adherence to HUD’s final rule providing equal access to HUD assisted or insured housing without regard to actual or perceived sexual orientation, gender identity or marital status and prohibiting inquiries regarding sexual orientation or gender identity.
1.1.14. Creating and keeping records to enable DHHS and HUD to determine whether program requirements are being met, allowing DHHS and HUD access to HMIS for NHAP funded records
1.1.15. Entering complete, accurate and timely program and participant data in HMIS, or comparable database for agencies exempt from the federal HMIS requirement as identified in 24 CFR §§ 576 et seq. Data shall include at a minimum the required data elements as defined by HUD and shall be entered as close to real time as possible.
1.1.16. When referring a NHAP program participant for legal services, provide written certification to Legal Aid of Nebraska, on a form approved by DHHS, indicating the participant has been screened and is eligible for street outreach, emergency shelter, homelessness prevention or rapid rehousing services. The referral form for Legal Aid is located at: http://dhhs.ne.gov/Pages/Nebraska-Homeless-Assistance-Program-Providers.aspx.
1.1.17. Participating in required educational/technical assistance sessions.
1.1.18. Subscribing to and utilizing NHAP’s Provider webpage for funding and resource information at the following current location, or as later modified by DHHS: http://dhhs.ne.gov/Pages/Nebraska-Homeless-Assistance-Program-Providers.aspx.
1.1.19. Subscribing to and utilizing HUD’s Exchange Mailing List page for ESG and ESG-CV related updates and announcements
Performance Requirements
1.1.20. Awardees must serve the number of individuals and households outlined by the Awardee in Form 4 (attached hereto).
1.1.21. Awardees must meet or increase the percent of individuals who discharge to Permanent Housing. The Awardees baseline performance measurement is established in Form 4.
1.1.22. Awardee must submit required performance measurements in the format established by NHAP on a quarterly basis or as requested by NHAP.
1.1.23. At any time during the term of the award, DHHS may require the Awardee to provide written justification if the performance goals set by the Awardee are not met.
1.1.24. Future project funding is subject to Awardee meeting the performance standard or providing adequate justification, subject to DHHS approval.
1.1.25. Applicants must provide proposed performance outcomes using Form 4.
Reporting Requirements
1.1.26. Awardees must gather and record the necessary information into the Homeless Management Information System (HMIS) (or comparable system for domestic violence service or legal services providers exempt from using HMIS).
1.1.27. Awardees in the Omaha Continuum of Care (CoC) must submit complete and accurate quarterly data reports for the preceding quarter to the HMIS System Administrator selected by the Omaha CoC by the due dates below.
Period
Due Date
The later of April 1, 2021 or the date of execution of the grant to June 30
July 5
July 1 – September 30
October 5
October 1 – December 31
January 5
1.1.28. Awardees in the Balance of State or Lincoln Continuums of Care must submit complete and accurate quarterly data reports for the preceding quarter to the HMIS System Administrator selected by the Balance of State CoC by the due dates below.
Period
Due Date
The later of April 1, 2021 or the date of execution of the grant to June 30
July 10
July 1 – September 30
October 10
October 1 – December 31
January 10
1.1.29. Awardees, who are domestic violence shelters or legal services providers and who do not utilize the HMIS System, must submit complete and accurate quarterly data reports for the preceding quarter to the NHAP office by the due dates below.
Period
Due Date
The later of April 1, 2021 or the date of execution of the grant to June 30
July 10
July 1 – September 30
October 10
October 1 – December 31
January 10
1.1.30. Provide reports, data and other information as requested by DHHS for review and programmatic monitoring by the due dates established.
Additional Requirements
1.1.31. Provide approval of the Application from the Continuum of Care, Form 5.
1.1.32. For emergency shelters, including motel/hotel vouchers, provide certification of local government approval, Form 6.
1.1.33. Signed Verification of Participation in the Continuum of Care and approval of the application for emergency funding (Form 5).
1.1.34. If applying for Emergency Shelter funding, approval of emergency shelter activities by local government for all cities or counties where shelter will occur (Form 6).
1.1.34.1. This approval must be obtained even if applicants are providing motel/hotel vouchers.
RFA PROCEDURE
This RFA seeks Applications to complete activities described in section 2, above. All Applications must conform to all instructions, conditions, and requirements included in this RFA. Applicants should carefully examine this RFA, as well as the requirements of the state or federal funds involved. Applications that DHHS determines do not conform to the requirements of this RFA, or Applications from ineligible entities, may be considered non-responsive and rejected without scoring.
RFA Point of Contact (“POC”)
Keith Roland/Oyinda Oyetunde
PO Box 94926
Lincoln, NE 68508
402-471-0727 [email protected]
From the date the RFA is issued until the Intent to Award is issued, communication from the Applicant or prospective Applicant is limited to the POC listed above (but see exceptions, below). After the Intent to Award is issued, the Applicant may communicate with individuals DHHS has designated as responsible for negotiating the Grant on behalf of DHHS. No member of the state government, employee of the state, or member of the Evaluation Committee is empowered to make binding statements regarding this RFA. The POC will issue any clarifications or opinions regarding this RFA in writing. Only the POC has the authority modify the RFA, answer questions, or render opinions on behalf of DHHS. Applicants shall not have any communication with, or attempt to communicate or influence any Evaluator.
The following exceptions to these restrictions are permitted:
1. The email submission of the Application to the designated email address designated in Submission of Applications, Section 3.5;
2. Contact made pursuant to pre-existing contracts, grants, or obligations;
3. Contact required by the schedule of events or an event scheduled later by the RFA POC; and
4. Contact required for negotiation and execution of the final grant.
DHHS reserves the right to reject an Applicant’s application, withdraw an Intent to Award, or terminate a Grant if DHHS determines there has been a violation of these procedures.
Schedule of Events
1
Release RFA
February 4, 2021
Pre-Applicant Information Session
February 10, 2021
2:00 pm Central Time
Last day to submit written questions
February 17, 2021
1
State responds to written questions through RFA “Addendum” and/or “Amendment” to be posted to the Internet at: http://dhhs.ne.gov/Pages/Grants-and-Contract-Opportunities.aspx
February 24, 2021
1
Application Review Period Begins (Application due date)
March 4, 2021
2:00 PM Central Time
1
Evaluation Period
March 4, 2021 to March 26, 2021
1
Post “Intent to Award” to Internet at: http://dhhs.ne.gov/Pages/Grants-and-Contract-Opportunities.aspx
March 29, 2021
2
Budget Period Start*
The Later of April 1, 2021 or the Date of the Execution of the Grant
*The Budget Period start may occur before a Grant is finalized, agreed to, and executed by the parties. Because this is just the period during which costs may be incurred, it does not reflect that any agreement between DHHS and any successful Applicant has gone into effect or is binding in any way. No binding agreement has been made between DHHS and any Applicant until a Grant is fully executed by both parties.
Pre-Applicant Information Session
DHHS will host a Pre-Applicant information session at the date and time listed above. Entities that are interested in applying for this RFA may participate via Webex by having a representative attend.
At the Pre-Applicant Information Session, the POC or a designated DHHS representative will provide general information about the funding and answer questions from potential Applicants.
At the date and time listed above in the Schedule of Events, entities can join the Webex meeting by clicking on the following link:
Join from the meeting link
https://nvcn-cio.webex.com/nvcn-cio/j.php?MTID=m02e232a088d75e5a954b33f82071abd9
Join by meeting number
Meeting number (access code): 145 010 6275
Meeting password: aNcyB3GKp23
Join from a mobile device (attendees only)
+1-415-655-0003,,1450106275## US Toll
Join by phone
+1-415-655-0003 US Toll
Global call-in numbers
Written Questions and Answers
Questions regarding information needed for an Application, as well as the meaning or interpretation of any RFA provision, must be submitted in writing to POC via email and clearly marked “RFA Number 3671; Questions.” The POC is not obligated to respond to questions that are received late, as set forth in the Schedule of Events.
Applicants should present, as questions, any assumptions upon which the Application is or might be developed. Applications will be evaluated without consideration of any known or unknown assumptions of an Applicant. The Grant will not incorporate any known or unknown assumptions of an Applicant.
Questions must be sent via e-mail to [email protected]. DHHS recommends that Applicants submit questions using the following format:
RFA Section Reference
RFA Page Number
Question
Written answers will be posted at the DHHS Website per the Schedule of Events. Written answers will become part of this RFA.
Submission of Applications
Applicants must submit a complete Application, including all the parts required herein, in one of three ways:
Electronically via email to [email protected]. The subject of the email shall indicate “RFA # (with the appropriate number filled in): Response of [Name of Organization].” The email shall include the Application as a single Portable Document Format (PDF) or multiple PDFs. Failure to provide the Application in the correct format may result in DHHS being unable to read or open the Application and thus rejecting it without Evaluation. The email shall request a read receipt. A read receipt will be supplied to the Applicants upon receipt of the email by DHHS’ Central Procurement Services. Central Procurement Services shall not forward the Applications to the program until the beginning of the Application Review Period.
Submission directly to the POC via United States Postal Service mail. The Application shall be sent to the POC’s address listed above in Point of Contact, Section 3.1. The Application itself shall remain sealed and shall not be opened until the beginning of the Application Review Period.
Hand delivered responses or responses delivered by FedEx or UPS should be delivered to:
ATTN: Oyinda Oyetunde
DHHS - 3rd Floor Reception Desk
301 Centennial Mall South
Lincoln, NE 68509
The Application itself shall remain sealed and shall not be opened until the beginning of the Application Review Period.
Regardless of submission method, Applicants must use the forms supplied by DHHS in this RFA unless specifically otherwise indicated herein. All Applications must be received by the beginning of the Application Review Period, as stated in the Schedule of Events, Section 3.2.
Evaluation Committee
Applications are evaluated by members of an Evaluation Committee(s). The Evaluation Committee(s) will consist of individuals selected at the discretion of DHHS. All members of the Evaluation Committee will disclose to DHHS any potential conflicts of interest before evaluation. Members with a conflict will be removed from the Evaluation Committee before scoring.
Any contact, attempted contact, or attempt to influence an evaluator that is involved with this RFA may result in the rejection of this Application and further administrative actions.
Evaluation of Applications
All complete Applications that are responsive to the RFA will be evaluated. DHHS reserves the right to evaluate Applicants and award funds in a manner utilizing criteria selected at DHHS’ discretion and in the best interest of meeting the objectives of the funding involved. The Evaluation will be conducted by the following method:
DHHS will initially evaluate all Applications to determine whether the Applicant is an eligible entity; whether the Application meets the minimum requirements of this RFA; and whether the Applicant poses risk of noncompliance with statutes, regulations, and the terms and conditions of the Grant, such that DHHS should not award funding. DHHS will award to the top scoring Applicant or Applicants, as DHHS determines and as funding allows. DHHS will conduct a fair, impartial, and comprehensive evaluation of all Applications in accordance with the predetermined criteria based on the Application. The Applicant’s responses to the Forms will be scored through a point method set forth below. DHHS will evaluate on the following categories with a maximum point potential for each:
1. Applicant’s Organizational Overview. Applicants will receive high scores if they have a defined and clear organizational structure; organizational experience in federal grants; qualified and capable personnel with experience in federal grants or equivalent credentials or experience; or can otherwise demonstrate that they will be a reliable Grantee who will use all awarded funds in a manner consistent with law and the requirements of this RFA. (25 points)
2. Applicant’s Work Plan. Applicants will receive higher scores if their work plan responds to the Project Description and meets the goals or objectives of the state funding and RFA, as well as evidencing the ability to meet expected outcomes, adhere to reporting deadlines or other deadlines, and complete any required evaluation activities. DHHS exercises sole discretion as to whether the Application adequately addresses the purposes and objectives of the state funding DHHS has received. (125 points)
3. Applicant’s Budget. Applicants must use the Budget sections of Form 4 to complete the budget. will receive higher scores if the budget is tailored to the work plan and utilizes allowable direct and indirect costs. Total request for funding itself will not determine score; rather, Applicants will be scored based on whether budget accurately reflects allowable costs of completing the work set forth in the work plan. (25 points)
4. Performance Measurements. Applicants will be evaluated based on responses to the Performance Measurements sections of Form 4. (25 points)
There are 200 total points available for Applications under this RFA.
DHHS may award to a single top Applicant, or may award to multiple top scoring Applicants, in its sole discretion. If all Applicants meet the minimum requirements and are meritorious, DHHS may also elect to award to all Applicants.
Late Applications
Applications received after the time and date of the Application opening will be considered late Applications. Late Applications will be rejected. All Applications must be electronically or physically received by the date and time of the Application Opening. The State is not responsible for Applications that are late or lost regardless of cause or fault. It is the Applicant’s responsibility to ensure Applications are received timely.
Corrections
An Applicant may correct a mistake in an Application prior to the time of opening by giving written notice to the POC of intent to withdraw the Application for modification, or to withdraw the Application completely. Changes in an Application after the Evaluation Period has begun are acceptable only if the change is made to correct a minor error. Whether an error is minor shall be determined by DHHS.
Grievance and Protest Procedures
All grievances must follow the DHHS Subaward and Grant Grievance/Protests Procedures, available on the DHHS website. Grievances must be filed timely.
Competition / Joint Efforts
Applicants may cooperate or submit Applications jointly, but all such Applications must clearly identify the Applicants involved, the roles each will have administering the grant, and that they are eligible for the grant, as set forth herein. Applicants may create a legal entity, or describe a plan for the creation of a legal entity, as a cooperative or joint venture if the entity itself is eligible for the grant and all Applicants are also eligible. DHHS shall determine the proper method for any resulting grant, should the joint Applicants be selected for funding.
DHHS Reservations of Authority During Application and Evaluation Process
After Evaluation of the Applications, or at any point in the RFA process, DHHS may take one or more of the following actions:
1. Amend the RFA;
2. Extend the time of or establish a new Application opening time (i.e., allowing additional time to submit Applications);
3. Waive deviations or errors in the RFA process and in Applications that are not material, do not compromise the RFA process or an Application, and do not improve an Applicant’s position;
4. Accept or reject a portion of or all of an Application;
5. Accept or reject all Applications;
6. Withdraw the RFA; or
7. Elect to reissue the RFA.
DHHS reserves the right to adjust the Applicant’s budget with successful Applicants after the Intent to Award is issued. DHHS also reserves the right to adjust the Work Plan with Applicant to meet the requirements of the grant, law, or to meet DHHS programmatic needs. DHHS also reserve the right to apply additional conditions based on the successful Application and the result of a pre-award risk assessment. If a scoring method is used to rank applications to determine funding amounts, all adjustments shall have no bearing on rank
If DHHS rejects all Applications, it may enter either reissue an RFA with the same or different specifications and terms, or it may negotiate a single or multiple Grants with individual Applicants or non-Applicants.
APPLICATION INSTRUCTIONS
Application Contents
A complete, responsive Application must contain the following completed documents:
Form 1 – Application Form and Cover Sheet;
Form 2 – Organization Overview
Form 3 – Applicant’s Work Plan
Form 4 – Applicant Budget and Proposed Performance Outcomes
Form 5 – CoC Verification; and
Form 6 – Certification of Local Government Approval, if applicable
Applications that do not contain all of the required sections will be rejected. An editable Microsoft Word-formatted document of the Forms will be posted on the DHHS Website, which Applicants may fill in and submit.
Applicant’s Organizational Overview
The Applicant’s Organization Overview section shall contain the following information about the Applicant. If the Application is a cooperative or joint venture between two or more entities, all information required in this section shall be provided for all entities, even if a new legal entity has been created or is planned to be created for the purposes of the Grant.
1. Organization Information. Applicant’s full legal name, including any other “doing business as” names, or any previous names the organization used.
2. Summary of Federal Grants Experience. A description of Applicant’s previous experience with receiving federal funds. This shall include, but not be limited to, experience receiving federal funds as a recipient or a Grantee. Applicant should describe and demonstrate knowledge of the Uniform Grant Guidance, as well as any specific experience with the particular federal program and funding source that funds this RFA.
3. Summary of Programmatic Experience. A description of Applicant’s experience with the type of programming or work contained in the Project Description, or other relevant work.
4. Personnel and Management. Applicant should identify individuals employed by Applicant, on its board of directors, or otherwise affiliated with Applicant, who have a demonstrated knowledge or experience with federal grants, the Uniform Grant Guidance, programmatic experience, or other relevant experience.
5. Agreements Terminated or Costs Disallowed. Applicant must provide a summary of any agreements executed within the last five (5) years with federal awarding agencies or pass-through entities (either as grant agreements, cooperative agreements, subawards, or contracts) that:
· Were terminated for cause; or
· Where Specific Conditions were placed on Applicant (see 2 CFR § 200.207).
If an Applicant has been debarred by the United States Federal government, it is not eligible to receive funding under this RFA.
Applicant’s Work Plan
The Work Plan must respond in detail to the Project Description. It must contain a description of the work activities Applicant is proposing to complete under the RFA. It should contain an understanding of the requirements for the project under the applicable state funding sources, and, as applicable, descriptions of timelines, outcome/process measures, and program evaluation activities.
Applicant’s Budget
Each budget should contain only costs that are allowable under the applicable statutes, regulations, terms and conditions of this RFA. Applicants will not be allowed to change their budgets once submitted to DHHS, unless the POC specifically requests, in writing, budget changes. Budgets may be modified as required by DHHS or in agreement between DHHS and the Applicant after the Intent to Award is announced. Applicants should not rely on budget changes or modifications in submitting their proposed budget, but should be able to perform the program activities consistent with their budget.
If an Applicant has or has prepared a cost allocation plan for this grant, it may submit it along with the Application.
· If Applicants plan to charge indirect costs other than through a cost allocation plan, Applicants thus must provide one of the following along with their budget: 1) A current federally-approved indirect cost rate agreement;
· Addendum C - HIPAA Business Associate Agreement Provisions – State Funds Grants
DHHS reserves the right to amend these terms at any time during the RFA; to negotiate the terms with selected Applicants; to amend or change these terms for any subsequent Grant signed and executed by the parties; or any combination of the above. Terms required by federal or state law will not be negotiated, and if an Applicant cannot agree to these terms, DHHS may withdraw or modify the Intent to Award and take any of the actions set forth herein.
Budget Changes
The final Grant may contain terms to allow a Grantee to modify a budget, with or without approval from DHHS. Applicants should not, however, rely on this when submitting budgets.
Direct Costs
Under this Grant, DHHS shall only pay for actual and allowable costs (as defined in this section and the authorities cited herein) incurred during the Budget Period.
To be allowable, all costs must be:
· Necessary for the performance of the Grant activities;
· Reasonable, as provided in 2 CFR § 200.404 ;
· Allocable to the federal award, as provided in 2 CFR § 200.405 ;
· Consistent with all other requirements of the Cost Principles in 2 CFR § 200 Subpart E ; and
· Consistent with all other law, regulation, policy, or other requirements applicable to the state or federal funds involved.
To be actual, all costs must be finalized and spent by the appropriate dates set forth in the Grant.
Applicants should be aware that direct personnel costs must be consistent with 2 CFR § 200.430, as applicable. These costs must be able to be backed by sufficient documentation, or must be shown to be allocable to the award via an alternative, allowable method, such as a random moment time study.
Indirect Costs
Federal law defines indirect costs as “costs incurred for a common or joint purpose benefitting more than one cost objective, and not readily assignable to the cost objectives specifically benefitted, without effort disproportionate to the results achieved.” 2 CFR § 200.1. All indirect costs may only be paid if they are consistent with the UGG.
As provided in 2 CFR § 200.414, indirect costs may only be paid from a grant if paid through a federally-approved rate or a rate negotiated between DHHS and the Applicant. If the Applicant has never had a federally-approved indirect rate, it may charge indirect costs as consistent with the federal rules for de minimis indirect costs.
Cost Allocation plans may set forth a direct allocation of all costs under a grant, or may allocate only a portion of those costs along with an indirect rate. Grantees may not, however, charge items as direct costs and also as indirect costs.
Program Income
Any revenue generated by the Grant is Program Income (see definition in 2 CFR § 200.1). Program Income requires an accounting of its use and must be handled in accordance with 2 CFR § 200.307. All program income generated by the Grants awarded as a result of this RFA must be handled under the method. Please see the regulations cited above for more detail.
TERMS
Applicants must be aware of the following terms when submitting their Applications. These terms will be included in the resulting Grant between the parties, as well.
Addenda
The following Addenda will be incorporated into any Grant with a selected Applicant:
· Addendum A - DHHS General Terms – State Funds Grants
· Addendum B - Insurance Requirements – State Funds Grants
· Addendum C - HIPAA Business Associate Agreement Provisions – State Funds Grants
DHHS reserves the right to amend these terms at any time during the RFA; to negotiate the terms with selected Applicants; to amend or change these terms for any subsequent Grant signed and executed by the parties; or any combination of the above. Terms required by federal or state law will not be negotiated, and if an Applicant cannot agree to these terms, DHHS may withdraw or modify the Intent to Award and take any of the actions set forth herein.
GLOSSARY OF TERMS
All terms shall have the meaning as set forth in 2 CFR §§ 200 et seq. or 45 CFR §§ 75 et seq. unless otherwise specifically set forth herein.
Agent/Representative: A person authorized to act on behalf of another.
Amend: To alter or change by adding, subtracting, or substituting.
Amendment: A written correction or alteration to a document.
Applicant: Non-Federal Entity that has applied for funding under this RFA.
Application: The written proposal submitted by the Applicant applying for funding under this RFA, which is composed of Forms 1 through 5.
Application Due Date: The date the RFA must be submitted to DHHS, and if not submitted by that time, rejected.
DHHS Website: www.dhhs.ne.gov
Evaluation: The process of examining an Applicant after opening to determine the Applicant’s responsibility, responsiveness to requirements, and to ascertain other characteristics of the Application that relate to determination of the successful award.
Evaluation Committee: Committee(s) appointed by DHHS that advises and assists DHHS in the evaluation of Applications.
Evaluator: An individual on the Evaluation Committee who advises and assists in the evaluation of Applications.
Grant: The Agreement executed, pursuant to the terms of the RFA, between DHHS and the Applicant.
Grantee: The entity that has executed a Grant with DHHS.
HHS Grants Guidance (“HHSGG”): The regulations codified at 45 CFR §§ 75 et seq., a re-codified version of the UGG, which provide the general administrative requirements for grant funding flowing down from the federal Department of Health and Human Services. See also Uniform Grant Guidance.
Intent to Award: A document noting the results of the RFA evaluation process, and identified any identified Applicant(s) with whom DHHS intends to award federal funds, but not a binding agreement with any promise to award.
Mandatory/Must: Required, compulsory, or obligatory.
May: Discretionary, permitted; used to express possibility.
Must: See Mandatory/Must and Shall/Will/Must.
Non-Responsive: When an Application does not meet the minimum requirements of this RFA.
Point of Contact (“POC”): The person designated to receive communications and to communicate.
Request for Applications (“RFA”): Written solicitation of competitive applications for federal grant funding.
Shall/Will/Must: An order/command; mandatory.
Should: Expected; suggested, but not necessarily mandatory.
Uniform Grants Guidance (“UGG”): The regulations codified at 2 CFR §§ 200 et seq., which provide the general administrative requirements for grant funding flowing down from the federal government. See also HHS Grants Guidance.
Will: See Shall/Will/Must.
FORM 1 – APPLICATION COVER SHEET
Instructions: This form must be signed and returned, along with the application materials, before the Application Due Date, to the POC or designated email address, as applicable.
RFA #
RELEASE Date
3671
February 4, 2021
APPLICATION DUE DATE
POINT OF CONTACT
March 4, 2021
Keith Roland/Oyinda Oyetunde
CERTIFICATION AND GUARANTEE OF COMPLIANCE
By signing this Application Cover Sheet, the Applicant guarantees compliance with the provisions stated in this Request for Application and certifies that all information contained in this Application is accurate. This Application is submitted pursuant to the terms of the RFA, and if the Applicant is awarded funding, it will be incorporated into the Grant between the parties. I understand that if anything in this Application conflicts with the RFA or with the subsequent Grant, the Grant and RFA shall govern as set forth in the Grant.
ORGANIZATION: _________________________________________________________________________
COMPLETE ADDRESS: ___________________________________________________________________
_______________________________________________________________________________________
CONGRESSIONAL DISTRICT: ____________________
TELEPHONE NUMBER: ___________________________ EMAIL ADDRESS: ________________________
_____ I CERTIFY THAT THIS ORGANIZATION IS AN “ELIGIBLE ORGANIZATION” AS DEFINED BY THIS RFA.
_____ I CERTIFY THAT THIS ORGANIZATION IS NOT PRESENTLY DEBARRED OR SUSPENDED.
SIGNATURE: ____________________________________________________________________________
TYPED NAME & TITLE OF SIGNER: _________________________________________________________
FORM 2 – APPLICANT’S ORGANIZATION
Applicant’s Mailing Address: Enter Name
Applicant’s Website: Enter Website Address
Applicant’s Fiscal Year Start Date: Select Start Date
End Date: Select End Date
Executive Director/President’s Name: Enter Name
Board Chair/President’s Name: Enter Name
Program Contact’s Name: Enter Name
Program Contact’s Title: Enter Title
Program Contact’s Email: Enter Email
Program Contact’s Phone: Enter Phone
21
Program Type – check all that apply:
☐ Emergency Shelter
☐ Transitional Housing
☐ Street Outreach
☐ Homeless Prevention
☐ Rapid Rehousing
Bed Type (for shelters only) – select one: Select Type
Population Served – select all that apply:
☐ Single adult males
☐ Single adult females
☐ Couples with children
☐ Couples without children
☐ Adult males with children
☐ Adult females with children
☐ Unaccompanied young males
☐ Unaccompanied young female
Primary Population/Need Served - select one: Select Primary
Counties Your Agency Serves in this Continuum of Care Region – enter all counties your agency serves in this Region (do NOT include counties outside of this Region as your submission of the application is an acknowledgement that you will not request reimbursement for clients in counties outside of the CoC. If you serve counties in multiple CoC regions then you need to submit an application for each CoC region (see next question) to provide NHAP billable services to your agency’s entire population): Enter Counties Served
Organizational Overview Questions
1. Organization Information. Applicant’s full legal name, including any other “doing business as” names, or any previous names the organization used.
2. Summary of Federal Grants Experience. A description of Applicant’s previous experience with receiving federal funds. This shall include, but not be limited to, experience receiving federal funds as a recipient or a Grantee. Applicant should describe and demonstrate knowledge of the Uniform Grant Guidance, as well as any specific experience with the particular federal program and funding source that funds this RFA.
3. Summary of Programmatic Experience. A description of Applicant’s experience with the type of programming or work contained in the Project Description, or other relevant work.
4. Personnel and Management. Applicant should identify individuals employed by Applicant, on its board of directors, or otherwise affiliated with Applicant, who have a demonstrated knowledge or experience with federal grants, the Uniform Grant Guidance, programmatic experience, or other relevant experience.
5. Agreements Terminated or Costs Disallowed. Applicant must provide a summary of any agreements executed within the last five (5) years with federal awarding agencies or pass-through entities (either as grant agreements, cooperative agreements, subawards, or contracts) that:
· Were terminated for cause; or
· Where Specific Conditions were placed on Applicant (see 2 CFR § 200.207).
If an Applicant has been debarred by the United States Federal government, it is not eligible to receive funding under this RFA.
FORM 3 – APPLICANT’S WORK PLAN
The Work Plan must respond in detail to the Project Description. The Work Plan must describe the needs in the Applicant’s service area due to the pandemic, and how the Applicant plans to meet that need. It should contain an understanding of the requirements for the project under the applicable state funding sources, and, as applicable, descriptions of timelines, outcome/process measures, and program evaluation activities.
FORM 4 – APPLICANT’S BUDGET AND PERFORMANCE OUTCOMES
Budget Criteria
Funding Request (Total NHAP Funding Request, should equal the combined total of the NHAP funding request for each service)
Total Funding Request: Enter amount
· NHAP Funding Request is for the following Program Type – check all that apply:
☐ Street Outreach
☐ Emergency Shelter
☐ Homelessness Prevention
☐ Rapid Rehousing
REQUEST FOR FUNDING
Under the detailed budget narratives on the following pages provide clear, complete and accurate information to support requested funding and demonstrate performance. All requested information needs to be completed for each component proposed. If a component is not requested, that component’s section may be deleted.
DEMONSTRATED PERFORMANCE
As part of the HEARTH Implementation Act, performance measures are to be used to demonstrate outcomes. These outcomes in turn measure program progress in meeting the defined goals and objectives. Primary goals of NHAP is ensuring that homelessness is brief, rare and only a one-time occurrence.
HUD requires all Emergency Solutions Grants subrecipients to enter required HUD data elements into HMIS or comparable database system.
STREET OUTREACH BUDGET
Funding Request
Requested Emergency funding for Street Outreach: Enter amount
Street Outreach Detailed Budget
Street Outreach (SO) Services
NHAP Request
Other Funds
Grand Total
Engagement Activities
Enter amount
Enter amount
Enter amount
Case Management
Enter amount
Enter amount
Enter amount
Legal Services
Enter amount
Enter amount
Enter amount
Emergency Health Services (licensed provider)
Enter amount
Enter amount
Enter amount
Emergency Mental Health Services (licensed provider)
Enter amount
Enter amount
Enter amount
Transportation
Enter amount
Enter amount
Enter amount
SO Services Direct Cost Allocation (if applicable)
Enter amount
Enter amount
Enter amount
SO SERVICES SUBTOTAL
Enter amount
Enter amount
Enter amount
Indirect Cost Rate (if applicable):
Enter amount
Enter amount
Enter amount
Street Outreach TOTAL
Enter amount
Enter amount
Enter amount
Street Outreach narrative: Provide a narrative description of the activities being proposed and a detailed description of how each line item was calculated (e.g., breakdown of personnel costs, service cost calculations, methods of determining cost allocation percentages, detail of operational expenses, etc.). Provide the total amounts, description, and name of funding source of other funds utilized to support the agency’s street outreach efforts. Please describe if the funding is confirmed or pending. If “Other Funds” is left blank or has a zero provide detail as to why no other funding is sought or received. Points will be deducted if the service narrative does not contain sufficient budget breakdown detail to replicate the calculated budget totals.
Enter Explanation
STREET OUTREACH PERFORMANCE
Populations Served 7/1/19 to 6/30/20
A. Population Served
B. Outcome Measures
C. Percent Achieved
B÷A=C
Unduplicated total number of adult "leavers" of homeless individuals served with Street Outreach
# of adult leavers:
Assessments for Coordinated Entry
Unduplicated number with assessments for Coordinated Entry
#
%
Exits to Positive Housing Destination
Unduplicated number placed in positive housing destinations at program exit
#
%
· Proposed % of individuals with assessments for Coordinated Entry:
· Proposed % of individuals exiting to Permanent Housing Destinations:
· Unduplicated count of individuals proposing to serve by Street Outreach with the Emergency Funds: #
· Unduplicated count of households proposing to serve by Street Outreach with the Emergency Funds: #
EMERGENCY SHELTER BUDGET
Funding Request
Requested Emergency funding for Emergency Shelter: Enter amount
Complete and include Form 6, if applicable
Emergency Shelter Detailed Budget
Emergency Shelter Essential Services
NHAP Request
Other Funds
Grand Total
Case Management
Enter amount
Enter amount
Enter amount
Legal Services
Enter amount
Enter amount
Enter amount
Child Care (licensed)
Enter amount
Enter amount
Enter amount
Education Services
Enter amount
Enter amount
Enter amount
Employment Assistance and Job Training
Enter amount
Enter amount
Enter amount
Outpatient Health Services
Enter amount
Enter amount
Enter amount
Outpatient Substance Abuse Treatment. (licensed)
Enter amount
Enter amount
Enter amount
Outpatient Mental Health Services (licensed)
Enter amount
Enter amount
Enter amount
Transportation
Enter amount
Enter amount
Enter amount
Life Skills Training
Enter amount
Enter amount
Enter amount
ES Services Direct Cost Allocation (If applicable)
Enter amount
Enter amount
Enter amount
SUBTOTAL SERVICES
Enter amount
Enter amount
Enter amount
Emergency Shelter Operations
NHAP Request RRReRequest
Other Funds
Grand Total
Emergency Shelter Operations
Enter amount
Enter amount
Enter amount
Hotel/Motel Vouchers
)
Enter amount
Enter amount
Enter amount
SUBTOTAL OPERATIONS
Enter amount
Enter amount
Enter amount
Indirect Cost Rate (if applicable): Rate %.
Enter amount
Enter amount
Enter amount
Shelter TOTAL eEMEREMERGGENCY
Enter amount
Enter amount
Enter amount
Emergency Shelter narrative: Provide a narrative description of activity being proposed and a detailed description of how each line item was calculated (e.g., breakdown of personnel costs, service cost calculations, methods of determining cost allocation percentages, detail of operational expenses, etc.). Provide the total amounts, description, and name of funding source of other funds utilized to support the agency’s emergency shelter activities. Please describe if the funding is confirmed or pending. If “Other Funds” is left blank or has a zero provide detail as to why no other funding is sought or received. Points will be deducted if the service narrative does not contain sufficient budget breakdown detail to replicate the calculated budget totals.
Enter Explanation
EMERGENCY SHELTER PERFORMANCE
Populations Served 7/1/19 to 6/30/20
Unduplicated total number of program participants served with Emergency Shelter
A.
All Leavers
#
B. Outcome Measures
C. Percent Achieved
B÷A=C
Exits to Permanent Housing Destination
Unduplicated number placed in permanent housing destinations at program exit
#
%
· Proposed % of individuals exiting to Permanent Housing Destinations:
· Unduplicated count of individuals proposing to serve by Emergency Shelter with the Emergency Funds: #
· Unduplicated count of households proposing to serve by Emergency Shelter with the Emergency Funds: #
HOMELESSNESS PREVENTION BUDGET
Requested Emergency funding for Homeless Prevention: Enter amount
Homelessness Prevention Detailed Budget
Homelessness Prevention Services
NHAP Request
Other Funds
Grand Total
Housing Search and Placement
Enter amount
Enter amount
Enter amount
Housing Stability Case Management
Enter amount
Enter amount
Enter amount
Legal Services
Enter amount
Enter amount
Enter amount
Transportation
Enter amount
Enter amount
Enter amount
Mediation
Enter amount
Enter amount
Enter amount
Credit Repair
Enter amount
Enter amount
Enter amount
HP Services Direct Cost Allocation (if applicable)
Enter amount
Enter amount
Enter amount
SUBTOTAL SERVICES
Enter amount
Enter amount
Enter amount
Homelessness Prevention Financial Assistance
NHAP Request RRReRequest
Other Funds
Grand Total
Rental Application Fees
Enter amount
Enter amount
Enter amount
Security Deposits (up to 2 months’ rent)
Enter amount
Enter amount
Enter amount
Last Month’s Rent (up to 1 month)
Enter amount
Enter amount
Enter amount
Utility Deposits (gas, water, electric, sewage)
Enter amount
Enter amount
Enter amount
Utility Payment (gas, water, electric, sewage)
Enter amount
Enter amount
Enter amount
Moving Costs
Enter amount
Enter amount
Enter amount
SUBTOTAL FINANCIAL ASSISTANCE
Enter amount
Enter amount
Enter amount
Homelessness Prevention Rent Assistance
NHAP Request RRReRequest
Other Funds
Grand Total
Rental Assistance-Short-Term ( ≤ 3 months)
Enter amount
Enter amount
Enter amount
Rental Assistance-Medium-Term (> 3 mo. ≤ 24 mo.)
Enter amount
Enter amount
Enter amount
Rental Assistance-Rental Arrearage
Enter amount
Enter amount
Enter amount
SUBTOTAL RENT ASSISTANCE
Enter amount
Enter amount
Enter amount
Indirect Cost Rate (if applicable): Rate %.
Enter amount
Enter amount
Enter amount
Homelessness Prevention TOTAL
Enter amount
Enter amount
Enter amount
Homelessness Prevention narrative: Provide a narrative description of activity being proposed and a detailed description of how each line item was calculated (e.g., breakdown of personnel costs, methods of determining cost allocation percentages, detail of operational expenses, etc.). Provide the total amounts, description, and name of funding source of other funds utilized to support the agency’s homeless prevention efforts. Please describe if the funding is confirmed or pending. If “Other Funds” is left blank or has a zero provide detail as to why no other funding is sought or received. Points will be deducted if the service narrative does not contain sufficient budget breakdown detail to replicate the calculated budget totals.
Enter Explanation
HOMELESSNESS PREVENTION PERFORMANCE
Populations Served 7/1/19 to 6/30/20
Unduplicated total number of all of homeless individuals served with Homelessness Prevention
A.
All Leavers
#
B. Outcome Measures
C. Percent Achieved
B÷A=C
Exits to Permanent Housing Destination
Unduplicated number placed in permanent housing destinations at program exit
#
%
· Proposed % of individuals exiting to Permanent Housing Destinations:
· Unduplicated count of individuals proposing to serve by Homeless Prevention with the Emergency Funds: #
· Unduplicated count of households proposing to serve by Homeless Prevention with the Emergency Funds: #
RAPID REHOUSING BUDGET
NHAP Emergency Funding for Rapid Rehousing: Enter amount
Rapid Rehousing Detailed Budget
Rapid Rehousing Services
NHAP Request RRReRequest
Other Funds
Grand Total
Housing Search and Placement
Enter amount
Enter amount
Enter amount
Housing Stability Case Management
Enter amount
Enter amount
Enter amount
Legal Services
Enter amount
Enter amount
Enter amount
Transportation
Enter amount
Enter amount
Enter amount
Mediation
Enter amount
Enter amount
Enter amount
Credit Repair
Enter amount
Enter amount
Enter amount
RR Services Direct Cost Allocation (if applicable)
Enter amount
Enter amount
Enter amount
SUBTOTAL SERVICES
Enter amount
Enter amount
Enter amount
Rapid Rehousing Financial Assistance
NHAP Request RRReRequest
Other Funds
Grand Total
Rental Application Fees
Enter amount
Enter amount
Enter amount
Security Deposits (up to 2 months’ rent)
Enter amount
Enter amount
Enter amount
Last Month’s Rent (up to 1 month)
Enter amount
Enter amount
Enter amount
Utility Deposits (gas, water, electric, sewage) eelectwater,ssssesesewage) only)
Enter amount
Enter amount
Enter amount
Utility Payment (gas, water, electric, sewage)
Enter amount
Enter amount
Enter amount
Moving Costs
Enter amount
Enter amount
Enter amount
SUBTOTAL FINANCIAL ASSISTANCE
Enter amount
Enter amount
Enter amount
Rapid Rehousing Rent Assistance
NHAP Request RRReRequest
Other Funds
Grand Total
Rental Assistance-Short-Term ( ≤ 3 months)
Enter amount
Enter amount
Enter amount
Rental Assistance-Medium-Term (> 3 mo. ≤ 24 mo.)
Enter amount
Enter amount
Enter amount
Rental Assistance-Rental Arrearage
Enter amount
Enter amount
Enter amount
SUBTOTAL RENT ASSISTANCE
Enter amount
Enter amount
Enter amount
Indirect Cost Rate (if applicable): Rate %.
Enter amount
Enter amount
Enter amount
Rapid Rehousing TOTAL
Enter amount
Enter amount
Enter amount
Rapid Re-Housing: Provide a narrative description of activity being proposed and a detailed description of how each line item was calculated (e.g., breakdown of personnel costs, methods of determining cost allocation percentages, detail of operational expenses, etc.). Provide the total amounts, description, and name of funding source of other funds utilized to support the agency’s rapid re-housing services. Please describe if the funding is confirmed or pending. If “Other Funds” is left blank or has a zero provide detail as to why no other funding is sought or received. Points will be deducted if the service narrative does not contain sufficient budget breakdown detail to replicate the calculated budget totals.
Enter Explanation
RAPID REHOUSING PERFORMANCE
Populations Served 7/1/19 to 6/30/20
Unduplicated total number of program participants served with Rapid Rehousing
A.
All Leavers
#
B. Outcome Measures
C. Percent Achieved
B÷A=C
Exits to Permanent Housing Destination
Unduplicated number in permanent housing destinations at program exit
#
%
· Proposed % of individuals exiting to Permanent Housing Destinations:
· Unduplicated count of individuals proposing to serve by Rapid Rehousing with the Emergency Funds: #
· Unduplicated count of households proposing to serve by Rapid Rehousing with the Emergency Funds: #
FORM 5 – CoC VERIFICATION of PARTICIPATION
REQUIRED: Verification of Participation form that includes the number of your Continuum of Care meetings held; the number of meetings attended by a representative of your agency and is signed by the authorized person from your Continuum of Care
GROUP INFORMATION
Name of CoC Attended:
Type of CoC Meetings Attended:
|_|Committee
|_|Subcommittee
|_|Task Force
|_|Workgroup
Name of CoC authorized person/chair:
Representative Email:
Representative Phone:
AGENCY INFORMATION
Agency Name:
Name(s) of Staff that Attended Meeting(s):
MEETING INFORMATION
Number of CoC Meetings Held:
Number of CoC Meetings Attended by Staff from this Agency:
Did the agency consult the CoC for project approval while preparing the NHAP Emergency Fund application and its proposed activities?
|_|YES|_|NO
Do the agency’s proposed NHAP activities align with the CoC’s priorities for serving persons experiencing homelessness and persons at risk of homelessness?
|_|YES|_|NO
I verify the above Meeting Information is accurate and current, as of this date.
______________________________________________________________________________
Signature of Group RepresentativeDate
FORM 6 – CERTIFICATION OF LOCAL GOVERNMENTAL APPROVAL
CERTIFICATION OF LOCAL GOVERNMENT APPROVAL
FOR NONPROFIT ORGANIZATIONS RECEIVING
ESG FUNDS FROM STATE SUBRECIPIENTS FOR SHELTER ACTIVITIES
I, _Enter Name_ (name of local government official and title), duly authorized to act on behalf of the _Enter Name_ (name of jurisdiction), hereby approve the following emergency shelter activities provided/proposed by _Enter Name_(name of nonprofit organization), which are located/plan to be located in _Enter Name(s)_ (name(s) of jurisdiction(s)
Description of emergency shelter activities: Enter Description
___________________________________________________________________________
Signature and Date
___________________________________________________________________________
Typed or Written Name of Signatory Local Official
___________________________________________________________________________
Title
Note: In order to receive Emergency Solutions Grant funding, this certification is required by the U.S. Department of Housing and Urban Development. It does NOT need to be completed annually for the same emergency shelter activities funded the previous year. However, the local government has the opportunity to withdraw its prior approval at any time. If approval is withdrawn, please notify the Nebraska Homeless Assistance Program office by emailing dhhs.homelessassistance.gov.
36
43
NHAP
REQUEST
OTHER
SOURCES
GRAND TOTAL
Essential Services
$0.00
Legal Services
Indirect Cost*
$0.00
SUBTOTAL
$0.00$0.00$0.00
Essential Services
$0.00
Legal Services
Operations (including minor repairs)
$0.00
Indirect Cost*
$0.00
SUBTOTAL
$0.00$0.00$0.00
Services- Housing R & S
$0.00
Legal Services
Financial Assistance- Housing R & S
$0.00
Rent Assistance -Tenant-Based
$0.00
Rent Assistance -Project-Based
$0.00
Indirect Costs*
$0.00
SUBTOTAL
$0.00$0.00$0.00
Services- Housing R & S
$0.00
Legal Services
Financial Assistance- Housing R & S
$0.00
Rent Assistance -Tenant-Based
$0.00
Rent Assistance -Project-Based
$0.00
Indirect Costs*
$0.00
SUBTOTAL
$0.00$0.00$0.00
$0.00$0.00$0.00
GRAND TOTAL
Agency Name:
NHAP Emergency Funds PROPOSED BUDGET
STREET
OUTREACH
SHELTER
HOMELESSNESS
PREVENTION
RAPID RE-HOUSING
Personnel InstructionsINSTRUCTIONSA) ESG ACTIVITY = Select one of the ESG Activities that allows personnel costs from the dropdown list B) ESG-ALLOWABLE PERSONNEL COST = Select one of the ESG personnel-related allowable costs from the dropdown listC) NAME = Enter name of staff person who will be providing the serviceD) TITLE = Enter title of that personE) TOTAL FTE = Enter the total FTE for that person (e.g. 1 FTE = 40 hours/week, .5FTE = 20 hours/week)F) NHAP FTE = Enter the amount of the total FTE that person will be providing NHAP service (e.g. 50% of fulltime person = .5FTE)G) EMPLOYMENT STATUS = Select person is current employee or is 'to be hired' from dropdown listH-L) NHAP COST = Enter the portion of the total cost of person's wages projected for each ESG ActivityM) TOTAL ANNUAL NHAP COST = Spreadsheet will automatically total the costs entered in Columns H-LTOTAL PERSONNEL = Spreadsheet will automatically total the costs entered in Column M
PersonnelESG ACTIVITY (select one from dropdown list)ESG-ALLOWABLE PERSONNEL COST (select one from dropdown list)NAMETITLETOTAL FTENHAP FTEEMPLOYMENT STATUS (select one from dropdown list)STREET OUTREACHSHELTERHOMELESSNESS PREVENTIONRAPID REHOUSINGHMISTOTAL NHAP ANNUAL COSTNHAP COSTNHAP COSTNHAP COSTNHAP COSTNHAP COST$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00TOTAL NHAP PERSONNEL$0.00
HMIS budgetHMIS/DV Database System NAHP RequestOther FundsGrand TotalHardware / SoftwareEnter amountEnter amountEnter amountEquipment CostsEnter amountEnter amountEnter amountData Entry / AnalysisEnter amountEnter amountEnter amountData QualityEnter amountEnter amountEnter amountTrainingEnter amountEnter amountEnter amountReportingEnter amountEnter amountEnter amountIndirect Cost (must have approved rate)Enter amountEnter amountEnter amount
TOTALEnter amountEnter amountEnter amount
RR BudgetRapid Rehousing NHAP RequestOther FundsGrand TotalServ-Housing Search and PlacementEnter amountEnter amountEnter amountServ-Housing Stability Case ManagementEnter amountEnter amountEnter amountServ-MediationEnter amountEnter amountEnter amountServ-Credit RepairEnter amountEnter amountEnter amountServ-Legal Service (available to an applicant only providing legal services)Enter amountEnter amountEnter amountFIN ASST-Rental Application FeesEnter amountEnter amountEnter amountFIN ASST-Security Deposits (up to 2 months’ rent)Enter amountEnter amountEnter amountFIN ASST-Last Month’s Rent (up to 1 month)Enter amountEnter amountEnter amountFIN ASST-Utility Deposits (gas, electric, water, sewage)Enter amountEnter amountEnter amountFIN ASST-Utility Payment (gas, electric, water, sewage)Enter amountEnter amountEnter amountFIN ASST-Moving CostsEnter amountEnter amountEnter amountRental ASST-Short-Term ( ≤ 3 mo)Enter amountEnter amountEnter amountRental ASST-Medium-Term (> 3 mo, ≤ 24 mo)Enter amountEnter amountEnter amountRental ASST-Rental ArrearageEnter amountEnter amountEnter amountIndirect Cost (must have an approved rate)Enter amountEnter amountEnter amountGRAND TOTALEnter amountEnter amountEnter amount
HP budgetHomeless Prevention Detailed BudgetHomeless PreventionNHAP Request RRReRequestOther FundsGrand TotalServ-Housing Search and PlacementEnter amountEnter amountEnter amountServ-Housing Stability Case ManagementEnter amountEnter amountEnter amountServ-MediationEnter amountEnter amountEnter amountServ-Credit RepairEnter amountEnter amountEnter amountServ-Legal Service (available to an applicant only providing legal services)Enter amountEnter amountEnter amountFIN ASST-Rental Application FeesEnter amountEnter amountEnter amountFIN ASST-Security Deposits (up to 2 months’ rent)Enter amountEnter amountEnter amountFIN ASST-Last Month’s Rent (up to 1 month)Enter amountEnter amountEnter amountFIN ASST-Utility Deposits (gas, water, electric, sewage) eelectwater,ssssesesewage) only)Enter amountEnter amountEnter amountFIN ASST-Utility Payment (gas, water, electric, sewage)Enter amountEnter amountEnter amountFIN ASST-Moving CostsEnter amountEnter amountEnter amountRental ASST-Short-Term ( ≤ 3 mo) Enter amountEnter amountEnter amountRental ASST-Medium-Term (> 3 mo, ≤ 24 mo)Enter amountEnter amountEnter amountRental ASST-Rental ArrearageEnter amountEnter amountEnter amountIndirect Cost (must have an approved rate)Enter amountEnter amountEnter amountGRAND TOTALEnter amountEnter amountEnter amount
ES budgetEmergency ShelterNHAP RequestOther FundsGrand TotalET Serv-Case ManagementEnter amountEnter amountEnter amount
ET Serv-Child Care (licensed)Enter amountEnter amountEnter amount
ET Serv-Education ServicesEnter amountEnter amountEnter amountET Serv-Employment Assistance and Job TrainingEnter amountEnter amountEnter amountET Serv-Outpatient Health Enter amountEnter amountEnter amountET Serv-Outpatient Substance Abuse Trt (licensed)Enter amountEnter amountEnter amountET Serv-Outpatient Mtl Health (licensed)Enter amountEnter amountEnter amountET Serv-TransportationEnter amountEnter amountEnter amountET Serv-Life Skills TrainingEnter amountEnter amountEnter amountLegal Services (available to an applicant only providing legal servicesEnter amountEnter amountEnter amountShelter OperationsEnter amountEnter amountEnter amountHotel/Motel Vouchers (if shelter is unavailable)Enter amountEnter amountEnter amountIndirect Cost (must have an approved rate)Enter amountEnter amountEnter amountGRAND TOTALEnter amountEnter amountEnter amount
SO performance
A. Population ServedB. Outcome MeasuresC. Percent AchievedJan 01/16 B÷A=Cto Dec 31/16
Unduplicated number of homeless individuals served with Street Outreach # Housing Destination:Unduplicated number of persons placed in permanent housing destinations #*Supporting documentation %on page #*Supporting documentation on page #
Non-Cash Benefits:Unduplicated number of persons with more non-cash benefits at program exit #%
*Supporting documentation on page #
Increased or Maintained Employment Income:Unduplicated number of persons who increased or maintained employment at program exit #%*Supporting documentation on page #
SO budgetStreet Outreach NHAP RequestOther FundsGrand TotalEngagement ActivitiesEnter amountEnter amountEnter amountCase ManagementEnter amountEnter amountEnter amountEmergency Health Services (licensed) provider)Enter amountEnter amountEnter amountEmergency Mental Health Services (licensed) provider)Enter amountEnter amountEnter amountTransportationEnter amountEnter amountEnter amountIndirect Cost (must have an approved rate)Enter amountEnter amountEnter amountGRAND TOTALEnter amountEnter amountEnter amount
TOTAL budgetAgency Name: NHAP Emergency Funds PROPOSED BUDGETNHAP REQUESTOTHER SOURCESGRAND TOTALSTREET OUTREACHEssential Services$0.00Legal ServicesIndirect Cost*$0.00SUBTOTAL$0.00$0.00$0.00 SHELTEREssential Services$0.00Legal ServicesOperations (including minor repairs)$0.00Indirect Cost*$0.00SUBTOTAL$0.00$0.00$0.00HOMELESSNESS PREVENTIONServices- Housing R & S$0.00Legal ServicesFinancial Assistance- Housing R & S $0.00Rent Assistance -Tenant-Based$0.00Rent Assistance -Project-Based$0.00Indirect Costs*$0.00SUBTOTAL$0.00$0.00$0.00RAPID RE-HOUSINGServices- Housing R & S $0.00Legal ServicesFinancial Assistance- Housing R & S $0.00Rent Assistance -Tenant-Based$0.00Rent Assistance -Project-Based$0.00Indirect Costs*$0.00SUBTOTAL$0.00$0.00$0.00GRAND TOTAL$0.00$0.00$0.00*To be reimbursed for Indirect Costs, an approved Indirect Cost Rate Proposal must be on file at DHHS or the de minimus rate of 10% must be used.