HomeMy WebLinkAboutbocc.res.009.2009CONTRACT # ~ `~ - 2oa ~
A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS
OF PITKIN COUNTY TO APPROVE
THE 2009-2010 COMMUNITY SERVICES BLOCK GRANT APPLICATION /
9'- ~ (9-l'.-~-2~ir~eu.-7~
Resolution #~ (d ~- ~Or/
RECITALS
1. The Department of Local Affairs requires that upon assuming the responsibility for the
administration of the Community Service Block Grant (CSBG) program, the Board of
County Commissioners will establish and plan for local priorities that achieve the
objectives of the program. In addition, the BOCC accepts responsibility for the efficient
management of individual projects to ensure that local priorities will guide the program.
2. The Pitkin County Board of County Commissioners wishes to support the CSBG mission
to make a measurable and potentially significant impact, within the federal resources
available, on the causes of poverty in communities throughout the State or in those areas
of communities where poverty is a particularly acute problem as a means to remove
obstacles and solve problems which block the achievement of self-sufficiency.
3. The Pitkin County Board of County Commissioners recognizes that hunger is a
significant barrier to citizens being able to achieve self-sufficiency. Providing emergency
food assistance for the homeless and for individuals in transition in a safe environment
helps to stabilize and support these individuals as they work on their care plans.
NOW, THEREFORE BE IT RESOLVED by the Board of County Commissioners of Pitkin
County, Colorado,
SECTION 1.
1. The Pitkin County Commissioners wish to support the plan as outlined in the Community
Services Block Grant application:
A. $11,630 (100%) to The Right Door, a 501 (c)(3) non-profit, to provide direct
emergency assistance for case management clients at or below 125% of poverty,
including:
1. Emergency food, including meal and food vouchers for clients using the
case management resource center at the Health & Human Services Building
2. ADMINISTRATION
The Director of Health and Human Services will take full responsibility for the
administration of this grant.
SECTION 2:
This resolution shall not have any effect on existing litigation and shall not operate as an
abatement of any action or proceeding now pending under or by virtue of the ordinances released
or amended as herein provided, and the same shall be construed and concluded under such prior
ordinances.
SECTION 3:
If any section, subsection, sentence, clause, phrase or portion of this ordinance is for any
reason held invalid or unconstitutional in a court of competent jurisdiction, such portion shall be
deemed a separate, distinct and independent provision and shall not affect the validity of the
remaining portions thereof.
SECTION 4:
A public hearing on the resolution shall be held on _January 14, 2009, in the Pitkin
County Courthouse Annex, Aspen, Colorado.
NOTICE OF PUBLIC HEARING PUBLISHED 1N THE ASPEN TIMES WEEKLY ON
INTRODUCED, READ AND ADOPTED ON ~- ~ CIJGcY ~~ , 2009.
*PUBLISHED BY TITLE N/D SHORT SUMMARY, AFTER ADOPTION, IN THE ASPEN
TIMES WEEKLY ON ~`7~~~•~~d , 2009.
APPROVED AS TO FORM:
a
John Ely
C y Atto
BOARD OF COUNTY COMMISSIONERS OF
PITKIN COUNTY, COLORADO
i
atti Kay-Clappe ,Chairman
_a ~
Date: ~ ~ ~' ~
MANAGER APPROVAL:
~-
Hila Fletcher
County Manager
r~
RECOMMENDED FOR ADOPTION:
~ L y~~ ~' ~._L~-s:c~_ ~~
~~
Nancy N. Sun en
Director of Health and Human Services
3
CSBG ALERT
2008-09 Community Services Block Grant (CSBG) Application and Plan
DUE -JANUARY 7, 2009 (*DOLA GRANTED EXTENSION TO 7/30/09)
PROGRAM PERIOD: March 1, 2009 To February 28, 2010
GRANTEE: PITKIN COUNTY, COLORADO
FEDERAL OBJECTIVE Identify
Objective(s)
with an
X
1. Employment
~. Education
3. Income Management
4. Housing
5. Emergency Services x
6. Nutrition
7. Linkages with Other
Pro rams
8. Self-Sufficiency
9. Health
TOTAL CSBG ALLOCATION REQUESTED $ 11,360
LIST OF SUBGRANTEES AND AMOUNT AWARDED:
Use additional sheets if necessary.
The Right Door $11,360
SUBGRANTEE NAME AMOUNT AWARDED
SUBGRANTEE NAME AMOUNT AWARDED
SUBGRANTEE NAME AMOUNT AWARDED
SUBGRANTEE NAME
AMOUNT AWARDED
SUBGRANTEE NAME AMOUNT AWARDED
2008-09 Community Services Block Grant (CSBG) Application and Plan
DUE -JANUARY 7, 2009
NAME OF ELIGIBLE ENTITY: PITKIN COUNTY HEALTH $ HUMAN SERVICES
ADDRESS OF ELIGIBLE ENTITY: 0405 Castle Creek Road, Suite 7
Street address and mailing address if different from street address
ASPEN CO 81611
CitylTown State Zip Code
CONTACT PERSONS INFORMATION:
PRIMARY Contact Person for Eligible Entity: Nan Sundeen
Phone Number for Primary Contact Person: (970)920-5209
Use direct line number and/or extension
Fax Number for Primary Contact Person: (970)920-5198
Email Address for Primary Contact Person: Nan.Sundeen(a~co.pitkin.co.us
PROGRAM Contact Person: Mitzi Ledingham (*Mitzi shares signature authority with Nan
for this grant)
Phone Number for Program Contract Person: (970)920-5766
Use direct line number and/or extension
Fax Number for Program Contact Person: (970)920-5558
Email Address for Program Contact Person: Mitzi.Ledingham(c~co.pitkin.co.us
FINANCIAL Contact Person: Connie Garofolo - Mitri submits financial reports and
reimbursement requests
Phone Number for Financial Contract Person: (970) 920-5231
Use direct line number and/or extension
Fax Number for Financial Contact Person: (970) 920-5230
Email Address for Financial Contact Person: Connie.Garofolo(a~co.pitkin.co.us
Page 2 of 59
CSBG Grant Year 2009-10
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Names, Phone Numbers, and Emails of County Commissioners for Eligible Entity:
If a multi county entity list the names and phone numbers of all county commissioners in each of the
counties for the multi county area. Use additional sheet if necessary
Michael Owsley (970) 920-5153 Michael.Owsley@co.pitkin.co.us
Commissioner Name Phone Number Email
Patti
920-5154
n.co.us
George Newman (970) 920-5158 George.Newman@co.pitkin.co.us
Commissioner Name Phone Number Email
Jack Hatfield
Commissioner Name
(970) 920-5152
Phone Number
Rachel Richards (970) 920-5155 rachelrichards@comcast.net
Commissioner Name Phone Number Email
Commissioner Name Phone Number Email
Commissioner Name
Phone Number Email
Commissioner Name Phone Number Email
Page 3 of 59
CSBG Grant Year 2009-10 /'
!`
The grantee assures that activities implemented with CSBG funds will be:
o used to accomplish the State CSBG Goal and Objective stated in the State Plan; and
within the requirements set forth in the Community Services Block Grant Act, Title IV of the Civil
Rights Act, the Age Discrimination Act of 1975, the Rehabilitation Act of 1973, Public Law 103-
227, Part C, Environmental Tobacco Smoke, also known as the Pro-Children Act of 1994 (Act),
Certification Regarding Drug-Free Workplace Requirements, Certification Regarding Lobbying,
Certification Regarding Debarment, Suspension, and Other Responsibility Matters -Primary
Covered Transactions, Office of Management and Budget (OMB Circular A110 and A122), and
the current State of Colorado CSBG Plan.
The grantee also assures that it will:
specifically consider, in a public meeting the designation of any local public or private entity to
carry out the county community service activities under contract with the county, any local
community action agency (CAA) which received federal fiscal 1981-82 funding;
consider, on the same basis as other non-governmental organizations, religious organizations to
provide the CSBG services, so long as the program is implemented in a manner consistent with
the Establishment Clause of the first amendment to the Constitution. Grantees shall not
discriminate against an organization that provides assistance under, or applies to provide
assistance, on the basis that the organization has a religious character. (Please review Sec.679
Operational Rule in the CSBG Act);
o provide for coordination between community anti-poverty programs and ensure, where
appropriate, that emergency energy crisis intervention programs under Title XXVI (relating to low-
income home energy assistance) are conducted in such community;
o provide, on an emergency basis, for the provision of such supplies and services, nutritious foods,
and related services, as may be necessary to counteract conditions of starvation and malnutrition
among low-income individuals;
o coordinate, to the extent possible, programs with and form partnerships with other organizations
serving low-income residents of the community and members of groups served, including
religious organizations, charitable groups, and community organizations;
o establish procedures under which aloes-income individual, community organization, or religious
organization, or representative of low-income individuals that considers its organization, or low-
income individuals, to be inadequately represented on the CSBG board (or other mechanism) to
petition for adequate representation;
o in the case of public organizations, have a tripartite advisory board which shall have members
selected by the organization and shall be composed so as to assure that not fewer than 1/3 of the
members are persons chosen in accordance with democratic selection procedures adequate to
assure that these members (a) are representative of low-income individuals and families in the
neighborhood served, (b) reside in the neighborhood, and (c) are able to participate actively in
the development, planning, implementation, and evaluation of program funded.
o in the case of private non-profit entities, have a tripartite board that participates in the
development, planning, implementation, and evaluation of the program to serve low-income
communities. The board shall be composed so as to assure that (a) 1/3 of the members are
Page 4 of 59
CSBG Grant Year 2009-10 ~,~
elected officials, holding office on the date of selection, or their representatives, except that if the
number of such elected officials reasonably available and willing to serve on the board is less
than 1/3 of the membership of the board, membership on the board of appointive public officials
or their representatives may be counted in meeting such 1/3 requirement; (b) not fewer than 1/3
of the members are person chosen in accordance with democratic selection procedures adequate
to assure that these members are representative of low-income individuals and families in the
neighborhood served, and each representative of low-income individuals and families selected to
represent a specific neighborhood within a community resides in the neighborhood represented;
and (c) the remainder of the members are officials or members of business, industry, labor,
religious, law enforcement, education, or other major groups and interest in the community
served;
prohibit the purchase or improvement of land, or the purchase, construction, or permanent
improvement (other than low-cost residential weatherization or other energy-related home
repairs) of any building or facility with CSBG funds;
o prohibit, including subcontractors, (a) any partisan or nonpartisan political activity or any political
activity associated with a candidate, or contending faction or group, in an election for public or
party office, (b) any activity to provide voters or prospective voters with transportation to the polls
or similar assistance in connection with any such election, or (c) any voter registration activity.
prohibit that persons shall, on the basis of race, color, national origin or sex, be excluded from
participation in, be denied the benefits of, or be subjected to discrimination under, any program or
activity funded in whole or in part with CSBG. Any prohibition against discrimination on the basis
of age under the Age Discrimination Act or 1975 (42 U.S.C 6101 et seq.) or with respect to an
otherwise qualified individual with a disability as provided in Section 504 of the Rehabilitation Act
of 1973 (29 U.S.C. 12131 et seq.) shall also apply to any such program or activity.
o participate in the Results-Oriented Management and Accountability (ROMA) System, and
describe outcome measure to be used to measure performance in promoting self-sufficiency,
family stability, and/or community revitalization;
o make available for public inspection each plan prepared as part of the program planning process.
The grantee may, at its initiative, revise any plan prepared for CSBG funding and shall furnish the
revised plan to the Director of the Community Services Block Grant under the Department of
Local Affairs. Each plan prepared for submission shall be made available for public inspection
within the county and/or service area in such a manner as will facilitate review of, and comments
on, the plan;
o cooperate with the State, to determine whether grantee performance goals, administrative
standards, financial management requirements, and other requirements of the State, in
conducting monitoring reviews including (1) a full on-site review for each grantee at least once
during each 3-year period, (2) on-site review for each newly designated grantee immediately after
the completion of the first year in which funds were received, (3) follow-up reviews with grantees
that fail to meet the goals, standards, and requirement established by the State, and (4) other
reviews as appropriate, including reviews of grantees with other programs that have had other
federal, State, or local grants terminated for cause.
o make available appropriate books, documents, papers, and records for inspection, examination,
copying, or mechanical reproduction on or off the premises upon reasonable request by the U.S.
Controller General, the State, or their authorized representatives should an investigation of the
uses of CSBG funds be undertaken;
Page 5 of 59
CSBG Grant Year 2009-10
in the case of county governments or subgrantees which receive a CSBG award in excess of
$100,000, comply with the following three certifications related to the "Limitation on use of
appropriated funds to influence certain Federal Contracting and financial transactions (P.L. 101-
121, Section 319 and USC Title 31 Section 1352)":
1. No Federal appropriated funds have been paid or will be paid by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with the awarding of any Federal
contract, continuation, renewal, amendment, or modification of any Federal contract,
grant, loan, or cooperative agreement.
2. If any_ funds other than Federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or any employee of a Member
of Congress in connection with this Federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form LLL, "Disclosure
Form to Report Lobbying," in accordance with its instruction.
3. The undersigned shall require that the language of this certification be included in the
award document for subawards at all tiers (including subcontracts, subgrants, and
contracts under grants, loans, and cooperative agreements) and that all subrecipients
shall certify and disclose accordingly.
The grantee certifies to the best of its knowledge and belief, that it and its principals:
a) are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transactions by any Federal department or agency;
b) have not within athree-year period preceding this proposal been convicted or had a civil
judgment rendered against them for commission of fraud or a criminal offense in connection
with obtaining, attempting to obtain, or performing a public transaction; violation of Federal or
State antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
c) are not presently indicted for otherwise criminally or civilly charged by a governmental entity
(Federal, State or local) with commission of any of the offenses enumerated in paragraph (b)
of this certification; and
d) have not within athree-year period preceding this application had one or more public
transactions (Federal, State or local) terminated for cause or default.
(If you are unable to certify to any of the statements in this certification, please attach an
explanation to this application.) ~
Patti-Kay Clapper, Chair of the Board of County Commissioners
If Grantee: Chairman of the Board of County Commissioners must sign
IfMulti-County Service Agency: Chairman of the Board of Directors with delegated contracting
authority must sign.
POSITION TITLE: Chair of the E3oard of County Commissioners DATE: 9/ -a~ "~
Page 6 of 59
CSBG Grant Year 2009-10 ~ y
TRIPARTITE BOARD
For each eligible entity that receives Community Services Block Grant dollars there must be a tripartite
board in place. The responsibilities of the tripartite board are very clear in the CSBG Act of 1998,
Section 6766: "The eligible entity shall administer the community services block grant program through a
tripartite board that fully participates in the development, planning, implementation, and evaluation of the
program to serve low-income communities."
The CSBG Act includes the Composition of the board which is to be determined using a democratic
process:
~ 1/3 elected public officials or their representatives
~ 1/31ow-income individuals or their representative
~ 1/3 members business, industry, labor, religious, law enforcement, education or other major
group of interest in the community served.
The following page(s) must be filled out completely and returned with the application and plan.
Include the date of most current by-laws: we do not have by-laws
TRIPARTITE BOARD MINUTES:
Attach a copy of the CSBG Tripartite Board minutes of the meeting when the CSBG application
was reviewed and approved by your CSBG Tripartite board.
These minutes are not the minutes from the Board of County Commissioners.
A QUORUM MUST BE PRESENT FOR THE APPROVAL OF THE APPLICATION AND PLAN BY THE TRIPARTITE
BOARD.
FINAL APPROVAL MEETING ON JANUARY 12T" WILL BE ATTACHED
PROOF OF PUBLIC HEARING:
Attach a copy of the public notice, including the listing in the local newspaper for each county
served, calling for public review and comment on your CSBG Application and Plan.
To be attached for final
MINUTES OF PUBLIC HEARING:
Attach a copy of the minutes of the Public Meeting when the CSBG Application was reviewed and
approved by the Board of County Commissioners or Agency Executive Board.
To be attached for final
Page 7 of 59
CSBG Grant Year 2009-10 /I
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Page 9 of 59
CSBG Grant Year 2009-10
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COMMUNITY ACTION PLAN:
As required in the reauthorized CSBG Act, please answer all 5 questions using additional
sheets as needed. SUBCONTRACT012S are NOT required to submit an Action Plan.
~. COMMUNITY NEEDS ASSESSMENT:
Our State office must secure from each CSBG eligible entity, as a condition to receipt of
funding, a community action plan that includes acommunity-needs assessment for the
community served. This community-needs assessment may be coordinated with community-
needs assessments conducted for other programs. The Community Needs Assessment must
address the needs of those in the community who are at or below 125% of poverty. A first step
for a Community Action Plan is a survey of clients served to determine where the gaps may be
in assisting individuals to become self-sufficient and to move out of poverty.,
The Community Action Plan includes the results of the community needs assessment,
the service delivery system, how coordination occurs with other public and private resources,
and information on the innovative community and neighborhood-based initiatives.
Pitkin County Health & Human Services continues to actively address community
problems through collaborative problem-solving. Pitkin County is a resort economy,
with work fluctuating between the winter and summer tourist seasons. It is an
expensive place to live, which makes saving in anticipation of off-season (spring and
fall) unemployment even more of a challenge. Job loss or job uncertainty can lead to
families in crisis, which can manifest itself through domestic violence and substance
abuse.
The Pitkin County Health & Human Services Collaborative (the POD) meets monthly to
provide networking opportunities and to discuss issues of mutual interest. An active
Nameless Coalition has been meeting regularly fo find community solutions for our
homeless and indigent community. While Pitkin's homeless numbers are small, there
have been virtually no resources or outreach to assist this group in the past. The
Coalition is working to fril that gap. As well, a team of case managers meets regularly
to jointly address the needs and care coordination of our "difficult to serve" adults,
children and families. The team includes case managers working in the areas of
mental health, substance abuse, child welfare, child and adult protection, senior
services and the faith community. This team has been approved to serve as the CSBG
Tripartite Board and as such, will review and direct CSBG activities in 2009.
The POD meets in the fall to develop an assessment of the current status of the
community and of health and human service delivery system in order to present this
information to the joint City Council and Board of County Commissioners. This year's
presentation on October 7, 2008 focused on the general economic trends and their
effects on our population, as well as the difficulties posed by substance use and mental
health issues, and on issues affecting our senior population. In terms of economic
stressors, housing costs remain the top concern, taking a disproportionate percentage
of income for the working class, leaving less money to pay for other needs. Workers
travel longer and longer commutes in order to find affordable and available housing.
Per the 2004 self-sufficiency index, 19% of the households in the county earn less than
the self sufficiency standard. This means that many families are living paycheck to
paycheck, and just one unexpected expense can take them into crisis. As a result, the
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CSBG Grant Year 2009-10 ; ~
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demands put on the non-profit human service providers increase. At the same time,
non-profits are finding it increasingly difficult to attract and maintain qualified employees
in this expensive market.
Pitkin County is seeing a rapidly aging population. Locals are retiring in place, where in
the past they had moved out of the community for retirement. Many are retiring, or plan
to retire, in affordable worker housing units. Years of working seasonal jobs and living
paycheck to paycheck mean many have no retirement savings or assets. Often, family
members are not living nearby, and so they have no caregiver resources. As well,
second homeowners, who own 55% of Pitkin real estate, are choosing to retire, or
spend extended amounts of time in the county. Their expectation for services often
reflects their experiences in an urban environment, rather than a rural community. All
this is putting increasing demand on services. Homemaker services must drive long
distances to serve the entire Roaring Fork Valley, and are seeing the maximum number
of clients.
The Adult Care Coordination task force began meeting in May 2005, and includes
members of health and human service non-profits including mental health and
substance abuse professionals, law enforcement and the courts, the housing office, the
library, county senior services and county human services. The purpose of this task
force is to work toward developing acomprehensive/coordinated response to adults in
crisis. The goals are:
• To clarify and promote the services that are available to this population (and
their limits).
• To develop case management services for the mentally ill with realistic
expectations.
• To find a way to better coordinate services through a proactive "community
support program."
Through on-going discussion, the issue of homelessness and the lack of temporary
housing solutions for people in transition kept reoccurring. An effort has been made to
reconnect the faith community and human service agencies to encourage a coordinated
community-wide effort to address this issue. The Homeless Coalition evolved as a
result. The Coalition has worked diligently to ensure that the County consider the needs
of our most vulnerable homeless adults on an on-going basis. 2008-2009 is the third
year that the Winter Shelter Project has been in place at St. Mary's church.
Organization of the shelter project is becoming formalized through the creation of a
separate 501 C-3 agency to manage the Shelter and be a vehicle for on-going proactive
planning. This progress can be attributed to the committed actions of this community-
based coalition comprised of 40 volunteers representing a wide spectrum of the
community.
Case Managers work with Father O'Brien of St. Mary's church to staff the shelter along
with two volunteers per night. The case managers work to build relationships over time
and develop a sense of trust with the guests. With that trust, they are better able to help
the homeless move towards a plan of self-sufficiency.
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CSBG Grant Year 2009-10
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The Day Center at the county's Health & Human Services Building continues to serve
our indigent population. This is a place for the homeless and people in transition to
come and get a hot meal, take a shower, wash their clothes, look for a job, get their
documents in order (birth certificate, etc.), ,and work with a case manager on a regular
basis. It is difficult for people in crisis to deal with disability paperwork or applications
for food stamps when they don't know where they are going to be day-to-day. The Day
Center and the Shelter provide some stability for this population.
2009-2010 Proposal:
The Pitkin County Youth and Family Services Division, in analyzing service delivery and
resource allocation during 2008, found that many low-income clients in crisis have
incomes that exceed the 125% of poverty level requirement for CSBG funds-even
though they are financially strapped. Pitkin County families have higher incomes,
although in many cases not high enough to actually keep pace with the high costs of
living in the County. It was found that, in many cases, access to Child Welfare "Core"
and Colorado Works Diversion funding met the needs for additional case management
and treatment services designed to improve family functioning.
In addition, the Board of County Commissioners (BOCC) approved the establishment of
a $20,000 Emergency Assistance Fund (EAF) beginning in January, 2009 for the 2009
budget year, with wide discretion for use to assist individuals and families, at all income
levels, in crisis or in transition. The Youth and Family Services team felt that this
additional resource will complement existing funding resources satisfactorily to meet the
needs of their caseload.
In the Spring of 2008, The Pitkin County Senior Services team also elected to withdraw
participation in the CSBG program due to the income restrictions -most, if not all, of
Pitkin County Seniors needing case management services have incomes over 125% of
poverty. The team decided to work with existing resources to provide assistance for
their senior population. Among other factors, the non-profit homemaker's services
agency had restructured their program, allowing for greater service latitude.
In order to develop a community plan for CSBG funds, the case management/case
review team in Pitkin County, composed of specialists in the area of substance abuse,
mental health, youth and family issues, senior care and the faith community, was
solicited via email to answer the following questions:
• What are the three most urgent needs of clients whose income is at or below
125% of poverty?
• What are the gaps in services?
• What are the challenges of providing services for these individuals?
• How do the case managers coordinate public and private resources as they
develop a plan for their clients?
Page 12 of 59
CSBG Grant Year 2009-10
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Their responses echo the concern that we can best utilize CSBG funding through
providing for our most needy and vulnerable population served by the Right Door in the
form of immediate food assistance.
Sufficiency programs for low-income clients in the case management program
provided through The Right Door. Emergency Services will primarily include food
assistance, but could also include scholarships/financial assistance with the cost of
substance abuse counseling and treatment.
Emergency Services: The Right Door (TRD)
We are proposing to allocate CSBG funding to The Right Door clients who participate
in the hot meal program and are most often indigent with no financial resources.
The Right Door began as a the result of a community task force working to develop an
alternative to Pitkin County having its own detoxification center. In February 2005, it
received non-profit status. The Right Door provides case management to clients who
are abusing or in crisis with drugs and alcohol that are referred by law enforcement, the
medical community, mental health agencies, and by the general community (including
self-referrals). In 2005-2006, they provided service to 387 individuals. Seventy (70%)
percent of their clients were male. In 2007 over 700 individuals were served, and that
number increased to over 800 in 2008.
In July 2006, the Board of County Commissioners accepted staff recommendations to
dedicate additional space in the Health & Human Services Building for a case
management day center, acknowledging that the greatest increases in demand for
services are coming from the newly formed case manager programs including The
Right Door. Since 2007, The Right Door has managed a Day Center for people in
transition. This resource center provides a safe place for people to come, take a
shower, wash their clothes, and talk with a member of The Right Door's staff or other
case managers about community resources and alternative behaviors. A hot meal
(dinner) is brought over from Aspen Valley Hospital across the street, and hot lunches
prepared on site will be made available (daily) to people in transition through the CSBG
program.
Once an individual is out of crisis, The Right Door works one-on-one, picking up clients
at the detox center in Glenwood Springs and driving them back to their home
community in Aspen. They develop relationships based on trust, and help guide their
clients into appropriate services. Many clients have lost their jobs, their housing, and
their family relationships due to substance abuse, and are without resources to afford
substance abuse treatment programs. Scholarship assistance for treatment and
prescription medication will help those who are involved in a case management
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CSBG Grant Year 2009-10 /,
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program and have regular contact with The Right Door to afford the next step in their
recovery.
Z. SERVICE DELIVERY SYSTEM:
Describe the service delivery system for services provided or coordinated with CSBG.
Emerpency Services: The Right Door (TRD)
The Right Door serves four types of clients, whose involvement with the program varies
based on the amount of time required and level of commitment by the client. These
range in frequency from one-time contacts requesting information and transport to
clients who agree to case management and participate actively for several weeks or
more. The Right Door will assess the financial status of clients as part of their intake
procedure. Food assistance will be offered to all clients who qualify financially, whether
it is a one-time interaction or an on-going relationship. Scholarship assistance for
treatment programs in the region will be offered to clients who qualify financially and are
actively engaged in a case management program with The Right Door. The Right Door
will report on the client's work toward sobriety and their progress toward self-sufficiency.
As a subgrantee, The Right Door will submit their invoices for reimbursement to Pitkin
County, and Pitkin County will submit a request for reimbursement from CSBG.
3. LINKAGES:
A. Describe how linkages will be developed to fill identified gaps in services, through
the provision of information, referrals, case management, and follow up
consultations.
B. Describe how linkages will be established between government and other social
service programs to assure effective delivery of service to low-income individuals
and to avoid duplication of such services
Pitkin County is a small community with limited resources for low-income individuals.
Human Service agencies are constantly working together to identify and fill gaps in
services. Active, on-going collaboration prevents duplication of services. Pitkin County
hosts the health and human services collaboration called the POD, which meets
monthly to discuss community needs and issues, and provides opportunities for
networking and collaboration. Approximately 35 agencies participate. The Pitkin
County POD meets with Eagle County and Garfield County Human Service agencies
twice each year to address regional issues.
Pitkin County Health & Human Services and The Right Door work with the Aspen Pitkin
Housing Authority so that low-individuals and seniors who are not complying with their
lease arrangement and having difficulty managing their finances have access to a care
manager in order to work out alternatives other than eviction.
The Pitkin County Case Review team meets regularly, providing a venue where the
involved agencies work to find individualized, multi-agency solutions for our indigent,
homeless, and difficult to serve adult clients. An executive team of this group serves as
the Tripartite Board for CSBG.
Page 14 of 59
CSBG Grant Year 2009-10
r~
Case management provides a safe place for clients to go for help in learning how to
navigate the system. Successful case management requires a comprehensive
knowledge of local resources-providers, services, programs, eligibility requirements
and financial arrangements. The Right Door is co-located in the Health & Human
Services Building with health & human service non-profits that provide mental health
care, substance abuse counseling and treatment, and case management programs for
adults who fall outside of traditional services. Public assistance has an office in that
same wing, and the Youth & Family Services division is on the same floor. The Right
Door receives referrals from the Pitkin County Jail, Aspen Valley Hospital, local police
and sheriff offices, Aspen Counseling Center and the Pitkin County court system.
4. COORDINATION WITH OTHER PUBLIC AND PRIVATE RESOURCES:
Describe how CSBG funds will be coordinated with other public and private resources,
which would include any resources beyond financial.
The Right Door receives support from the Pitkin County Healthy Community Fund, a
dedicated property tax that provides financial support to health & human service non-
profits through a grant program. The Healthy Community Fund is managed by Pitkin
County contract management. The Right Door also receives financial support from the
City of Aspen, the Aspen and Snowmass Police Departments, Pitkin County Courts and
Jail, the Thrift Shop (Aspen), the Aspen Community Foundation, the Aspen Valley
Medical Foundation, family foundations and individual donors.
The Pitkin County Healthy Community Fund has also provided for the development of an
Emergency Assistance Fund beginning in January, 2009 that will be implemented by the
public assistance technicians to provide emergency support (on a one-time per year
basis). The Emergency Assistance Fund will be used to support Pitkin County residents
who are lawfully present, who are not eligible for other public assistance programs to tide
them over and who can identify a onetime lump sum to help them move toward self
sufficiency. Emergency Assistance Fund dollars may be used, but are not limited to, the
following:
• rental and/or mortgage assistance
• motel or shelter assistance for one or two nights for homeless or disabled families
• utility payments when either LEAP or Energy Outreach benefits are not available or
have been exhausted
• Gas for personal vehicles to get a client to work or other destinations such as
medical appointments or shelter in another town
• Greyhound bus tickets to get families or individuals transportation to the home of a
relative or friend if they are without resources, a home and transportation
• car repairs to get a client to work
• food vouchers
• limited prescription assistance when either waiting for Medicaid approval or not
eligible
• dental/medical support to supplement the $500 Medicare maximum for seniors or
the same for families that are under or un-insured.
Page 15 of 59
CSBG Grant Year 2009-10
5. INNOVATIVE COMMUNITY AND NEIGHBORHOOD-BASED INITIATIVES:
Describe how CSBG funds will be used to support innovative community and
neighborhood-based initiatives related to the purposes of CSBG, which may include fatherhood
initiatives and other initiatives with the goal of strengthening families and encouraging effective
parenting.
CSBG Funds through The Right Door will help individuals in crisis find resources and
on-going support as they battle their addictions. It will provide immediate assistance-
such as food-as well as longer-term assistance through scholarships for those clients
who are ready to commit to addressing their substance through treatment. As a result,
individuals, families and the community will be strengthened. Both agencies funded by
CSBG dollars will continue to participate in the Homeless Coalition and the case
management team, working to improve the quality of life oflow-income members of our
community.
The following language is a quote from the CSBG Act to fulfill the requirements of the above
listed information:
(3) information provided by eligible entities in the
State, containing--
" (A) a description of the service delivery system,
for services provided or coordinated with funds made
available through grants made under section 675C(a)(Grants to
Eligible Entities and Other Organizations.),
targeted to low-income individuals and families in
communities within the State;
" (B) a description of how linkages will be
developed to fill identified gaps in the services,
through the provision of information, referrals, case
management, and followup consultations;
" (C) a description of how funds made available
through grants made under section 675C(a) will be
' coordinated with other public and private resources; and
" (D) a description of how the local entity will use
the funds to support innovative community and
neighborhood-based initiatives related to the purposes
of this subtitle, which may include fatherhood
initiatives and other initiatives with the goal of
strengthening families and encouraging effective
parenting;
" (4) an assurance that eligible entities in the State will
provide, on an emergency basis, for the provision of such
supplies and services, nutritious foods, and related services,
as may be necessary to counteract conditions of starvation and
malnutrition among low-income individuals;
" (5) an assurance that the State and the eligible entities
in the State will coordinate, and establish linkages between,
governmental and other social services programs to assure the
effective delivery of such services to low-income individuals
and to avoid duplication of such services, and a description of
how the State and the eligible entities will coordinate the
provision of employment and training activities, as defined in
section 101 of such Act, in the State and in communities with
entities providing activities through statewide and local
workforce investment systems under the Workforce Investment Act
of 1998;
" (6) an assurance that the State will ensure coordination
between antipoverty programs in each community in the State, and
Page 16 of 59
CSBG Grant Year 2009-10 ~~
ensure, where appropriate, that emergency energy crisis
intervention programs under title XXVI (relating to low-income
home energy assistance) are conducted in such community;
" (7) an assurance that the State will permit and cooperate
with Federal investigations undertaken in accordance with
section 678D;
" (8) an assurance that any eligible entity in the State
that received funding in the previous fiscal year through a
community services block grant made under this subtitle will not
have its funding terminated under this subtitle, or reduced
below the proportional share of funding the entity received in
the previous fiscal year unless, after providing notice and an
opportunity for a hearing on the record, the State determines
that cause exists for such termination or such reduction,
subject to review by the Secretary as provided in section
678C(b);
" (9) an assurance that the State and eligible entities in
the State will, to the maximum extent possible, coordinate
programs with and form partnerships with other organizations
serving low-income residents of the communities and members of
the groups served by the State, including religious
organizations, charitable groups, and community organizations;
" (10) an assurance that the State will require each
eligible entity in the State to establish procedures under which
a low-income individual, community organization, or religious
organization, or representative of low-income individuals that
considers its organization, or low-income individuals, to be
inadequately represented on the board (or other mechanism) of
the eligible entity to petition for adequate representation;
" (11) an assurance that the State will secure from each
eligible entity in the State, as a condition to receipt of
funding by the entity through a community services block grant
made under this subtitle for a program, a community action plan
(which shall be submitted to the Secretary, at the request of
the Secretary, with the State plan) that includes a community-
needs assessment for the community served, which may be
coordinated with community-needs assessments conducted for other
programs;
" (12) an assurance that the State and all eligible entities
in the State will, not later than fiscal year 2001, participate
in the Results Oriented Management and Accountability System,
another performance measure system for which the Secretary
facilitated development pursuant to section 678E(b), or an
alternative system for measuring performance and results that
meets the requirements of that section, and a description of
outcome measures to be used to measure eligible entity
performance in promoting self-sufficiency, family stability, and
community revitalization; and
" (13) information describing how the State will carry out
the assurances described in this subsection.
Page 17 of 59
CSBG Grant Year 2009-10
~G
BUDGET -Use only the attached forms.
Complete your budget in as much detail as possible utilizing the provided format. This
information will be used for monitoring and performance evaluation. It is critical
to include any and all costs that will be associated with the CSBG Program.
PERSONNEL COSTS
Indicate the CSBG dollar amount allocated to each position(s) funded including fringe benefits.
Indicate the percentage (%) of the person's time paid with CSBG funds on timesheets, unless
actual timekeeping is tracked. Each employee paid with CSBG must have a signed timesheet
indicating the time spent on CSBG activities.
DIRECT OPERATING COSTS
Direct program costs can be identified with delivery of a particular project, service, or activity
undertaken to achieve an objective of the grant program. For CSBG, these purposes and
eligible activities are specified in the reauthorizing statute and reflected in the national ROMA
performance measures. Direct program costs are incurred for the service delivery and
management components within a particular program or project. Therefore, direct costs include
expenditures on some activities with administrative qualities, equipment, training, conferences,
travel, and contracts, as long as those expenses relate specifically to a particular program or
activity, not to the general administration of the organization.
ADMINISTRATIVE COSTS also referred to as INDIRECT/OVERHEAD
Administrative costs are equivalent to typical indirect costs or overhead. As distinguished from
administration or management expenditures that qualify as direct costs, administrative costs
refer to central executive functions that do not directly support a specific project or service.
Incurred for common objectives that benefit multiple programs administered by the grantee
organization, or the organization as a whole, administrative costs are not readily assignable to a
particular program funding stream. Rather, administrative costs relate to the general
management of the grantee organization, such as strategic direction, board development,
executive director functions, accounting, budgeting, personnel, and procurement. If your
indirect costs are based on a percentage that figure must be consistent throughout the grant
year.
SUBCONTRACT COSTS.
Those dollars allocated out to subcontractors to provide CSBG related services. This
information needs to be as detailed as the information provided by the eligible grantee in order
for the grantee to monitor the subcontractor for compliance in both program and financial
operations in accordance with alt applicable laws for CSBG. This would include the application
and plan, CSBG Act, and OMB circulars.
Page 18 of 59
CSBG Grant Year 2009-10 `~ 1
This page intentionally left blank.
Page 19 of 59
CSBG Grant Year 2009-10 t~
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Colorado CSBG ROMA Instructions by Section Headincs:
FOR EACH PROCaRAM FUNDED BY CSBG USE ONE (1) FORM.
Summary Sheet Instruction Form
Implementing Agency:
Complete Name of the Organization applying for CSBG funding.
Select ONE National Indicator:
These are provided in the CSBG Manual and within the application and plan document.
Select ONE Federal Objective:
Applicants must mark ONE Federal Objective. See Federal Objectives descriptions to determine the
Federal Objective that should be identified.
Select ONE National Goal:
Select only ONE (1), your primary outcome.
GOAL 1 Low-income people become more self-sufficient.
FAMILY
GOAL 2 The conditions in which low-income people live are improved.
COMMUNITY
GOAL 3 Low-income people own a stake in their community.
COMMUNITY
GOAL 4 Partnerships among supporters and providers of services to low-income
people are achieved.
AGENCY
GOAL 5 Agencies increase their capacity to achieve results.
AGENCY
GOAL 6 Low-income people, especially vulnerable populations, achieve their
potential by strengthening family and other supportive systems.
FAMILY
Low income Target Population:
Indicate the specific population of whom you provide services. The purpose of this documentation is to
track programs that are specific to youth or specific to seniors. If the population is not either youth or
seniors do not check either box, it will be assumed that you provide services to all populations.
Page 23 of 59
CSBG Grant Year 2009-10 ~ ~ J
,~ (~
COLORADO CSBG ROMA SUMMARY SHEET
CONTRACTOR/SUBCONTRACTOR
County/Multi County: Pitkin
Implementing Agency The Right Door
(Each agencylsubcontractor receiving CSBG dollars must complete this form)
Implementing Agency Contact Person: Brad Osborn
Complete Mailing Address, including zip:
405 Castle Creek Rd Suite 1 Aspen CO 81611
Phone Number (970) 920-2662 Fax: (970) 920-7540
Email Address: bradCa~therightdoor orq
Program Period: March 1, 2009 to February 28, 2010
Select ONE National Indicator: 6 2-Emergenc~Assistance
(see CSBG National Indicators sheet)
(i.e. 1.2, 2.1,6.2, etc.)
SELECT ONE FEDERAL OBJECTIVE
^ Employment ^ Nutrition ^ Linkages with Other Programs
^ Income Management ^Self-Sufficiency ^ Housing
® Emergency Services ^ Education ^ Health
SELECT ONE NATIONAL GOAL/OUTCOME:
The National Goal and National Indicator should match. (i.e. National Indicator 1.2, National Goal 1)
^ Goal 1Low-income people become more self-sufficient. (Family)
^ Goal 2 The conditions in which low-income people live are improved. (Community)
^ Goal 3Low-income people own a stake in their community. (Community)
^ Goal 4 Partnerships among supporters and providers of services to low-income people are
achieved. (Agency)
^ Goal 5 Agencies increase their capacity to achieve results. (Agency)
® Goal Low-income people, especially vulnerable populations, achieve their potential by
strengthening family and other supportive systems. (Family)
LOW INCOME TARGET POPULATION:
ONLY CHECK IF YOUR PROGRAM THAT IS FUNDED WITH CSBG DOLLARS SERVES ONLY SENIORS OR YOUTH.
SENIORS
Program Director Signature:
YOUTH
Date:
Name and Title: Brad Osborn Executive Director The Right Door
Page 24 of 59
CSBG Grant Year 2009-10
0
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This completes the Application and Plan for the Community Services Block Grant
Program.
Return to either Lucia or Christy by January 7, 2009.
Lucia Smead
CSBG Program Manager
Colorado Department of Local Affairs
1313 Sherman Street, Rm. 521
Denver, CO 80203
Iucia.smeadCa.state.co. us
303-866-3128 phone
303-866-4819 fax
Christy Culp
Community Development Specialist
Colorado Department of Local Affairs
1313 Sherman Street, Rm. 521
Denver. CO 80203
christy.culp@state.co.us
303-866-2369 phone
303-866-4819 fax
The following pages provide information to assist the
eligible grantee in filling out the application and plan.
Review each section to make sure that the information
provided in the application and plan is correct.
This information will be used in the contract Scope of Work.
Once you receive the contract from the Department of Local
Affairs review the Scope of Work that was approved for your
entity. It will describe the services that have been agreed
upon by the information contained within this application
and plan and the approved dollar amount for each entity.
Every aspect of the application and plan must match.
This includes, but is not limited to, the federal
objectives, national indicators, budget narrative,
services to be provided and outcomes to the client.
Page 26 of 59
CSBG Grant Year 2009-10
~~
2009- NATIONAL INDICATORS
Goal 1: Low-Income People Become More Self-Sufficient (Individual
or
National Performance Indicator 1.1-Employment
The number and percentage oflow-income participants in community action employment initiatives who
get a job or become self-employed as measured by one or more of the following:
A. Unemployed and obtained a job.
B. Employed and obtained an increase in employment income.
C. Achieved "living wage" employment and benefits.
National Performance Indicator 1.2 -Employment Supports
The number oflow-income participants for whom barriers to initial or continuous employment are reduced
or eliminated through assistance from community action as measured by one or more of the following:
A. Obtained pre-employment skills/competencies required for employment and received training
program certificate or diploma.
8. Completed ABE/GED and received certificate or diploma.
C. Completed post-secondary education program and obtained certificate or diploma.
D. Enrolled children in "before" or "after" school programs, in order fo acquire or maintain
employment.
E. Obtained care for child or other dependant in order to acquire or maintain employment.
F. Obtained access to reliable transportation and/or driver's license in order to acquire or
maintain employment.
G. Obtained health care services for themselves or a family member in support of employment
stability.
H. Obtained safe and affordable housing in support of employment stability.
1. Obtained food assistance in support of employment stability
National Performance Indicator 1.3 -Economic Asset Enhancement and Utilization
The number and percentage of !ow-income households that achieve an increase in financial assets
and/or financial skills as a result of community action assistance, and the aggregated amount of those
assets and resources for all participants achieving the outcome, as measured by one or more of the
following:
A. Enhancement -
1. Number and percent of participants in tax preparation programs who identify any type of
Federal or Sfafe tax credit and the aggregated dollar amount of credits
2. Number and percentage obtained court-ordered child support payments and the expected
annual aggregated dollar amount of payments.
3. Number and percentage enrolled in telephone lifeline and/or energy discounts with the
assistance of the agency and the expected aggregated dollar amount of savings.
8. Utilization -
1. Number and percent demonstrating ability to complete and maintain a budget for over 90
days.
2. Number and percent opening an Individual Development Account (IDA) or other savings
account and increased savings, and the aggregated amount of savings.
3. Of participants in a community action asset development program (IDA and others):
a. Number and percent capitalizing a small business due to accumulated savings.
b. Number and percent pursuing post-secondary education due to accumulated savings.
c. Number and percent purchasing a home due to accumulated savings.
Page 27 of 59
CSBG Grant Year 2009-10 „ r•~
J
Goal 2: The Conditions in Which Low-Income People Live are
Improved (Community Goal)
This set of measures collects outcomes on successful projects that build "community assets," including
not only mat~riat improvements, Pike affordable homes and safe streets, but even changes in public policy
that will reduce the causes of poverty and revitalize the low-income community.
This indicator ask for two types of information for each project -the number of successful projects that fit
under the measure and an indicator of the scale or impact of each, i.e. the number of community
members who wiii benefit yearly from the new "opportunities" that the community improvement offers
upon its completion.
National Performance Indicator 2.1 Community Improvement and Revitalization
Increase in, or preservation of opportunities and community resources or services for low-income people
in the community as a result of communify action projects/initiatives or advocacy with other public and
private agencies, as measured by one or more of the follawing:
A. Accessible "living wage" jobs created or retained in the communify.
B. Safe and affordable housing units created in the community Through construction, weatherization or
rehabilitation achieved by community action activity or advocacy.
D. Accessible and affordable health care services/facilities for low-income people created or maintained.
E. Accessible safe and affordable childcare or child development placement opportunities for low-income
families created or maintained.
F. Accessible "before" school and "after" school program placement opportunities for low-income families
created or maintained.
G. Accessible new, preserved, or expanded transportation resources available to low-income people,
including public or private transportation.
H. Accessible preserved or increased educational and (raining placement opportunities for low-income
people in the community, including vocational, literacy, and life skill training, ABE/GED, and post secondary
education.
National Performance Indicator 2.2 -- Community Quality of Life and Assets
The quality of life and assets in low-income neighborhoods are improved by community action initiative or
advocacy, as measured by one or more of the following:
A. Increases in community assets as a result of a change in law, regulation or policy, which
results in improvements in qualify oflife and assets;
B. Increase in the availability or preservation of community facilities;
C. Increase in the availability or preservation of community services to improve public health
and safety;
D. Increase in the availability or preservation of commercial services within low-income
neighborhoods; and
E. Increase or preservation of neighborhood quality-of--life resources.
Page 28 of 59
CSBG Grant Year 2009-10
3~
Goal 3: Low-Income People Own a Stake in Their Community
(Community Goal)
National Performance Indicator 3.1-Civic Investment
The number of volunteer hours donated to Community Action.
National Performance Indicator 3.2 -Community Empowerment through Maximum
Feasible Participation
The number of low-income people mobilized as a direct result of community action initiative to engage in
activities that support and promote their own well-being and that of their community as measured by one
or more of the following:
A. Number oflow-income people participating in formal community organizations, government,
boards or councils that provide input to decision-making and policy setting through community
action efforts.
B. Number oflow-income people acquiring businesses in their community as a result of
community action assistance.
C. Number oflow-income people purchasing their own homes in their community as a result of
community action assistance.
D. Number oflow-income people engaged in non-governance community activities or groups
created or supported by community action.
Goal 4: Partnerships Among Supporters and Providers of Service to
Low-Income People are Achieved (Agency Goal)
National Performance Indicator 4.1-Expanding Opportunities through Community-Wide
Partnerships
The number of organizations, both public and private, community action actively works with to
expand resources and opportunities in order to achieve family and community outcomes.
Goal 5: Agencies Increase Their Capacity to Achieve Results (Agency
Gaal)
National Performance Indicator 5.1 -Broadening the Resource Base
The number of dollars mobilized by community action, including amounts and percentages from:
A. Community Services Block Grant (CSBG)
B. Non-CSBG Federal Programs
C. State Programs
D. Local Public Funding
E. Private Sources (including foundations and individual contributors, goods and services
donated)
F. Value of volunteer time
Page 29 of 59
CSBG Grant Year 2009-10 ~ j
~~
Goal 6: Low-Income People, Especially Vulnerable Populations,
Achieve Their Potential by Strengthening Family and Other
Supportive Systems (Individual or Family Goal)
National Performance Indicator 6.1-Independent Living
The number of vulnerable individuals receiving services from community action that maintain an
independent living situation as a result of those services:
A. Senior Citizens; and
B. Individuals with Disabilities
National Performance Indicator 6.2 -Emergency Assistance
The number oflow-income individuals or families served by community action that sought emergency
assistance and the percentage of those households for which assistance was provided, including such
services as:
A. Food
8. Emergency Payments to Vendors, including Fuel and Energy Bills
C. Temporary Shelter
D. Emergency Medical Care
E. Protection from Violence
F. Legal Assistance
G. Transportation
H. Disaster Relief
National Performance Indicator 6.3 -Child and Family Development
The number and percentage of all infants, children, youth, parents, and other adults participating in
developments! or enrichment programs that achieve program goals, as measured by one or more of the
following:
A. Infants and Children -
1. Infants and children obtain age appropriate immunizations, medical and dents! care.
2. Infant and child health and physical development are improved as a result of adequate
nutrition.
3. Children participate in pre-school activities to develop school readiness skills.
4. Children who participate in pre-school activities are developmentally ready to enter
Kindergarten or 9S~ Grade.
B. Youth -
1. Youth improve physical health and development.
2. Youth improve social/emotions! development.
3. Youth avoid risk-taking behavior for a defined period of time.
4. Youth have reduced involvement with criminal justice system.
5. Youth increase academic, athletic or social skills for school success by participating in
before or after school programs.
C. Parents and Other Adults -
1. Parents and other adults learn and exhibit improved parenting skills.
2. Parents and other adults learn and exhibit improved family functioning skills.
Page 30 of 59
CSBG Grant Year 2009-10 ~)
l
FEDERAL OBJECTIVES
Employment
Specific activities to be included in the Employment Service Category are: information about
employment and job training; job counseling; job placement and development; on-the-job
training activities to enhance the skills of working persons during employment; and summer
youth jobs programs. Other activities may be employment generating projects, skills training,
participation in planning and coordination of the Workforce Investment Act (WIA) or participation
in community employment programs.
Education
Information about educational opportunities, advice and guidance to eligible youth and adults
about educational opportunities, educational or informational activities conducted to inform the
public about problems and solutions of poverty in the community, support of Head Start
programs, child development and childcare classes, parenting skills education, projects to
mobilize community resources to meet educational needs and to arrange for partnerships and
coordinated initiatives in education projects.
Income Management
All CSBG funded energy efficiency activities should be included here. Other activities are as
follows: household financial counseling, income tax counseling, alternative energy installations,
public information regarding energy conservation, Weatherization Support, and other income
management projects.
Housinn
Specific activities to be included in Housing are: information about housing services, counseling
on homeownership, counseling in landlord/tenant relations as we!! as assistance in applying for
rent subsidies, home repair and residential rehab services, support for group homes, initiatives
enforcing the Community Reinvestment Act, participation in preparation of applications from
local governments for CDBG, rural water and wastewater facilities and Section 8 housing.
EmergencYServices
Activities can include: One-time payments to help meet emergency needs for shelter, food,
clothing, fuel, energy payments etc., temporary shelter and/or food programs for the homeless,
mobilizing, staring, distributing donations of money, food, clothing, etc. and professional
services to help persons meet one-time emergencies or recover from disasters, projects to
mobilize the resources of communities to meet emergency or disaster relief needs of eligible
persons.
Linkages
This objective includes activities such as: Information and referral to several different types of
programs serving eligible individuals, projects undertaken by agencies to identify and prioritize
the needs of eligible citizens, activities that recruit volunteers and coordinate their activities,
organizing community meetings or coordinating activities, such as beautification, recycling or
crime prevention campaigns. This objective includes transportation of eligible persons to
services they need within their communities that cannot be assigned to a single direct program
purpose in other service categories. Can also include elderly projects such as for multi-purpose
senior centers; or recreation, consumer and homemaker services.
Page 39 of 59
CSBG Grant Year 2009-10
~~
Self-Sufficiency
The purpose of this objective is to capture expenditures being devoted to comprehensive, long-
term programs of family development whose purpose is to help clients achieve a set of goals
which will result in greater self-sufficiency and will eliminate some of the causes of that family's
poverty.
Health
This objective is designed to capture the increasing number of health-related activities that have
historically been reported under "Linkages: Other." Specific activities could include:
transportation to medical services; medical or dental screening; immunizations; drug abuse or
alcoholism prevention and treatment; family planning -counseling, information or assistance;
rural health programs; health related information for all ages; periodic screening for serious
health problems; mental health screening referral and treatment.
Nutrition
This objective includes activities such as: Organizing and operating food banks, supporting food
banks of faith based and civic organization partners with food supplies and management
support; distributing surplus USDA commodities and other food supplies; administer the
Women, Infants, and Children (WIC) nutrition program; preparing and delivering meals,
especially to the homebound elderly; providing food in group settings; counseling about family
and children's nutrition; and initiating self-help projects, such as community gardens and
canneries, and food buying groups.
Page 32 of 59
CSBG Grant Year 2009-10
35
ROMA DEFINITIONS
ACTIVITY - What a program does with its inputs to fulfill its mission. Program activities result in
outputs.
BENCHMARKS -Performance data used for comparative purposes to compare future
performance.
IMPACT -The direct or indirect effects or consequences of achieving program goals.
INDICATOR -Specific items of information that track a program's success on outcomes
describes the observable, measurable characteristics or changes that represent achievement of
an outcome. Along with the number (#) and percent (%) of program participants that
demonstrate how well the program is doing with respect to the outcome.
INPUT - Resources a program used to achieve program objectives to support activities.
MEASURE -Used for assessing the achievement of objectives that may be quantitative or
qualitative, objective or subjective.
MILESTONES -Key accomplishments or threshold points through which participants must
pass to be successful.
OUTCOME -Benefits or changes for clients, households, or a community that are produced
during or after participation in program activities.
OUTCOME INDICATOR -Specific items of information that track a program's successes on an
outcome that describe observable, measurable characteristics or change that represent
achievement of an outcome.
OUTCOME MEASURE -Assessment of the results, effects or impact of a program activity
compared to its mission.
OUTCOME TARGET -Numerical objectives for a program's level of achievement on its
outcomes. Set targets for the number (#) and percent (%) of participants expected to achieve
desired outcomes in the next reporting period. To show the amount of change that expected to
happen to participants.
OUTPUT -Products of a program's activities. Another term for "outputs" is "units of service." A
program's outputs should produce desired outcomes for the program's participants.
OUTPUT MEASURE -The tabulation, calculation or recording of activity or effort that can be
expressed in a quantitative or qualitative manner.
PERFORMANCE -Accomplishment of actions that transform inputs through a process to
outputs and outcomes.
PERFORMANCE INDICATOR - A particular value or characteristic used to measure outputs or
outcomes.
SCALE -Instrument that is used to measure an outcome on a continuum. Used to show
incremental progress, stabilization, or decline.
Page 33 of 59
CSBG Grant Year 2009-10
3
FORMS FOR ALL REPORTS
PROGRAM, FINANCIAL,
AND FINAL DATA REPORT FOR CONGRESS
Page 34 of 59
CSBG Grant Year 2009-10
J
CSBG REQUEST FOR REIMBURSEMENT REPORT
Copies of backup information (receipts, invoices, signed timesheets,
etc.) must be provided with the Reimbursement Report. The backup
information must equal the amount being requested, detailed in the
Scope of Work, and be within the timeframe of the contract.
MAIL TO: TYPE OF PAYMENT: REPORTING AGENCY:
(Name and Remit Address)
CSBG
DOLA - DLGS Reimbursement
1313 Sherman Street -Room 521 _
Final
Denver, CO 80203 -
ATTN: Lucia Smead
PERIOD COVERED BY THIS REQUEST: PAYMENT REQUEST CONTRACT ENCUMBRANCE
NUMBER: NUMBER:
From: To:
(Mo/Day/Yr) (Mo/Day/Yr) L9CSBG
COMPUTATION OF AMOUNT of REIMBURSEMENT REQUESTED
a. Actual Cumulative Funds Expended
b. Total Funds Previously Received
c. Amount of this cash request
CERTIFICATION: SIGNATURE OF DATE REPORT SUBMITTED:
AUTHORIZED OFFICIAL:
I certify to the best of my knowledge and belief the
data above is correct and that all expenditures were
made in accordance with grant agreements.
I understand that upon submitting the FINAL Request
for Reimbursement Form any funds reported as
unexpended will be deobligated.
NAME AND TITLE: PHONE #:
(Type or Print)
( )
EMAIL ADDRESS:
Page 35 of 59
CSBG Grant Year 2009-10
--i ,'/
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2008 HHS POVERTY GUIDELINES
Persons
in Family or
Household 48 Contiguous
States and
D.C. 125%
of
Poverty
1 $10,400 $13,000
2 14,000 17,500
3 17,600 22,000
4 21,200 26,500
5 24,800 ~ 31,000
6 28,400 35,500
7 32,000 40,000
8 35,600 44,500
For each additional
person, add 3,600 4,500
SOURCE: Federal Register, Vol. 73, No. 15, January 23, 2008, pp. 3971-3972
Current guidelines will be provided annually, once received from the Federal Register.
Page 37 of 59
CSBG Grant Year 2009-10
Report Forms
CSBG SIX MONTH PROGRESS REPORT
DUE SEPTEMBER 3O EACH YEAR
Agericy and Program:
Name & Title of Person Filling this Report:
Date Report
Official's Name and Title:
1. Are you on target as it relates to your original application outcomes and indicators? Please
explain:
2. Are there any problems encountered (as it relates to your expected outcomes)? Please explain:
3. If the original outcome relates to National Goal 1 or 6: How many individuals/families have been
served thus far? (Remember we want actual numbers and this includes your dropouts.)
Page 38 of 59
CSBG Grant Year 2009-10 ~
rJ
CSBG FINAL PROGRAM REPORT DUE MARCH 31 EACH YEAR
MUST BE COMPLETED AND ACCOMPANIED WITH:
NATIONAL INDICATORS FORMS, SECTIONS E. F. AND G.
Name of
Period Ended: February
NATIONAL INDICATOR:
This must match with the one identified in
the application and plan.
Actual Amount of the CSBG spent:
Name & Title of Person Filling this Report:
Address:
Program Director's Name and Title:
Phone Number:
Please remember that the answers to these questions must relate to your original
application.
What services did you provide your clients? List all that applies.
2. What was the outcome for the client as a result of the service? Did they become more self-
sufficient? Are they moving out of poverty?
Provide one example of the impact of services provided. Give an overall picture, the
struggles/accomplishments, partnerships, other resources utilized and how this made an impact to the
intended recipient(s). Use additional paper.
Page 39 of 59
CSBG Grant Year 2009-10
~f
Part li: Outcomes of Efforts, FY 2009
Natipnal Performance Indicators -Agency-Level Forms
Name of Agency Reporting:
Goal 1: Low-income people become more self-sufficient.
National Performance Indicator 1.1
Guide
Employment Pages 9-13
The number and percentage of low- Number of
Participants
income participants in community action Expected to Number of
employment initiatives who get a job or Achieve participants Percentage
become self-employed as measured by Number of Outcome in Achieving Achieving
one or more of the following: Participants Reporting Outcome in Outcome in
Enrolled in Period Reporting Reporting
Program(s) (Target) Period Period
(#1 (#) (#1 (°~a)
A. Unemployed and
obtained a job
P .11
B. Employed and obtained
an increase in
employment income
P .12
C. Achieved "living wage"
employment and
benefits
P .13
Page 40 of 59
CSBG Grant Year 2009-10 j ~
L
Goal 7: Low-income people become more self-sufficient.
National Performance Indicator 1.2
Guide Number of
Employment Supports Pages 13-18 Number of Participants
Participants Achieving Outcome
The number of low-income participants for whom Enrolled in in
barriers to initial or continuous employment are Program(s) Reporting Period
reduced or eliminated through assistance from
community action as measured by one or more of (#) (#)
the followin
A. Obtained pre-employment skillslcompetencies
required for employment and received training
program certificate or diploma
P .15
B. Completed ABE/GED and received certificate
or diploma
P .16
C. Completed post-secondary education
program and obtained certificate or diploma
P .16
D. Enrolled children in "before" or "after" school
programs, in order to acquire or maintain
employment
P .16
E. Obtained care for child or other dependant in
order to acquire or maintain employment
P .17
F. Obtained access to reliable transportation
andlor driver's license in order to acquire or
maintain employment
P .17
G. Obtained health care services for themselves
or a family member in support of employment
stability
P .17
H. Obtained safe and affordable housing in
support of employment stability
P .18
I. Obtained food assistance in support of
employment stability
P .18)
Page 41 of 59
CSBG Grant Year 2009-10
n_,...r ~. r .. ........,e.,.,/n hnnmm~ mnro cclf arffiriPnt.
VVar ~. ~..Vrr-u~~.vn~c: - - - ----
National Performance
Indicator 1.3
Economic Asset
Enhancement and
Utilization
Number of
The number and percentage
oflow-income households that
Number of Participants
Expected to
Number of
Aggregated
Percentage
achieve an increase in Participants Achieve Participants Dollar Achieving
financial assets and/or Enrolled in Outcome in Achieving Amounts
t
P Outcome in
ortin
R
financial skills as a result of Program(s) Reporting Outcome in aymen
s,
( g
ep
community action assistance,
and the aggregated amount of Period
(Target) Reporting
Period Credits or
Savings) Period
ts and r
sources
th
ose asse
e
for all participants achieving (#) (#) (#) ($) (%)
the outcome, as measured by
one or more of the followin :
1. Number and
percent of
participants in tax
preparation
programs who
identify any type of
Federal or State
E tax credit and the
N aggregated dollar
H amount of credits
A
N 2. Number and
C percentage
E obtained court-
M ordered child
E support payments
N and the expected
T annual aggregated
dollar amount of
a ments
3. Number and
percentage
enrolled in
telephone lifeline
and/or energy
discounts with the
assistance of the
agency and the
expected
aggregated dollar
amount of savin s
Page 42 of 59
CSBG Grant Year 2009-10 1 ,.~
/~~
Number of
Number of Participants
Participants Achieving
National Performance Expected to Outcome in Aggregated
Indicator 1.3 Achieve Reporting Dollar Percentage
(Continued) Number of Outcome in Amounts Achieving
Participants Reporting period (Payments, Outcome in
Economic Asset Enrolled in Period Credits or Reporting
Enhancement and Program(s) (Target) Savings) Period
Utilization
1. Number and percent # # # $ °/,
demonstrating ability
to complete and
maintain a budget for
over 90 days
2. Number and
percent opening an
U Individual
T Development
I Account (IDA) or
~ other savings
I account and
'Z increased savings,
A and the aggregated
T amount of savin s
I 3. Of participants
O in a community
N action asset
development
program (IDA
and others):
a. Number
and percent a
capitalizing a
small business
due to _
accumulated
savings
b. Number b
and percent
pursuing post-
secondary
education due
to savings
c. Number c
and percent
purchasing a
home due to
accumulated
savings
Page 43 of 59
CSBG Grant Year 2009-10
Agency Narratives on Goal 1: Low-income people become more self-sufficient.
Page 44 of 59
CSBG Grant Year 2009-10
Goal 2: The conditions in which low-income people live are improved.
1 Number of
National Performance Indicator 2.
Guide Opportunities
Pages 21-28
Improvement and Revitalization
Communit and/or
y Community
Increase in, or preservation of opportunities and community Number of Resources
resources or services for low-income people in the community Projects or Preserved or
as a result of community action projects/ initiatives or Initiatives Increased
advocacy with other public and private agencies, as
#
#
measured b one or more of the followin
A. Accessible "living wage" jobs created or retained in
the community
P .25
B. Safe and affordable housing units created in the
community
P .25
C. Safe and affordable housing units in the community
preserved or improved through construction,
weatherization or rehabilitation achieved by
community action activity or advocacy
P .26
D. Accessible and affordable health care
serviceslfacilities for low-income people created or
maintained
P .26
E. Accessible safe and affordable childcare or child
development placement opportunities for low-income
families created or maintained
P .26
F. Accessible "before" school and "after" school
program placement opportunities for low-income
families created or maintained
P .26
G. Accessible new, preserved, or expanded
transportation resources available to low-income
people, including public or private transportation
P .27
H. Accessible preserved or increased educational and
training placement opportunities for low-income
people in the community, including vocational,
literacy, and life skill training, ABEIGED, and post-
secondary education
P .27
Page 45 of 59
CSBG Grant Year 2009-10
Goal 2: The conditions in which low-income people live are improved.
National Performance Indicator 2.2 Guide
Number of Number of
Community
Pages 28-31 Program Assets, Services,
Community Quality of Life and Assets Initiatives or
Ad
cac or Facilities
Preserved or
y
vo
The quality of life and assets in low-income neighborhoods are Efforts Increased
improved by community action initiative or advocacy, as
measured b one or more of the followin # #
A. Increases in community assets as a result of a change
in law, regulation or policy, which results in
improvements in quality of life and assets
P 29
B. Increase in the availability or preservation of
community facilities
P .29
C. Increase in the availability or preservation of
community services to improve public health and
safety
P .30
D. Increase in the availability or preservation of
commercial services within low-income
neighborhoods
P .30
E. Increase or preservation of neighborhood quality-of-life
resources
P .31
Agency Narratives on Goal 2: The conditions in which low-income people live are improved.
Page 46 of 59
CSBG Grant Year 2009-10 j
1
Goal 3: Low-income people own a stake in their community.
National Performance Indicator 3
1
.
Guide
Total Number of
Civic Investment Pages 31-32 Volunteer Hours
The number of volunteer hours donated to Community (#)
Action.
Total number of hours volunteered to community
action
In the rows below, tease include an additional indicators that were not ca tured above.
Please report the number found in Part I: Section F, Subsection IV (g) of the CSBG/IS Survey.
Goal 3: Low-income people own a stake in their community.
National Performance Indicator 3.2 Guide
Pages 32-34
Community Empowerment Through Maximum Feasible
Participation
The number of low-income people mobilized as a direct Number of
result of community action initiative to engage in activities
th
t
t
t
th
d th
f
d
i
ll
b
i
t Low-Income People
r own we
e
ng an
a
o
a
suppor
an
promo
e
e
-
their community as measured by one or more of the (#)
followin
A. Number of low-income people participating in
formal community organizations, government,
boards or councils that provide input to decision-
making and policy setting through community
action efforts
P .33
B. Number of low-income people acquiring
businesses in their community as a result of
community action assistance
P .34
C. Number of low-income people purchasing their
own homes in their community as a result of
community action assistance
P .34
D. Number of low-income people engaged in
non-governance community activities or groups
created or supported by community action
P .34
Page 47 of 59
CSBG Grant Year 2009-10 fo
/~
Agency Narratives on Goal 3: Low-income people own a stake in their community.
Page 48 of 59
CSBG Grant Year 2009-10 /~
Goal 4: Partnerships among supporfers and providers of services to iow-income people are
achieved.
Agency Narratives on Goal 4: Partnerships among supporters and providers of services to low-
income people are achieved.
Page 49 of 59
CSBG Grant Year 2009-10
~ `~,
Goal 5: Agencies increase their capacity to achieve results.
National Performance Indicator 5.1 Guide
Pages 36-37 Dollars Percentage
Broadening the Resource Base Mobilized Of Total
The number of dollars mobilized by community action, ($) (%)
includin amounts and ercenta es from:'
A. Communit Services Block Grant CSBG
B. Non-CSBG Federal Pro rams
C. State Pro rams
D .Local Public Fundin
E. Private Sources (including foundations and
individual contributors, goods and services
donated
F. Value of Volunteer Time
100%
TOTAL
In the rows below, lease lnc/uoe an atldltlonal rno~cators that were not ca tu~ea above.
`Please report using the totals found in Part l: Section F, Subsection l - lV of the CSBGlIS Survey.
Agency Narratives on Goal 5: Agencies increase their capacity to achieve results.
Page 50 of 59 , ,
CSBG Grant Year 2009-10 h'
"!
Goal 6: Low-income people, especially vulnerable populations, achieve their potential by
strengthening family and other supportive environments.
National Performance Indicator 6.1 Guide Number of
Pages 37-39 Vulnerable
Independent Living Individuals
Living
The number of vulnerable individuals receiving services from community action Independently
that maintain an inde endent livin situation as a result of those services: #
A. Senior Citizens
B. Individuals with Disabilities
Goal 6: Low-income people, especially vulnerable populations, achieve their potential by
strengthening family and other supportive environments.
National Performance Indicator 6.2 Guide
Emergency Assistance Pages 39-44
Percentag
The number of low-income individuals or e
Achieving
families served by community action that Unit of Number Number Outcome
sought emergency assistance and the Measuremen Seeking Receiving in
percentage of those households for which t Assistant Assistant Reporting
assistance was provided, including such e e Period
services as: (#) # (%)
A. Food -Indicate your state's unit of
measurement, such as bags,
packages, cartons, families,
individuals, etc.
P .41
B. Emergency Vendor Payments, Households
including FuellEnergy Bills
P .41
C. Temporary Shelter Households
P .42
D. Emergency Medical Care Households
P .42
E. Protection from Violence Households
P .43
F. Legal Assistance Households
P .43
G. Transportation Households
P .43
H. Disaster Relief Households
P .44
In the rows below. please include any additional indicators that wen: not captured above (plea se include the type of unit being reF
ported).
Page 51 of 59
CSBG Grant Year 2009-10 , r J
~I{
Goa16: Low-income people, especially vulnerable populations, achieve their potential by
cfrnnnfhnninn family anr! nfhPr crinnnl'fiVP_ P_nVlrAnmentS.
National Performance Indicator
6.3 Guide ber of
Pages 44-49 icipants Percentage
Child and Family Development ected to Number of Achieving
The number and percentage of all Achieve Participants Outcome
infants, children, youth, parents, and Number of Outcome in Achieving in
other adults participating in Participants Reporting Outcome in Reporting
developmental or enrichment Enrolled in Period Reporting Period
programs that achieve program Program(s) (Target) Period
goals, as measured by one or more
of the followin
# #
#
1. Infants and children
N obtain age appropriate 1.
F immunizations, medical
A and dental care
N 2. Infant and child health
T and physical development
S are improved as a result 2.
of adequate nutrition
8 3. Children participate in
pre-school activities to
C develop school readiness 3
H skills
I 4. Children who participate
L in pre-school activities are
D developmentally ready to 4
R enter Kindergarten or 15~
E Grade
N
1. Youth improve physical
health and development
2. Youth improve 1.
social/emotional
development.
Y 3. Youth avoid risk-taking 2.
O behavior for a defined
U period of time
T 4. Youth have reduced 3.
H involvement with
criminal
justice system 4.
5. Youth increase academic,
athletic or social skills for
school success by 5.
participating in before or
after school ro rams.
A 1. Parents and other adults
D learn and exhibit
U improved parenting skills 1.
L 2. Parents and other adults
T learn and exhibit improved
S family functioning skills 2.
Page 52 of 59
CSBG Grant Year 2009-10 ~~~
Agency Narratives on Goal 6: Low-income people, especially vulnerable populations, achieve
their potential by strengthening family and other supportive environments.
Page 53 of 59
CSBG Grant Year 2009-10 .•~~
~~
r
Part 1: Section E. CSBG Expenditures by Service Cateporv
Agency reporting:
Table 1: Funding By Service Category and Funding Source, FY 2009
Service Category # of
Agencies
Reporting
CSBG
Funds
1. Em to ment
2. Education
3. income Mana ement
4. Housin
5. Emer enc Services
6. Nutrition
7. Linka es
8. Self-Sufficienc
9. Health
Totals: ~
Of the CSBG funds reported above, $ were for administration.
(Please consult the instructions regarding what constitutes administration.)
Table 2: Of the funding Listed in Table 1: Funds for Services by Demographic Category, FY 2008
# of
Demographic Category Agencies CSBG
Reporting Funds
1. Youth
2. Seniors
Section F: Other Resources Administered and Generated
Page 54 of 59 l ~/~
CSBG Grant Year 2009-10 ~ 1
by the CSBG Network
Subsection I.
1. Name of Local Agency Reporting 1.
2. Amount of FY 2009 CSBG allotted to reporting agency 2. $
3. Federal Resources (other than CSBG)
a. Weatherization (DOE (include oil overcharge $$)
b. LIHEAP- Fuel Assistance (HHS) (include oil overcharge $$)
c. LIHEAP- Weatherization (HHS) (include oil overcharge $$)
d. Head Start (HHS)
e. Early Head Start (HHS}
f. Older Americans Act (HHS)
g. SSBG (HHS)
h. Medicare/Medicaid (HHS)
i. Community Food and Nutrition (HHS)
j. Temporary Assistance to Needy Families (TANF)
k. Child Care Development Block Grant (CCDBG)
I. Other HHS resources (list in order of size):
1
2
3
4 All Other
TOTAL HHS Other:
m. WIC (USDA)
n. Afl USDA Non-Food Programs (e.g. rural development)
o. All Other USDA Food Programs
p. CDBG -Federal, State, and Local
q. Housing Programs (HUD): q1. Section 8
q2. Section 202
r. All other HUD including homeless programs
s. Employment and training programs (US DOL)
t. Other US DOL programs
u. Corporation for National Services (CNS) Programs
v. FEMA
w. Transportation (US DOT)
3a. a.
3b. I~b.
3c. $
3d. $
3e. $
3f.
3g. $
3h.
3i.
3j.
3k. $
31.
3m.
3n.
30.
3p.
3q1.
3q2.
3r.
3s.
3t.
3u.
3v.
3w.
x. Other Federal Sources (list in order of size):
1
2
3
4 All Other TOTAL Federal Other: 3x.
0
TOTAL: NON-CSBG FEDERAL RESOURCES $
Page 55 of 59
CSBG Grant Year 2009-10 •~>~
/)
Section F: Other Resources Administered and
Generated
Subsection 11. State Resources
a. State appropriated funds used for the same purpose a.
as federal CSBG funds
Note: Verify with State Administrator that this figure matches state submission in Section A, Item 5.
b. State housing and homeless programs
c. State nutrition programs
d. State day care and early childhood programs
e. State energy programs
f. State health programs
g. State youth development programs
h. State employment and training programs
i. State Head Start programs
j. State senior programs
k. State transportation programs
I. State education programs
m. State community and economic development programs
n. State rural development programs
1 $
2 $
3 $
4 $
5 $
6 $
7 $
8 $
9 $
10 $
11 $
12 $
13 $
ALL OTHER: $
Total Fundin4
Amount,
State Other
Total Funding Amount
0
TOTAL: STATE RESOURCES
If any of these resources were also reported under Subsection
(Federal Resources), please estimate the amount.
Page 56 of 59 ~
CSBG Grant Year 2009-10 ;~~
Section F; Other Resources Administered and Generated
Subsection 111. Local Resources
a. Amount of unrestricted funds appropriated by a.
local government
b. Value of Contract Services b.
c. Value of in-kind goods/services received from local
government. c.
TOTAL: LOCAL PUBLIC RESOURCES
If any of these resources were also reported under
Subsection I or ll, please estimate the amount.
Subsection 1V. Private Sector Resources
a. Funds from foundations, corporations, United Ways,
other non-profits
b. Other donated funds
c. Value of other donated items, food clothing, furniture, etc.
d. Value of in-kind services received from businesses
e. Fees paid by clients for services
f. Payments by private entities for goods or services for
low-income clients or communities
a.
b.
c.
d.
e.
f.
g. Number of volunteer hours donated g.
TOTAL: PRIVATE SECTOR RESOURCES
!f any of these resources were also reported under Subsection !,
!I or lll, please estimate the amount.
ALL OTHER RESOURCES
TOTAL: (FEDERAL, STATE, LOCAL, PRIVATE)
less amount of double count in Subsection II, III, I
Page 57 of 59
CSSG Grant Year 2009-10 (}
Section G: Client Characteristics
1. Name of Agency Reporting ~ ~ 2. Total resources in agency I I
reporting, Including CSBG
3. Total unduplicated number of persons about whom one or more characteristics were obtained
4. Total unduplicated number of persons about whom no characteristics were obtained
5. Total unduplicated number of families about whom one or more characteristics were obtained
6. Total unduplicated number of families about whom no characteristics were obtained
a. nnale
b. Female
TOTAL"
8.
b. 6-11
c. 12-17
d. 18-23
e. 24-44
f. 45-54
g. 55-69
h. 70+
TOTAL*
9.
b. White/Not Hispanic
c. Hispanic Origin
d. Native American/Alaskan
e. Asian/ Pacific Islander
f. Other
TOTAL*
a. 0-8
b. 9-121non-graduates
c. High school grad/GED
d. 12+ some post secondary
e. 2 or 4 yr college graduates
TO TAL***
a. No health insurance
b. Disabled
12.
a. Single parenUfemale
b. Single parent/male
c. Two-parent household
d. Single person
e. Two adults/no children
f. Other
TO TAL**'
a. One
b. Two
c. Three
d. Four
e. Five
f. Six
g. Seven
h. Eight or more
TOTAL***
a. Unduplicated # of Families
Reporting One ar More Sources
b. No Income
c. TAN F
d. SSI
e. Social Security
f. Pension
g General Assistance
h. Unemployment Insurance
i. Employment + other sources
j. Employment only
k. Other
a. Up to 50%
b. 51 % to 75%
c. 76% to 100%
d. 101 % to 125%
e. 126% to 150%
f. 151% and over
TOTAL**
a. Own
b. Rent
c. Homeless
d. Other
TOTAL***
The sum of this category should not
* exceed the value of Item 3.
The sum of this category should not
** exceed the value of Items 8 e-h.
The sum of this category should not
exceed the value of Item 5.
Page 58 of 59
CSBG Grant Year 2009-10 1
END OF DOCUMENT
Page 59 of 59
CSBG Grant Year 2009-10 J ~