HomeMy WebLinkAboutbocc.con.244.20 - BOCC DocuSign Envelope ID:7817037F-E798-473E-A872-D3B5519BBE7F
Contract No. 244.20
SNAP OUTREACH CONTRACTOR AGREEMENT
Between HUNGER FREE COLORADO and PITKIN COUNTY HUMAN SERVICES
For October 1, 2020 to September 30, 2021
This SNAP Outreach CONTRACTOR AGREEMENT ("Agreement") is made on October 1,
2020,by and between HUNGER FREE COLORADO ("HFC"), a Colorado nonprofit
corporation, having its primary place of business at 1355 South Colorado Blvd, Suite 201,
Denver, CO 80222 and PITKIN COUNTY HUMAN SERVICES (PCHS), a Colorado nonprofit
corporation having its primary place of business at 405 Castle Creek Road, Suite 103, Aspen, CO
81611.
TABLE OF CONTENTS
1. SERVICES PROVIDED BY CONTRACTOR 2
2. TERM OF CONTRACT 2
3. PAYMENT 2
4. COMPLIANCE 3
5. CLIENT PRIVACY, DATA SECURITY AND DATA GOVERNANCE 3
6. REPORTING 5
7. INDEPENDENT CONTRACTOR RELATIONSHIP 6
8. EQUAL EMPLOYMENT OPPORTUNTITY. 7
9. INDEMNIFICATION 7
10. DISPUTE RESOLUTION. 8
11. TERMINATION OF CONTRACT. 8
12. SEVERABILITY. 8
13. ENFORECEMENT &WAIVER 8
14. NON-DISCLOSURE & CONFIDENTIALITY 8
15. INTELLECTUAL PROPERTY 9
16. HUNGER FREE COLORADO RESPONSIBLITIES 9
17. TELEPHONIC SIGNATURE COMPLIANCE. 10
18. ENTIRE AGREEMENT, MODIFICATIONS &NOTICE. 11
19. APPLICABLE LAW 11
20. CONTACTS 11
DocuSign Envelope ID:7817037F-E798-473E-A872-D3B5519BBE7F
UPDATED: 12/11/2020
1. SERVICES PROVIDED BY CONTRACTOR.
PCHS agrees to diligently perform the services described in the SNAP Outreach Project
Proposal approved by the Colorado Department of Human Services (the "Services"
Attachment A) in a timely manner during Contract Term. PCHS has discretion over the
method, details, and means of performing the Services, and will comply with both state
and federal guidelines regarding SNAP Outreach eligible activities governing the use of
SNAP Outreach funds at all times. PCHS will provide the Services, and may at its own
expense, employ such employees or agents as PCHS deems necessary to perform the
Services provided this is in line with services described in the state-approved SNAP
Outreach Project proposal.
2. TERM OF CONTRACT
This Agreement is effective October 1, 2020 and will continue in effect until September
30, 2021 (the "Term"), unless terminated earlier by either final completion of the
Services and acceptance of the Services by HFC and the Colorado Department of Human
Services (CDHS), or in accordance with the provisions of Section 11. Pending successful
execution of the services outlined in ATTACHMENT A, it is the intent of CDHS and
HFC to continue supporting this SNAP Outreach partnership with PCHS for additional
years beyond this initial Term, providing continued funding from the United States
Department of Agriculture (USDA) Food and Nutrition Services Division (FNS), the
Colorado Department of Human Services (CDHS) and The Colorado Health Foundation
(TCHF).
3. PAYMENT.
Payment will be made monthly on a reimbursable basis upon completion of the Services
described in ATTACHMENT A and submission of expense reports as described in
Section 6. Upon receipt of the expense report, HFC will include PCHS expenses, based
on actual SNAP Outreach-eligible expenses incurred, in monthly reports to the State of
Colorado for reimbursement in accordance with federal and state rules and guidelines
governing SNAP Outreach and HFC's SNAP Outreach contract with the State.
Within 30 days of HFC receipt of reimbursement funds from the State, PCHS will be
reimbursed in the amount that corresponds with the approved expense report. Total
payment will not exceed the budgeted amounts as described in ATTACHMENT A.
Should the Colorado Department of Human Services (CDHS) deem that less than 100%
of the activities and expenditures submitted for any monthly reimbursement request are
non-reimbursable, HFC is not responsible for providing PCHS with funds that make-up
for the difference in reimbursements requested and received. Only reimbursements
approved by CDHS can be sent to PCHS.
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DocuSign Envelope ID:7817037F-E798-473E-A872-D3B5519BBE7F
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4. COMPLIANCE.
PCHS agrees to comply with all relevant Federal, State and Local requirements related to
SNAP Outreach. This includes an ANNUAL SITE VISIT conducted by HFC. It also
includes, but may not be limited to, ensuring all SNAP Outreach workers complete the
following trainings prior to engaging in SNAP Outreach:
• Civil Rights Training
• CBMS Training (if Applicable)
• PEAK Pro Training
• Telephonic Signature Training(if Applicable)
Additionally, all SNAP Outreach workers will sign the Colorado Department of Human
Services Food and Energy Confidentiality Agreement(See ATTACHMENT B)prior to
engaging in SNAP Outreach.
Finally,PCHS must retain all supporting financial documentation used for submitted
Monthly Invoices throughout the grant cycle and for three years thereafter(See Section
6) and make those documents available to HCF or CDHS within two business days.
5. CLIENT PRIVACY, DATA SECURITY AND DATA GOVERNANCE.
In the execution of this contract, PCHS will collect and receive Personally Identifiable
Information(PII) which must be kept confidential. PCHS agrees to take all reasonable steps
to ensure confidentiality of PII and to protect these data as defined below.
a. Definition of Confidential Data and Personally Identifiable Information
(PII).
In the execution of this contract, PCHS will collect and receive Personally Identifiable
Information(PII) which must be kept confidential. PII is any data that could potentially
identify a specific individual and includes, but is not limited to:
i. Name
ii. Date of Birth
iii. Social Security Number
iv. Other unique IDs
v. Personally Identifiable Financial Information
vi. Medical Information
vii. Health Information
viii. Any other data that could potentially be used to identify a specific
individual
If PCHS is unsure whether a class of data is considered PII and must therefore be kept
confidential, it will act as though these data are PII until it has expressed written
confirmation from HFC that those data are not covered.
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b. Secure PII and Maintain Client Privacy.
PCHS will take all reasonable steps to ensure client information is secure and
confidential. This includes ensuring PII is secured such that physical documents are
locked when not in use and digital documents are password protected. It also requires
ensuring PII is not left unattended and visible on either a desk or on a desktop such that it
can be viewed by unauthorized individuals. Finally, it mandates that data are disposed of
properly including shredding of PII stored on paper.
c. Data Retention.
Upon completion or termination of this agreement, PCHS will dispose of all PII and will
not maintain PII beyond the term of this agreement. Disposal should protect the
information, including shredding any hard copies and deletion of all electronic copies,
including within archived data sets.
d. Access Restrictions
PCHS will limit access to PII attained as part of this contract to only those staff engaged
in SNAP Outreach, who have completed all trainings identified in Section 4 and who
have signed a confidentiality agreement(see Attachment B). Staff who have not
completed trainings and/or not signed a confidentiality agreement shall not have access to
any PII attained as part of this contract.
e. Minimally Necessary Principle.
PCHS will limit the use of PII to that which is minimally necessary to complete the work
associated with this contract. This implies that as part of this contract, PCHS will not
collect PII unless it is necessary for SNAP Outreach or to meet the obligations contained
herein.
f. Incidents and Remediation.
PCHS agrees to make a good faith effort to identify any use or disclosure of confidential
data not authorized by this Agreement. If PCHS becomes aware of any inappropriate
release, disclosure or breach of Sensitive Data, it will notify HFC within 24 hours and
will cooperate regarding recovery, mitigation, remediation, and any necessary actions to
comply with state and federal law. Additionally, PCHS may not contact impacted
individuals until HFC and PCHS have agreed upon a remediation plan in partnership with
any necessary government agencies. Finally, following an incident, PCHS will work with
HFC to reduce the risk of future breeches.
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6. REPORTING.
PCHS agrees to provide reports on both the substance of SNAP Outreach activities and
itemized expenses reports for inclusion to the Colorado Department of Human Services
(CDHS) for monthly reimbursements. This includes the following reports:
• Monthly Activities Report. By the 5th of each month, PCHS will provide HFC
the total number of SNAP Applications, Change Reports and Redeterminations
for the prior month. The data are due by the 5th even if the 5th is a weekend,
though PCHS may always submit the report early.
Additionally, by the 15th of each month, PCHS will provide HFC data via the
Monthly Activities Report(template provided by HFC). The report is due by the
15th even if the 15th is a weekend, though PCHS may always submit the report
early. At a minimum this report will include:
o Number of SNAP Applications, Change Reports and Redeterminations for
households with people over 60 years old in the month
o Number of touch points with clients:
• Events attended/hosted(if applicable)
• Number of materials distributed(if applicable)
• Total number of people engaged around SNAP Outreach (if
applicable)
o Brief narrative (roughly 1 paragraph) description of SNAP Outreach
activities conducted in the month
o Brief narrative (roughly 1 paragraph) account of challenges encountered
with SNAP Outreach efforts
o Brief narrative (roughly 1 paragraph) describing any necessary supports
that HFC, the State, counties or other entities may be able to provide to
improve SNAP Outreach efforts
• Annual Activities Report.No later than October 9th, 2021 PCHS will provide
HFC data via the Annual Activities Report(template provided by HFC), which
will mirror the Monthly Activities Report in content.
• Monthly Invoices. PCHS shall ensure that expenses submitted as part of these
invoices are exclusive to SNAP Outreach activities and shall not include work or
activities performed for other programs. If PCHS staff provide multiple services
in the course of their work, they must delineate the portion of work for SNAP
Outreach activities via a time reporting process.
The first Monthly Invoice for this contract will be due by November 10th and
consecutively on the 10th of each month thereafter. Invoices must, at a minimum, include:
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o Itemized Expenses - Itemized documentation of actual expenses for
SNAP-eligible activities using the billing templated provided by HFC and
CDHS.
o Time Reporting - Time reports for each staff involved in the project and
payroll reports, such as a payroll register detailing payroll and benefits
paid. HFC will provide a template for this reporting, which must be
signed by supervisory staff.
Expenses not included by the l Oth of the month may be added to the following month's
Invoice. Incomplete invoices shall be returned to PCHS without payment and may be
added to the following month if finalized following the 10th of the month.
The final invoice shall be due on October 30th, or 30 days after the termination of the
agreement, whichever occurs first. This invoice shall be marked FINAL and no additional
payments may be made from this agreement after the final invoice has been submitted.
7. INDEPENDENT CONTRACTOR RELATIONSHIP.
PCHS and HFC understand and agree that PCHS's relationship to HFC is that of an
independent contractor, and nothing in this Agreement creates a joint venture,
partnership, or employer-employee relationship. Accordingly, PCHS and its employees
and agents, if any, are not entitled to any benefits that may ordinarily be extended to
employees of HFC, and PCHS and its employees and agents and are not authorized to
make any representation, contract or commitment on behalf of HFC unless specifically
authorized to do so by HFC. During the Term of this Agreement, PCHS is free to provide
services to any other organizations.
a. Materials,Equipment and Supplies.
PCHS will furnish and cover the up-front cost of materials and equipment necessary to
perform the Services, such as computer hardware and software, desk telephone, office
furniture, office equipment such as printer, copier, fax machine, as well as office
supplies. HFC will reimburse PCHS for only those materials, equipment and supplies
itemized in PCHS's proposed budget and budget narrative, which were approved
expenses by the Colorado Department of Human Services (CDHS).
b. Expenses.
PCHS is responsible for all reasonable business expenses associated with providing the
Services as described in ATTACHMENT A. HFC will reimburse reasonable expenses
outlined in the approved budget including mileage reimbursement at the current federal
mileage reimbursement rate and other pre-approved travel expenses. Federal mileage
reimbursement are often adjusted each year on January 1, therefore, the mileage rate for
this contract may change on January 1, 2021 and the approved budget will adjust
accordingly.
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DocuSign Envelope ID:7817037F-E798-473E-A872-D3B5519BBE7F
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c. Contractor's Employees.
HFC may not control, direct, or supervise PCHS's employees in the performance of the
Services described in ATTACHMENT A. HFC will provide training and technical
assistance related to SNAP Outreach as described in Section 16 and PCHS may seek
further guidance from HFC regarding training, invoicing, organizational relationships or
technical concerns.
d. Benefits and Taxes.
PCHS is solely responsible for payment of all federal, state and local income and payroll
taxes with respect to compensation received under this Agreement. HFC has no
responsibility for the withholding or payment of federal, state or local taxes, for
withholding or contributions under the federal insurance contributions act(FICA), or for
contributions under the federal unemployment tax act(FUTA) on behalf of PCHS or its
employees in connection with the Services.
e. Insurance.
HFC will not provide or procure insurance, including health, life, dental or vision
insurance, workers' compensation, unemployment, or liability insurance, on behalf of
PCHS or its employees. Throughout the Term of this Agreement, PCHS will maintain its
own workers compensation insurance, unemployment insurance and automobile
insurance in the amounts required by statute. At HFC's request, PCHS will provide
certificates or other acceptable evidence of insurance evidencing the foregoing coverage
and will provide HFC with prompt written notice of any material change to the same.
8. EQUAL EMPLOYMENT OPPORTUNTITY.
PCHS shall not discriminate against any employee or participant because of age, sexual
orientation, gender, marital status, physical or mental disability, race, color, national
origin, military status, religion, or any other protected class. PCHS will take affirmative
action to ensure that employees and participants are treated without regard to their age,
sexual orientation, gender, marital status,physical or mental disability, race, color,
national origin, military status, religion, or any other protected status.
9. INDEMNIFICATION.
PCHS agrees to indemnify and hold harmless HFC and its officers, directors, agents and
employees (each a"Covered Party") from and against any and all liabilities, losses,
claims, damages,judgments, costs, expenses, obligations,penalties including interest and
attorney fees that it shall incur or suffer that arise out of, result from, or relate to HFC's
activities pursuant to this Agreement.
Further, HFC agrees to indemnify and hold harmless PCHS and its officers, directors,
agents and employees (each a"Covered Party") from and against any and all liabilities,
losses, claims, damages,judgments, costs, expenses, obligations, penalties including
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interest and attorney fees that it shall incur or suffer that arise out of, result from, or relate
to PCHS's activities pursuant to this Agreement.
10. DISPUTE RESOLUTION.
HFC and PCHS agree that, in the event a dispute arises between them concerning this
Agreement, HFC and PCHS will submit the dispute to binding arbitration according to
the rules of the American Arbitration Association. Any such arbitration shall be
conducted in Denver, Colorado. Each party shall be solely responsible for its legal
expenses associated with such arbitration and any subsequent proceedings.
11. TERMINATION OF CONTRACT.
Should either party wish to terminate this Agreement for material breach, the terminating
party will provide the other party at least thirty(30) days' written notice of and the
opportunity to cure the breach. Before terminating the Agreement, CDHS must first be
notified and given fifteen (15) days to respond. Termination for breach will not preclude
the terminating party from exercising any other remedies for breach.
12. SEVERABILITY.
If any of the provisions of this Agreement are held invalid or unenforceable, such
invalidity/unenforceability will not invalidate or render unenforceable the entire
Agreement, rather the entire Agreement will be construed as if not containing the
particular invalid or unenforceable provision(s); the rights and obligations of the parties
will be construed and enforced accordingly to effectuate the intent and purposes of this
Agreement.
13. ENFORECEMENT & WAIVER.
The failure of either party in any instance to insist upon strict performance of any of the
terms and provisions of this Agreement shall not be construed as a waiver of the right to
assert any such terms and provisions on any future occasion or of damages caused
thereby.
14. NON-DISCLOSURE & CONFIDENTIALITY.
In the course of performing the Services described in ATTACHMENT A, PCHS, HFC
and their employees and agents may have access to documents, data or other information
(which may be in the form of printed materials, electronic data, oral statements or other
formats), which is confidential and proprietary in nature.
Each party and its employees and agents will not, either during or after the Term of this
Agreement, directly or indirectly publish or otherwise disclose to any third party, or use
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for personal gain, any confidential information without the prior written consent of the
other party. If either PCHS or HFC is uncertain about whether a specific document or
piece of information is considered confidential, PCHS will consult with the other party.
Each party will ensure that all confidential information is stored securely and shared only
with the other party and certain third parties approved by each party. PCHS and HFC and
their employees and agents will keep confidential any computer security passwords
received during the term of this agreement and will not share such passwords with any
other person. Upon termination of this Agreement, any confidential information obtained
by PCHS or HFC or their employees or agents will promptly be returned to the other
party.
Additionally, all SNAP Outreach workers will sign the Colorado Department of Human
Services Food and Energy Confidentiality Agreement(See ATTACHMENT B)prior to
engaging in SNAP Outreach.
15. INTELLECTUAL PROPERTY.
Each party represents and warrants that all material or content, regardless of the media in
which it is submitted("work product"), provided by either party to the other party will be
original works or that it has the right to grant the other party the rights in the work
product granted by this Agreement Each party also represents and warrants that the work
product does not infringe any copyright, trademark, trade secret or other proprietary,
contractual or personal right of another. PCHS Each party will ensure that the work
product contain facts and statements that are true and accurate. HFC has the right to use
PCHS's name,by-line,photograph, likeness or biographical material in connection with
the use,publication or republication of the work product resulting from this Agreement.
HFC also has the right to edit and prepare derivative works of the work product with
PCHS's prior written consent, which will not be unreasonably withheld.
16. HUNGER FREE COLORADO RESPONSIBLITIES.
HFC agrees to provide PCHS with:
• SNAP Outreach Training—HFC will train PCHS SNAP Outreach staff on all
necessary aspects of SNAP Outreach. This includes:
i.Compliance trainings including Civil Rights Training
ii.Technical training on the use of PEAK Pro, CBMS, and telephonic
signature
iii.SNAP eligibility and benefits
• Software Licenses—via the Colorado Department of Human Services, HFC will
provide PCHS SNAP Outreach staff with PEAK Pro licenses and will
provide one read-only CBMS license for PCHS. HFC will also provide licenses
for GoToMeeting or an approved alternative for use as part of the telephonic
signature.
• Telephonic Signature Storage and Retrieval—HFC will provide a secure
upload feature via Form Assembly for PCHS to upload telephonic signatures for
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storage and retrieval. As part of this service, HFC will be responsible for the secure
storage of all telephonic signatures provided by PCHS for a period of five years.
• Technical Assistance—In partnership with the Office of Information Technology
(OIT), HFC will provide technical assistance for PEAK Pro and CBMS
• Evaluation and Data—HFC will provide PCHS with support in analyzing data
and understanding how PCHS SNAP Outreach efforts fit within the larger SNAP
Outreach picture in Colorado.
• Relationship Support—HFC will support PCHS with building and maintaining
relationships with county Human Service Departments, other SNAP Outreach
partners, the Colorado Department of Human Services and other entities related to
SNAP Outreach.
17. TELEPHONIC SIGNATURE COMPLIANCE.
PCHS may complete SNAP Applications in person or telephonically. As part of accepting
and recording telephonic signatures, PCHS will ensure it:
• Records Signatures—PCHS will record telephonic signatures, or recordings of
clients granting their permission to submit an application on their behalf. These
signatures will include responses to all of the CDHS approved assent questions.
• Saves Signatures—PCHS will save recordings and will associate them with
individual client records, using an approved HIPPA-compliant method.Recordings
will be saved in accordance with current naming conventions.
• Send Signatures to HFC—PCHS will send all telephonic signatures
to HFC using the Form Assemble Portal or other approved secure file transfer
protocol.
• State Review—PCHS will provide MP3, MP4 or WAV files of these recordings
within two business days of a request from HFC or the Colorado Department of
Human Services. PCHS will also comply with all audits and reviews of the telephonic
signature process, by either HFC or CDHS.
• Follows-up with Printed Materials—PCHS will mail a copy of the authorized
letter and a printed copy of the application to the client for all applications processed.
• Provides Clients with Mail Option—PCHS will provide clients with the option
to do the application via mail and hard copy and will track clients exercising this
option, including their name, the date of the call and the date of the follow-up action.
• Remedies Technical Failures—in the event of a technical failure rendering a
telephonic signature unusable, PCHS contact the applicant and attempt to obtain a
new telephonic signature.
• Reports Discrepancies—PCHS will contact the appropriate county Department
of Human Services to report application discrepancies.
Additionally, PCHS will ensure all staff utilizing telephonic signature will comply with the
following:
• Attain Agreement for Telephonic Assistance—staff will ensure applicants
agree to telephonic assistance prior to starting an application by phone.
• Notify When Recording—staff will notify applicants when they are recording
the conversation.
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• Proficiency Reading and Explaining Requirements—staff will be proficient at
reading the Rights and Responsibilities and the Verbal Assent Statement. If an
applicant does not understand either of these, staff will provide further clarification.
• Follow-up—After completing an application, staff will mail the applicant both
the approved letter and a hard copy of the application. These materials should include
the applicants' next steps, documents necessary for verification, and how to
contact PCHS should issues arise.
18. ENTIRE AGREEMENT,MODIFICATIONS & NOTICE.
This Agreement constitutes the entire agreement and understanding between the parties
with respect to the subject matter hereof and supersedes all prior agreements and
understandings. Any modification to this Agreement, including Attachment(s), must be
in writing, signed by HFC and PCHS and should the modification relate to the
expectations as laid out in ATTACHMENT A, the Colorado Department of Human
Services (CDHS)must be notified and given fifteen(15) days to respond. Notice shall be
deemed given when delivered by hand or by a courier service, or when deposited in the
US Mail, first class postage affixed, addressed to the party to be notified at the address
provided herein, or such other address as may be given by notice.
19. APPLICABLE LAW.
This Agreement shall be construed in accordance with and governed by the laws of the
State of Colorado.
20. CONTACTS.
The contact information for HFC and PCHS are as follows:
For HUNGER FREE COLORADO:
Emily Hunter
SNAP PEAS Manager
Hunger Free Colorado
720.583.3280
Emily@HungerFreeColorado.org
For PITKIN COUNTY HUMAN SERVICES:
Samuel Landercasper
Economic Assistance Manager
Pitkin County Department of Human Services
970.429.6167
samuellandercasper@pitkincounty.com
PCHS agrees maintain a contact for HFC for SNAP Outreach and to notify HFC of any
changes to this contact within 10 business days of the change.
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DocuSign Envelope ID:7817037F-E798-473E-A872-D3B5519BBE7F
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HUNGER FREE COLORADO
DocuSigned by:
kur
Signature: r3r3BAD92743B4CA
b"'
Brett Reeder
Name:
Title: Director of client services
12/11/2020
Date:
PITKIN COUNTY HUMAN SERVICES
DocuSigned by:
Signature: i1 Cr
1C,9931 7`r39C171
Nan sundeen
Name:
Director of Human services
Title:
12/15/2020
Date:
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DocuSign Envelope ID:7817037F-E798-473E-A872-D3B5519BBE7F
ATTACHMENT A: CONTRACTOR SERVICES & BUDGET
For PITKIN COUNTY HUMAN SERVICES(PCHS) SNAP Outreach FFY 2020-21
GOAL: 240 SNAP Applications (includes new applications, redeterminations and change
reports)by 9/30/2021 —84 by 2/28/2021
Increase capacity for food-insecure residents of Pitkin County to connect to food resources by
providing SNAP outreach and application assistance. In FFY20 PITKIN COUNTY
DEPARTMENT OF HUMAN SERVICES's goal is to submit 240 SNAP Applications
(includes new applications, redeterminations and change reports) by September 30, 2021. As a
milestone, PITKIN COUNTY DEPARTMENT OF HUMAN SERVICES aims to have
submitted 84 SNAP Applications by February 28th 2021 (35% of the annual goal within the first
5 months). If PITKIN COUNTY DEPARTMENT OF HUMAN SERVICES does not meet this
milestone, HFC and PITKIN COUNTY DEPARTMENT OF HUMAN SERVICES will jointly
revisit the plan and budget and make any necessary adjustments.
DESCRIPTION OF CONTRACTOR SERVICES
This project reimburses 25% (0.25 FTE) of Pitkin County's Eligibility and Outreach Specialist
(EOS) and 11% (0.11 FTE) of their Benefits Specialist(BS)to increase the County's capacity
around SNAP outreach and enrollment. When face-to-face contact is allowed, these workers are
primarily stationed out in the community, in various locations throughout Pitkin County,
providing direct SNAP application assistance where clients in need are located. When social
distancing does not allow for face-to-face services, these workers follows up with clients to
process change reports and redeterminations and to complete applications which came in without
enough information to determine eligibility. All activities include services and supports provided
in Spanish as well as English.
The project also reimburses 10% (0.10 FTE) of Pitkin County's Economic Assistance Manger
(EAM)to provide supervision and project management. The EAM provides support to the EOS
and the BS to ensure that their outreach activities are successful. The support provided may
include outreach to community partners, assistance securing locations for events, and project
oversight and supervision. The EAM also carries out all communication and collaboration with
HCF and completes the required reporting duties for the grant.
DocuSign Envelope ID:7817037F-E798-473E-A872-D3B5519BBE7F
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BUDGET
The total budget for this work is $37,409 as shown below.
Table 1. Budget
(a) (d=a+b+c)
Public Cash (c) Total Non- (e) (f=d+e)
Expenses [STATE] Private Cash Federal Federal Funds Total Funds
(g)Personnel(Salary and Benefits) $ 14,964 $ 3,741 $ 18,705 $ 18,705 $ 37,409
Other Direct Costs
(h)Copying/Printing/Materials $ - $ - $ - $ - $ -
(i)Internet/Telephone $ - $ - $ - $ - $ -
(j)Equipment and Other Capital Expenditures $ - $ - $ - $ - $ -
(k)Supplies and Non Capital Expenditures $ - $ - $ - $ - $ -
(I)Building/Space $ - $ - $ - $ - $ -
(m)Other $ - $ - $ - $ - $ -
(n=h+i+j+k+l+m)Subtotal Other Direct Costs $ - $ - $ - $ - $ -
Travel
(o)Long Distance $ - $ - $ -
(p)Local $ - $ - $ -
(q=o+p)Subtotal Travel $ - $ - $ - $ - $ -
(r)Contractual $ - $ - $ -
(s=g+n+q+r)Total Personnel,Direct Costs,
Travel,and Contractual $ 14,964 $ 3,741 $ 18,705 $ 18,705 $ 37,409
(t=indirect cost rate X r)Indirect Costs $ - $ - $ - $ -
(u=s+t)TOTAL $ 14,964 $ 3,741 $ 18,705 $ 18,705 $ 37,409
Over the course of this project, total reimbursement will not exceed $37,409 in allowable costs
and will not exceed $37,409. Throughout the course of the Term, PCHS may shift money
across line items, but not by more than 20% of each line without prior written consent by
HFC.
The table below provides further detail on each line item.
Table 2. Budget Detail
(g) Personnel Eligibility a Outreach Specialist 0.25 FTE: $14,322
• $12,220 is X.X FTE @ Salary of $48,880
• $2,102 is X.X FTE @ Benefits of$8,410
Benefits Specialist 0.11 FTE: $11,369
• $7,661 is X.X FTE @ Salary of $69,644
• $3,708 is X.X FTE @ Benefits of $33,707
Economic Assistance Manager 0.10 FTE: $11,718
• $8,951 is X.X FTE @ Salary of $89,504
• $2,767 is X.X FTE @ Benefits of $27,675
TOTAL PERSONNEL: $37,409
Total $37,409
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DocuSign Envelope ID:7817037F-E798-473E-A872-D3B5519BBE7F
UPDATED: 12/11/2020
ATTACHMENT B: FOOD AND ENERGY CONFIDENTIALY AGREEMENT
Division of Food and Energy Assistance
Confidentiality Agreement
I, ,understand that in the course of my employment or contract
with the State of Colorado, its offices, agencies and/or departments either by direct contract or
through agreements between State offices, agencies or departments I may receive or become
aware of business or personnel information that is sensitive and/or confidential and not available
to the general public.
This information may be written, electronic, or verbal and come from a variety of sources. I
understand that this information may be subject to special protections under State or Federal laws
or polices of the State office, agency or department. I understand that I am not to intentionally
access sensitive or confidential information unless it is necessary in order for me to complete my
job responsibilities and if so, such necessity will be set out in a statement of work regarding the
specific project I am working on.
I acknowledge that I have an affirmative responsibility to protect all sensitive or confidential
information I become aware of during the course of my duties. I further understand that this
obligation does not apply to information I may become aware of that is available to the general
public, through common knowledge or internet search.
I understand that in the performance of my duties I may be requested to provide sensitive or
confidential information to others. I agree to hold in confidence and to not disclose any sensitive
or confidential information to any person, including employees of state, federal or local
governments including law enforcement, except to those who have an official business reason for
the information. Should I have any questions regarding the proper handling or disclosure of
confidential or sensitive information, I will immediately notify my supervisor or manager and/or
the supervisor or manager of the project I am working on for further clarification and direction
prior to releasing any information.
If I willfully and knowingly disclose such information in any manner to any person or agency not
entitled to receive the information, I understand that I may be subject to adverse action, including
corrective or disciplinary action, dismissal or personal liability depending on the severity of my
actions and applicable law. It is my duty and responsibility to return all State information and not
to retain any copies, in any format upon the completion of my employment or contract.
I acknowledge that I have read, understand and will adhere to the above requirements with
respect to sensitive and/or confidential information.
Signature:
Printed name:
Date:
Data Recipient should maintain a copy of the executed form and provide it upon request
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DocuSign Envelope ID:7817037F-E798-473E-A872-D3B5519BBE7F
UPDATED: 12/11/2020
ATTACHMENT C: CDHS TELPHONIC SIGNATURE POLICY(PITKIN COUNTY HUMAN
SERVICESAL LEAD)
Telephonic Signature Policy
Updated April 20, 2020
The Colorado Department of Human Services' (CDHS) Supplemental Nutrition Assistance
Program (SNAP), also known as Food Assistance, works closely with our Outreach
partners to provide food security to eligible Coloradans. In order to provide streamlined
application assistance, telephonic signatures, defined as verbal assent for application
assistance and submission, are a helpful step to assist individuals in the community
connect to SNAP.
Below is the outline of Colorado's telephonic signature policy to which all Colorado
SNAP Outreach Vendors must comply.
Accepting a Telephonic Application
1. Each SNAP Outreach vendor employs highly trained customer service
representatives.
2. After educating the client about the benefit(s) they may be able to receive, the
representative informs the client of the various methods in which they can apply
for SNAP. These methods include via PEAK, in-person at a county office, SNAP
Outreach vendor location, by telephone with the SNAP Outreach vendor, or paper
application through postal mail, email, or fax.
3. If the client would like to complete the telephonic application, the representative
should explain to the client that the information collected is entered into the
PEAK online application system. It is recommended that SNAP Outreach vendors
build processes around asking all questions on the PEAK application form.
4. Representative will explain to clients who are completing a SNAP telephonic
application that they may need to still complete an eligibility interview with a
county representative and may be asked similar questions to confirm the
information sent to the county office by the SNAP Outreach vendor.
5. Clients who request a paper application will be mailed a copy from the SNAP
Outreach vendor within 24 hours of the client request.
6. Telephonically submitted applications must have a marker to notate the
application was completed using a telephonic signature.
a. In the application signature name field, each SNAP Outreach vendor using
telephonic signature will put their PITKIN COUNTY HUMAN SERVICES's
PCHS+tel after the applicant's last name.
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DocuSign Envelope ID:7817037F-E798-473E-A872-D3B5519BBE7F
UPDATED: 12/11/2020
Voice Signatures
1. SNAP Outreach vendors must record the verbal assent from the client regardinga
summary of the information provided to them, and the date of the telephonic
signature recording. SNAP Outreach vendors may elect, but are not required, to
record the entire telephone conversation.
2. All callers are notified that their verbal assent of the summary of the information
shared with them is being recorded. If the entire conversation is being recorded,
callers must be informed of this at the beginning of the conversation.
3. The client's verbal assent must be captured in their preferred language.
4. SNAP Outreach vendors must confirm and capture the client's full name as part of
the telephonic signature.
5. All telephone conversations where a SNAP application is completed must include
the reading of CDHS approved statements attesting to the accuracy of information.
The applicant must agree to these statements in order to have the application
submitted. The following statements must be read as part of the assent:
a. I confirm that my household is applying for SNAP benefits.
b. I understand the questions and statements on this application.
c. I affirm under penalty of perjury that the information I provided is true, to
the best of my knowledge, including information concerning citizenship and
non-citizen status.
d. I confirm the identity of each applicant and will/have provided their
correct name, date of birth and social security number.
e. I understand that I will be provided a summary of the information collected
during this application and a copy of the Rights and Responsibilities to keep
for my records. I will read through the document and report any errors,
changes, or questions.
6. SNAP Outreach vendor representatives complete telephonic SNAP applications with
the client and submit them through Colorado PEAK.
Records and Storage
1. Recordings must be made and stored in WAV or MP3 or MP4 format, as these
formats can be easily submitted to and accessed for review.
2. If recorded in WAV format, the recording should be transferred to MP3 or MP4.
SNAP Outreach vendors must transmit the telephonic files to the agency when
requested.
3. Recordings must be transmitted and protected in accordance with the high-
security parameters including password protected login, archive encryption,and
standard computer security software.
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DocuSign Envelope ID:7817037F-E798-473E-A872-D3B5519BBE7F
UPDATED: 12/11/2020
4. All recordings must remain accessible and retrievable for five years after the
recording date. Recordings may be required to be kept longer if the case is under
review for IPV or other client error. Recordings will be appropriately backed-up to
ensure that they are protected while being stored.
a. CDHS will conduct a review of the backup process of all SNAP
Outreach vendors using electronic signatures to validate security and
process. Should the agency experience a data failure or a problem
with electronic submission to CDHS, vendors will be able to provide
the CDHS with a replacement copy of the recording.
5. Should the agreement between the SNAP Outreach vendor and CDHS be
terminated, the vendor will transfer all telephonic signature recordings to CDHS
within 30 days.
Monitoring and Compliance
1. In order to verify compliance, telephonic signatures should be sampled and reviewed on a
regular basis to ensure that the preceding criteria are met. This is currently done on a
monthly basis by reviewing SNAP Outreach vendors' telephonic signatures from the month
prior.
2. An Excel sheet of all SNAP Outreach applications (Name, PEAK Tracking #, Date, etc.)
completed with a telephonic signature for the previous month should be uploaded to the
SNAP Outreach Telephonic Signatures Google Drive.
a. Please upload to the appropriate vendor folder and month and year.
b. The Excel sheet of applications must be uploaded by the 10th of the month, or the
next working day.
3. Five random applications will be selected. Within a week, CDHS will notify vendors via
encrypted email of the selected files to upload. Vendors must upload the selected five
audio files to the appropriate vendor folder in the Google Drive.
a. Audio files must be uploaded by the 20th of the month, or the next working day.
4. Notify cdhs_snap_outreacheducation@state.co.us after any document(s) has been
uploaded to the Google Drive.
a. If a vendor has an extenuating circumstance and cannot meet the deadline,please
notify this email as soon as possible.
5. CDHS will notify vendors of any recommendations or findings and will proceed with further
instructions.
Confirmations and Receipt
1. Once a telephonic application is successfully completed, a copy of the application
will be printed from PEAK. This application will be sent promptly to the applicant
for confirmation and review. First class postal mail is the preferred method of
delivery.
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DocuSign Envelope ID:7817037F-E798-473E-A872-D3B5519BBE7F
UPDATED: 12/11/2020
2. To prevent loss of SNAP benefits to the applicant or application processingdelays,
CDHS encourages SNAP Outreach vendors to submit the application electronically
via PEAK on the same day the telephonic signature is received.
3. Along with a copy of the submitted application, the SNAP Outreach vendor will
include a CDHS approved cover letter which includes the following information:
a. Instructions on how to correct application inaccuracies with the SNAP
Outreach vendor or the appropriate county SNAP office
b. Next steps in the application process including instructions on how to
complete the SNAP interview
c. Contact information for the SNAP Outreach vendor
d. Contact information for the appropriate county SNAP office
e. Additional information on requested documentation for expedited eligible
households and households not requesting document assistance from the
vendor
4. SNAP Outreach vendors will keep a record of the client's request to amend any
application inaccuracies, including the date and time of the request.
5. SNAP Outreach vendors will keep a record of any effort that staff makes to contact
a county office to report an application discrepancy and will include this
information in the client's summary file should CDHS request it for an
administrative hearing, audit, or other oversight purposes.
Bilingual service requirements
1. SNAP Outreach vendors may employ in-house staff who speak other languages.
a. If unable to assist a client with their language needs, the SNAP Outreach
vendor will discontinue the telephonic application process and will connect
an individual to the appropriate county SNAP office.
2. SNAP Outreach vendors will record an applicant's preferred spoken and written
language as part of the application.
Signature: Date:
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DocuSign Envelope ID:7817037F-E798-473E-A872-D3B5519BBE7F
UPDATED: 12/11/2020
ATTACHMENT D: TELEPHONIC SIGNATURE USER AGREEMENT
Telephonic Signature Policy
Required Training Elements of the Outreach Workers
Please initial next to each statement and then sign and date this form. It is the
responsibility of PITKIN COUNTY HUMAN SERVICES to maintain a signed copy of this form
on file to ensure they are in compliance with the process agreed to by the parities
I understand that before starting an application by phone, the client must
agree to telephonic assistance.
If the client requests a paper application to be mailed to them instead of
telephonic assistance, I understand that I will provide the copy within twenty-
four hours and inform the client of other ways of applying.
I am comfortable reading the CDHS Telephonic Signature Assent
statements. If a person asks me to explain this in more simplistic terms, I
understand how to do this.
I understand that I must notify the client that a county worker may be
contacting them for an eligibility interview and may request additional
information in order to determine the client's eligibility for Food Assistance.
I understand that I must notify the client that I am recording their verbal
assent statements which will include their confirmation of understanding.
_I understand that I must confirm the identity of the applicant by asking for
their full name.
I understand that all recordings must include the following application
elements: a confirmation of the identity of the applicant, CDHSTelephonic
Signature Assent statements and the date the application was signed.
I understand how to start, record, and save telephonic signatures.
If there is a system failure of the recording, I understand my responsibilities
to correct this by notifying the client immediately and re-record their verbal
assent.
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DocuSign Envelope ID:7817037F-E798-473E-A872-D3B5519BBE7F
UPDATED: 12/11/2020
I understand how to add my PITKIN COUNTY HUMAN SERVICES PCHS plus
the word "tel" after a client's last name in the signature field of the PEAK
application. (e.g. PCHS_tel)
I understand that after each telephonic signature application, I must
promptly send to the client a printed copy of the submitted PEAK application
with a letter outlining next steps, how to correct anything wrong in the
application, and county contact information. In the case that the individual
does not have a mailing address, the client is able to use General Delivery asa
substitute.
I understand how to explain to a client how to correct errors contained in
their application.
Employee Signature Date:
Last updated 4/2020
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