Loading...
HomeMy WebLinkAboutcommunity.service.block.grantREADING AND PUBLIC HEARING ON DRAFT RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF PITKIN COUNTY, COLORADO TO APPROVE THE 2004-2005 COMMUNITY SERVICE BLOCK GRANT APPLICATION AGENDA ITEM SUMMARY REGULAR MEETING DATE: Wednesday, January 28, 2004 AGENDA ITEM TITLE: Resolution to approve the Community Service Block Grant Application STAFF RESPONSIBLE: Nan Sundeen, Susan Berdahl DESCRIPTION OF ISSUE: The Community Service Block Grant (CSBG) is a federal grant dedicated to helping families and individuals achieve personal and economic self-sufficiency. It is administered through the County to subgrantees whose programs serve those who live or work in Pitkin County with income levels of 125% of or below federal poverty guidelines. Colorado's allocation for CSBG funding has not yet been determined, but we are told to base our application on the 2000 census information. That would mean that Pitkin County would anticipate receiving $11,491 in CSBG funding from March 1, 2004 through February 28, 2005. This is an increase in funding, up from $10,044 in 2003-2004. As in prior years, we advertised the opportunity to apply for funding as a subgrantee in the weekly County newspaper ad from December 15, 2003, through January 5, 2004. Applications were due on January 7. In addition, we contacted subgrantees for the current year (Community Health Services, Inc., Columbine Homemakers for Independent Living and the Salvation Army in Glenwood Springs) through email and regular mail, and we made reminder calls. The opportunity was also announced at the January POD meeting. In response, we received one inquiry from an agency that decided not to apply and one application from a Current subgrantee, Community Health Services, Inc. On January 21, 2004, the CSBG Board composed of JeffKremer (Aspen Counseling Center) and Cecelia Martin (Kids First) representing the private sector, Susan Berdahl representing the public sector and Nonie Hoffman (Pitkin County Social Services), representing low-income persons met (Nonie via telephone) and reviewed the proposal from Community Health Services, Inc., and the grant application and plan. They recommend that the funding allocated to Pitkin County be used to support the cost of birth control methods and education to prevent unplanned pregnancy and to support the cost of lab tests and prevention education to treat and prevent the spread of communicable diseases for persons whose income is at or below 125% of the federal poverty level. Community Health Services will administer these programs with the anticipated $11,491 in funding. Attached to this AIS are a copy of the resolution and a copy of the grant application. RECOMMENDED BOCC ACTION: It is recommended that the BOCC adopt the Resolution to approve the 2004-2005 Community Service Block Grant Application. A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF PITKIN COUNTY TO APPROVE THE 2004-2005 COMMUNITY SERVICE BLOCK GRANT APPLICATION Resolution 4/2004 RECITALS 1. The Department of Local Affairs requires that upon assuming the responsibility for the administration 0fthe 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 insure the local priorities will guide the program. 2. The Pitkin CountyBoard of County Commissioners wish, 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 orin 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 the following are significant barriers to citizens achieving self-sufficient in Pitkin County: · Unplanned Pregnancy · Untreated and delayed treatment of communicable diseases NOW, THEREFORE BE IT RESOLVED by the Board of County Conunissioners of Pit, in county, Colorado, SECTION 1. The Pitkin County Commissioners wish to support the plan as outlined in the Community Service Block Grant application: A. $11,491 to Community Health Services, Inc. to provide: 1. $8,991 toward providing birth control methods and education to those at or below 125% of the federal poverty level. 2. $2,500 toward the cost of lab tests and education/prevention of communicable diseases for those who are at or below 125% of the federal poverty level. ADMINISTRATION The Director of 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 the 28th day of January, 2004, in the Pitkin County Courthouse Annex, Aspen, Colorado. NOTICE OF PUBLIC HEARING PUBLISHED IN THE ASPEN TIMES WEEKLY ON ,2004. INTRODUCED, READ AND ADOPTED ON ,2004. *PUBLISHED BY TITLE AND SHORT SUMMARY, AFTER ADOPTION, IN THE ASPEN TIMES WEEKLY ON ,2004. ATTEST: Jeanette Jones Deputy Clerk and Recorder BY: Date: BOARD OF COUNTY COMMISSIONERS OF PITKIN COUNTY, COLORADO Dorothea Farris, Chairperson APPRQVED AS TO FORLM: John Ei~ MANAGER APPROVAL: Hilary ~_~.tcher Smith County Manager RECOMMENDED FOR ADOPTION: Nancy N. Sundeeh Director of Human Services GRANTEE: 2004-05 CSBG APPLICATION and PLAN Pitkin Count~ Health & Human Services ADDRESS: 0405 Castle Creek Road, Aspen, CO 81611 CONTACT PERSON: Nan Sundeen TITLE: Dir. Communi .ty Relations and Health & Human Service~ PHONE:(970) 920-5209 E-MAlI,:nans(~co.pitkin.co.us FAX: (970) 920-5198 COUNTIES INCLUDED IN THIS PLAN: Pitkin County TOTAL CSBG ALLOCATION $ 11~491.00 PROGRAM PERIOD: March L 2004 To February 28, 2005 attach ' needecL $ $ 7. Linkages with Other Programs 8. Self-Sufficiency 9. Health TOTAL $ $ $ $ $11,491.00 $11,491.00 $11~491.00 $11,491.00 CSBG APPLICATION DIRECTIONS I. GRANTEE INFORMATION AND FEDERAL OBJECTIVES: Check the Federal Objective(s) your agency activity(ies) will be addressing. For each activity, LIST ONLY ONE Federal Objective. II. BUDGET FORMAT: Complete your budget in as much detail as possible utilizing the provided format. This information will be used for monitoring and performance evaluation. PERSONNEL COSTS Indicate the CSBG dollar mount allocated to each position(s) funded including fringe benefits. Indicate the percentage (%) of the person's time paid with CSBG funds. 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, including salaries and benefits of program staff and managers, 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, procurement, and legal services. CAPITAL EXPENDITURES Please itemize the equipment you intend to purchase. For any Capitol Equipment costs, you are required to submit a narrative to describe equipment needed and your procurement process. The State requires that bids and final equipment invoices be submitted to the State. SUBCONTRACT COSTS Those dollars allocated out to subcontractors to provide CSBG related services. F. TOTAL CSBG FUNDS BUDGETED COLORADO CSBG CONTRACTOR/SUBCONTRACTOR SUMMARy'sH County: Pitldn Implemenffug Agency Community Health Services, Inc (Each agency/subcontractor receiving CSBG dollars must complete tMs'form) knplement~g Agency Contact Person: Tazi Lutcnng Completi Mailing Address, including zip: 405 Castle Creek Kd #6 Aspen, CO 81611 Phone Number (97_Z~ 920-5420 Fax: (:_970) 920-5419 Email Address: tmlpitkn@~rof, net Program Period March 1, 2004 to February 28, 2004_ CSBG Award: __$11,491 Select ONE Federal Objective [] Employment [] Income Management [~ Emergency Services [] Nutrition [] Self-Sufficiency [] Education [] Linkages with Other Programs [] Housing lEI Healtk Select ONE National Goal/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 slake in theft' comm,ufity. (Community) []Goal 4 Par~erships among supporters aud pro~ders ofservlces to low-income people ~re achieved. (Agency) []Goal 5 Agenc!~s increase their capacityto achieve results. (Agency) []Goal 6 Low-income people, especially vulucu'able populations, achieve their potential by strengthening family and other supportive systems. (Family) Select ONE National Direct Measure/Indicator (see CSBG National Goals and Outcome Measures sheet): 1.n (i.e. 6. a, l.n, 2. b, etc.) ' Low income Target Population: Citizens who live and work in Pitldn County and the RoaringForkValle¥ who are uninsured and underinsured with preventive health needs. i.e. Seniors, Youth, etc.) ~ ~BG National ~oals and Outcome Measures Eff¢cti~ October 1.1999 ~ ~ach go~ ~t c~e~o~s to ~e work ofyo~ agen~ ~d ~ bas~ on a c~ n~ assessmen~ s~l~ on~ m~o- ~none of~e ~st~d ,~es co=~=~to ~o~ o~o~ ~ge~,~=~tme~ e?~~ ~ ~o. ~ot~ ~some o~ ;~s ~d a~ly to o~ goals; us~ ~m ~herewr ~y se~m most appr~nam ~o youo me--es bMow, n~s shoMd be e~re~ed ~ ~o p~: ~e a~ co~ ~d ~e b~e~e to~ F~ e~le, when ~ me~e ~ tuber ofhomehol~ ~ng ~plo~en~ e~ress ~ as a factor of ~e ~ nmb~ ofho~ehol~ se~ed by ~e agency (e.g., 27 o~ of ). De not use percentage. 6OAL 1-: LOW-INCOME PEOPLE BECOME MORE sELF-SUFFICiENT . N~nber of participants secldng emplo3~ment who obt'aJn it [as .compare,? with the total number ofpa~cipants]- ). Number of participants maint~nln5 employment for a full twelve monms, at least ninety days. :. H~mber of households in which adult members obtain aud maintain employment for L Humber of households with an anuual increase in the number ofliours of employment. :. Humber of houseliolds.gaining health care coverage through employment ...... a result of earnings. ~. lqumber of households experiencing an mcrease m an annual mcorne as . . . . . ~,. Number of households experiencing an increase in annual income as a result ofrecezvmg allowable tax credits, such as the earned income md childcare tax credits a. Number of custodial households who experience an increase in anuual income as a result of regulas child support payments. , Number of participating families moving f~om substandard housing into stable smdard housing, as compared with the total number bf 3articipating q~m~t~es. i. Number of households which obtain and/or maintain home ownership. ~. Number of minority households which obtain and/or maintain home ownership. t. Number of people progressing toward literacy and/or GED. ~ Wum~er of people =a~g ~ro~ess towa post;secona~ ~es cr vo=~o~a ~. ,~-c~ ~ o. Other ontcome me~O) speomo to the work of Y0er age~o~. /~.,~ ~ ~ ~ -- ~ q. Number of households which demonstrated movement up one or more steps on a scale or matrix measm4ng self-sufl~cmncy r, Number of households schiex~ng point,ye movement m se~f-suffic~ency as demonstrated by an increase of at least one point m an overall score of a Fsmgy Develop~nent Scale. s. ~xnbe~ of households achieving stability in the . d3,,~,,~ou of a Family Devplopment M~tdx. ~OAL 2: THE CONO£~-ON$ IN WHICH LOW-INCOME PEOPLE LIVE ARE IMPROVEb Direct Measures; b. d. f. g- Number of access~le, living w~ge jobs creared and/or ret .a.thed. Lnerease in assessed value of homes as a result of rehabilitation projects. Increase in proportion of state and federal funds .alJocated for meeting emergency and long-term needs of the low-in~ome populatiom Increase in access ~o commu~ty services and resources by low-income people: Increase/n available hotising stock through new coastractio~- Increase in the availability and affordabflity of ~ssential services, e.g. transp~m'con~ medical care, ckild care. Othcx outcome measure(s) specific to the'work done by your agency. h. Number of hou~ehotds wh° believe the agency has helped nupr°ve the c°~diti°ns m which they Ev~ i. Number of com~anfdes which demous~ated movement up one or more steps ona scale or ma~ix measuring 6omsmmity se[f-su/~ciency, commnnky health, or community vitality, a;m~,~on of the Commu~it~ S~ Tool j.Number of c. .......... ;ges achieving stability in the II. BUDGET Cost Category Employment Education Income Housing Emergency Nutrition Linkages Self- Health TOTAL Management Services Su~ciency A. Personnel $ % of time paid with CSBG % % % % % %i % % % B. Direct $ Operating C. Indirect / $ Overhead (administrative) D. Capital $ Equipment E. Subcontract $11,491 $$11,491 F. TOTAL $11,491 $11,491 List all agencies and funding yon plan to subcontract with to ~rovide CSB¢ _Cpmmunit¥ Health Services, Inc. $11,491 ~ II. BUDGET NARRATIVE Cost Category Explain each CSBG cost as related to the proposed CSBG plan. Please add additional sheets ff necessary A. Personnel B. Direct Operating C. Indirect / Overhead D. Capital Equipment Describe equipment needed and your procurement process. The State requires that bids and equipment final invoices are submitted to the State. E. Subcontract 612 Ortho-Evra Patches: 612 x $12 (12 months x 51 clients, Could be up to 144 clients) = $7344 50 STD lab tests for 50 low income clients ~ $50 = -- $2,500 73 Deprovera injections ~ $22.56 each for up to 73 clients = $1,647 III. COMMUNITY ACTION PLAN: As required in the reauthorized CSBG Act, please answer all 5 questions using additional sheets as needed. Subcontractors are NOT required to submit an Action Plan. 1. Community Needs Assessment (including food needs): Our State office must secure from each CSBG eligible entity, as a condition to receipt of funding, a community action plan that includes a community- needs assessment for the community served. This community-needs assessment may be coordinated with community-needs assessments conducted for other programs. Community Health Services conducts a community health needs assessment for Pitkin, Eagle, and Garfield Counties every 5 years, the most recent in 1999. The purpose of the assessment is to provide a comprehensive health needs profile of the low income/medically underserved population of the Roaring Fork Valley. Data was collected through interviews with key informants by nursing doctorate and master degree students from the University of Colorado Health Sciences Center. Four themes emerged: · A disparity exists between financial resources and basic.needs in the low income/medically underserved population: wages are low relative to the cost of living. · Immigration of the Latino population has had a dynamic influence on community health issues. "While the Latino population fills the resort industry's crucial need for lowly paid workers, it seems that the resort industry and the community are challenged in filling the health care needs of the Latino community." · A need for increased communication and cooperation between Pitkin, Eagle and Garfield Counties exists. While there is a history of collaborative efforts, more collaboration is needed. · The ability of the low income/medically underserved population to access health care services appears impeded. There is a lack of indigent providers and an over-utilization of the ER for primary and acute care. A copy of the introduction and conclusions sections of the report, The Three Counties Study, is attached. 2. Service Delivery System: Please describe the service delivery system for services provided or coordinated with CSBG funds that target low-income individuals and families within your service area. Nurse Practitioners will provide birth control hormones, education, free pregnancy screenings, follow-up education and referrals in an effort to prevent unwanted pregnancies which further poverty in Pitkin County. Communicable disease screenings will be provided by appointment and include exams, ' necessary lab screening, medication, education and follow-up case management, as well a referrals to a physician as needed. 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. Community Health Services (CHS) meets monthly with other human service agencies through the Pitkin County "POD" to network and share information to eliminate gaps in services and further case management. Active, on-going collaboration helps prevent duplication of services. CHS staff educators and nurses are bilingual, and provide client care and referrals to assisting agencies and providers. Clients are sent referral reminders and lab test results as part of their follow-up services. B. Describe how linkages will be established between govemmen! and other social service programs to assure effective delivery of service to Iow-income individuals and to avoid duplication of such services. Community Health Services coordinates with Pitkin County Social Services to help eligible clients access Medicaid services to assure effective delivery of service to low income individuals. CHS staff receives regular'Medicaid eligibility updates and education. Pitkin County provides in-kind rent to Community Health Services in the county health & human services building. 4. Coordination with other Public and Private Resources: Please describe how CSBG funds will be coordinated with other public and private resources. CSBG funds are coordinated with funding from Pitkin County's health & human services grant program and funding from the City of Aspen in order to provide service to the community. Private donations also support the services provided by Community Health Services. 5. Innovative Community and Neighborhood-based Initiatives: Please 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. Providing birth control devices and education enables low-income families to plan their children and eliminate unwanted pregnancies, which further poverty levels. Communicable disease prevention through education and early detection of communicable diseases through screening and early treatment work to create a healthy community. CSBG funds will eliminate the financial harriers to service for low- income individuals and families. Access to these preventative health services offers individuals an opportunity for empowerment, self-sufficiency and family stability. CHS expects 100% success from these prevention measures and communicable disease control. ATTACHMENTS TO APPLICATION VI. BOARD MINUTES Please attach a copy of your CSBG Board minutes of the meeting when the CSBG application was reviewed and approved by your CSBG board. VII. PROOF OF PUBLIC HEARING: Please 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. VIII. MINUTES OF PUBLIC I-W~ARING Please attach a copy of the minutes of the Public Meeting when the CSBG Application was reviewed and approved. IX. ROMA LOGIC MODEl, Please attach an outcome plan/ROMA Logic Model for each activity funded. If funds are subcontracted, an outcome plan for each subcontract must also be included. Summary of Pitkin County CSBG Board Meeting Wednesday, January 21, 2004 Health & Human Services Building, Aspen, Colorado Attendance: JeffKremer, Cecelia Martin, Susan Berdahl in person Nouie Hoffman via speaker phone The purpose of the meeting was to review the grant proposal/plan and determine the allocation of lands. Every member of the Board had received a copy of the plan in advance and had reviewed it prior to the meeting. The group discussed the Community Action Plan. There were no questions, and they agreed that it accurately reflected community needs. The question was asked of the group as to whether this plan will support the CSBG mission to make a measurable and potentially significant impact, within the federal resources available, on the causes of poverty in communities tkroughout the State, by addressing unplanned pregnancy and the untreated and delayed treatment of communicable diseases. The cgmmittee was unanimous.in their agreement that this plan would do that. The recommendation of the group was that $11,491 be allocated to Community Health Services, Inc. to provide ca birth control methods and education, and ca lab tests and education/prevention for communicable diseases. Jeff Kremer inquired about why only one subgrantee proposal was submitted. Last year, three agencies applied for and received funding. Susan Berdahl outlined the efforts made to solicit applications, which included multiple contacts with current subgrantees in writing and by telephone, and multiple ads in the local daily paper. While no agency said that they were not applying because of the amount o£ record-keeping required, Susan has a sense that the smaller agencies simply do not have the capacity to fulfill the requirements of screening for income and collecting the data on clients that is required of this program. --Susan Berdahl VII. CERTIFICATIONS: The grantee assures that activities implemented with CSBG funds will be: 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), Ceffification 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 A 110 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 amendmem to the Constitution. Grantees shall not discriminate against an organization that provides assistance under, or applies to provide assistance, on the basis that the arganization has a religious character. (Please review Sec.679 Operational Rule in the CSBG Act); 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; 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; 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; 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 CSBG board (or other mechanism) to petition for adequate representation; 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 ro 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 Iow-income mdividuais and families in the neighborhood served, Co) reside in the neighborhood, and (c) are able to participate actively in the development, planning, implementation, and evaluation of program funded. in the case of private non-profit entities, have a unpartite 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 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 then: 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; 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 activi~j 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 respec~ 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. participate in the Resul~s-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; make available for public inspection each plan prepared as part of the program planning process. The grantee may. at lis initiative, revise any plan prepared for CSBG funding and shail finnish the revised plan te the Director of the Community Services Block Grant under the Deparunent of Local Affairs. Each plan prepared for submission shall be made available for public ~aspection within the eounw and/or service area in such a manner as will facilitate review of, and comments on, the plan; 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. make available appropriate books, documents, papers, and records for inspection, examination, copying, or mechanical reproduction on or offthe premises upon reasonable request by the U.S. Controller General, the State, or thei~ authorized representatives should an investigation of the uses of CSBG funds be undertaken; in the case of county governments or subgrantees'which receive a CSBG award in ~xcess of $100,000, comply with the following three certifications related to the "Limitation on use of al~propriated funds to kdluence certain Federal Contracting and fmancialtransactions (P.L. 101-121, Section 319 and USC Tire 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 Keport 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 debar~ed, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; b) have n°t within a three-year period preceding this proposal been convicted or had a civil judgment rendered against them for commission of fraud or a crkninal offense in connection with obtaiuing, attempting to obtain, or performing a public transaction; violation of Federal or State antitrus! statues or eonuniss~on of embezzlement, theit, forgery, bribeD,, falsification or desU'uction of records, making false statements, or receiving stolen property; c) are not presently indicted for otherwise efirninally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph Co) of this certification; end d) have not within a three-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.2 CONTRACTOR: POSITION TITLE: If County Grantee: Chairman of the Board of Coumy Commissioners must sign If Multi-County Service Agency: Chairman of the Board of Directors with delegated contracting authority must sign. V. CSBG BOARD LIST: Representatives of Private Sector: Name: JeffKremer Address: po Box 6668, Snowmass Village, CO 81615 Phone: (970'} 923-6337, (970) 920-5555 Name: Ceeelia Martin Address: 0074 Bus Barn, Aspen, CO 81611 Phone: (970) 925-4713, (970) 920~5363 Name~ Address: Phone: Representatives of Public Sector: Name: Susan Berdahl Address: 0405 Castle Creek Rd, Suite 7, Aspen, CO 81611 Phone: (970) 920-5766 Name: Address: Phone: Address: Phone: Nanle: Address: Phone: Address: Phone: Low-Income Persons or their Representatives: Name: Nonie Ho~rrnan Name: Address: 100 Elk R/m, Suite 122, Basalt, CO 81621 Address: Phone: (970) 927-9803 Phone: Address: Address:. Phone: Phone: COLORADO CSBG APPLICATION (ROMA Logic Model) AGENCY: Community Health Services~ Inc. PROGRAM: Family olanning and education, preventative health exams, laboratory testing for communicable disease control PROGRAM MISSION STATEMENT: To reduce financial barriers to needed health screenings and contraceptives for low-income residents who live or work in Pitkin Coun _ty which will increase self-sufficiency and eliminate unwanted Pregnancies, as well as reduce visits to hospital emergency rooms. National Goal #: 1 Circle ONE Outcome Goal: ~ Community Agency U or o) (2 or 3) (5 or 6) Prob em Se,tv.ce Ac!ivity or : Outcome · Indiqat0r (# and %) Me~_surement O ara Frequency Need or ' inrervem on ' Tool(s) Source and of bata Situat on ' COllect on .' Collect on : Procedures · Unplanned · Prevention of · Clients will be able to · Community Health · Case records · CHS's · Data is pregnancies unplanned decrease unplanned Services will offer 612 are kept on each Family collected at interrupt pregnancies with pregnancies and have monthly birth control patches client. Planning each visit employment provision of birth uninterrupted employment, and 73 injections to a · Birth control Coordinator and is for uninsured control methods and · Health care screenings potential of 217 women from injection collects available and Iow- education and lab tests will prevent the Iow-income families. Each recipients also pregnancy quarterly in income · Exams, education spread of communicable Iow-income resident or make an test res.ults a report residents, and lab tests to diseases to County residents worker can potentially appointment for and lab test form and · High cost of ~revent continued and workers, receive 4 injections or 12 the next injectionresults and also on an lab tests and spread of birth control patches in 3 months. A records annual exams in resort communicable annually, follow-up call to information basis. community diseases · · 50 Iow-income men and reschedule is ~n each )revent women will receive made if the client client's file. residents fi:om communicable disease is a no-show. That data is education and ~. screenings and lab tests to ·Communicable entered in a testing for identify and prevent further disease case database communicable transmission of sexually records are kept with the diseases. These transmitted diseases, on CEDARS, a Colorado barriers to self- statewide Dept. of reporting Health. sufficiency, system. EXPLANATIONS/DISCUSSION: Form Adapted by the Colorado Community Action Association and the Colorado Department of Local Affairs. Created by Virtual Outcomes College} © FY 2001, 2002, The Center for Applied Management Practices, Harrisburg, PA.