20-444-80-1489 Community Wellness Program Continuation Application

Helping Families. Supporting Communities. Empowering Individuals.

Summary Information

1. Awarding Agency Name: Illinois Department of Human Services 
2. Agency Contact: Karrie Rueter, Associate Director
Illinois Department of Human Services
Division of Family & Community Services
Bureau of Positive Youth Development
823 E Monroe, Springfield, IL 60701
Karrie.Rueter@illinois.gov 
3. Announcement Type: Continuation
4. Type of Assistance Instrument: Grant
5. Funding Opportunity Number: 20-444-80-1489-01
6. Funding Opportunity Title: Community Wellness Program 
7. CSFA Number: 444-80-1489
8. CSFA Popular Name: Community Wellness Program
9. CFDA Number(s): Not Applicable
10. Anticipated Number of Awards: 1
11. Estimated Total Program Funding: $793,300
12. Award Range $0 to $793,300
13. Source of Funding: State
14. Cost Sharing or Matching Requirement: No
15. Indirect Costs Allowed Yes
Restrictions on Indirect Costs It is anticipated that administrative costs, both
direct and indirect, will represent a small portion
of the overall program budget.
16. Posted Date: March 6, 2019
17.Application Range: March 6, 2019 to April 8, 2019 by 12:00pm
18. Technical Assistance Session: No

SECTION I
The following section provides Eligibility and Funding Information & Requirements for the Community Wellness Program Continuation Application.

  1. Eligibility Information
    1. Eligible Applicants
      This Continuation Application is limited to those public or private, not-for-profit community-based agencies who received an award from the Illinois Department of Human Services, Division of Family and Community Services for the implementation of the Community Wellness Project pursuant to DHS Funding Notice (19-444-80-1489) AND continue to meet the additional eligibility criteria below. Failure to provide the requested information as outlined herein to demonstrate these criteria are met will result in the application being removed from funding consideration.
    2. Pre-Qualification
      Applicant entities will not be eligible for a grant award until they have pre-qualified through the Grant Accountability and Transparency Act (GATA) Grantee Portal, www.grants.illinois.gov Grantee Links tab. Registration and pre-qualification are required annually. During pre-qualification, verifications are performed including a check of federal Debarred and Suspended status on the Illinois Stop Payment List and good standing with the Secretary of State. An automated email notification is sent to the entity alerting them of "qualified" status or providing information about how to remediate a negative verification (e.g., inactive DUNS, not in good standing with the Secretary of State). A federal Debarred and Suspended status cannot be remediated. The pre-qualification process also includes a financial and administrative risk assessment utilizing an Internal Controls Questionnaire. A Programmatic Risk Assessment must also be completed for each separate grant for which an applicant intends to apply. Applications from entities that have not completed the GATA pre-qualification process prior to the due date of this application will NOT be reviewed and will NOT be considered for funding. A Screenshot or statement indicating the applicants has completed Pre-Qualification steps and is currently Pre-Qualified will be required with the application.

      The Provider's proposed budget must be entered into the CSA system. The completed budget must be electronically signed and submitted in the CSA system, and a printed copy of the signed and submitted budget must be included with the application. To do this, the following is required: at a minimum, the applicant agency's Chief Executive Officer (CEO) or equivalent, or the Chief Financial Officer (CFO) or equivalent must be registered in the CSA system to electronically sign the required budget documents prior to submission. Budgets not submitted as described here and by the due date and time will not be considered.
      For more information about submitting a budget in the CSA system, refer to Appendix 1 and also see: http://www.dhs.state.il.us/OneNetLibrary/27896/documents/Contracts/FY18-GATA-Budgets/DHSBudgetTrainingManual_Revision_3_28_18.pdf
    3. Dun and Bradstreet Universal Numbering System (DUNS) Number and System for Award Management (SAM)
      Each applicant is required to:
      1. Be registered in SAM before submitting the application. The following link provides a connection for SAM registration: https://governmentcontractregistration.com/sam-registration.asp;
      2. provide a valid DUNS number in its application; and
      3. continue to maintain an active SAM registration with current information at all times in which the applicant has an active Federal, Federal pass-through or State award or an application or plan under consideration by a Federal or State awarding agency.
        DHS may not make a Federal pass-through or State award to an applicant until the applicant has complied with all applicable DUNS and SAM requirements and, if an applicant has not fully complied with the requirements by the time DHS is ready to make the award, DHS may determine that the applicant is not qualified to receive the award and use that determination as a basis for making the award to another applicant.
    4. Mandatory Requirements of Applicant
      The Mandatory Requirements are essential items that must be met by the Applicant. If any Mandatory Requirement is not met, the responding Applicant's entire proposal will not be considered. DHS is not obligated to make an award to any applicant that fails to meet all mandatory requirements.
      1. The provider must be in a position to begin providing services on July 1, 2019.
      2. Technology: Agencies awarded funds through this funding notice must have a computer that meets the following minimum specifications for the purpose of utilizing the required DHS eCornerstone web-based reporting system and the receipt/submission of electronic program and fiscal information:
        • Internet access, preferably high-speed
        • Email capability
        • Microsoft Excel
        • Microsoft Word
        • Adobe Reader
      3. State and Federal Laws and Regulations: The agency awarded funds through this NOFO must agree to comply with all applicable provisions of state and federal laws and regulations pertaining to nondiscrimination, sexual harassment and equal employment opportunity including, but not limited to: The Illinois Human Rights Act (775 ILCS 5/1-101 et seq.), The Public Works Employment Discrimination Act (775 ILCS 10/1 et seq.), The United States Civil Rights Act of 1964 (as amended) (42 USC 2000a-and 2000H-6), Section 504 of the Rehabilitation Act of 1973 (29 USC 794), The Americans with Disabilities Act of 1990 (42 USC 12101 et seq.), and The Age Discrimination Act (42 USC 6101 et seq.).
  2. Funding Information & Requirements
    1. Funding Information
      1. This award is funded with State General Revenue funding and does NOT have an in-kind and/or financial match requirement.
      2. This Continuation Application is considered an application for renewal funding.
      3. All funding is subject to appropriation by the General Assembly.
      4. The Department anticipates funding 1 renewal applicant to provide services as described in this funding announcement.
      5. Approximately $793,300 will be made available under the notice.
      6. Subject to appropriation, the grant period will begin no sooner than July 1, 2019 and will continue through June 30, 2020.
      7. Funding allocated under this grant is intended to provide direct services to youth. It is expected that administrative costs, both direct and indirect, will represent a small portion of the overall program budget. The funding amount requested for FY20 should reflect the actual grant amount required to implement the proposed plan, which may be less than the amount granted in FY19. Any budget deemed to include inappropriate or excessive administrative costs will not be approved. Program budgets and narratives must detail how all proposed expenditures are necessary for program implementation.
      8. Proposed project budgets and narratives must be sufficiently detailed and justified to be approved by DHS.
      9. Subcontractor Agreement(s) and budgets must be pre-approved by the Department and on file with the Department. Subcontractors are subject to all provisions of this Agreement. The successful Applicant Agency shall retain sole responsibility for the performance of the subcontractor.
        The release of this funding notice does not obligate the Illinois Department of Human Services to make an award. Work cannot begin until a contract is fully executed by the Department.
    2. Grant funds - Use Requirements
      All applicants will use grant funds according to the guidelines, conditions and parameters set forth in this funding notice and in compliance with federal statutes, regulations and the terms and conditions of any applicable federal awards.
      Please refer to 2 CFR 200 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, PART 200 Subpart E - Cost Principles to determine the appropriateness of costs.
      1. Allowable costs:
        Allowable costs are those that are necessary and reasonable based on the activity(ies) contained in the Scope of Work, are justified in the Budget Narrative, and are allowable under Subpart E of 2 CFR 200. Funding allocated under these grants is intended to provide direct services to youth. It is expected that administrative costs, both direct and indirect, will represent a small portion of the overall program budget. Any budget deemed to include inappropriate or excessive administrative costs will not be approved. Program budgets and narratives must detail how all proposed expenditures are necessary for program implementation.
      2. Unallowable costs
        Please refer to 2 CFR 200 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, PART 200 Subpart E - Cost Principles to determine the appropriateness of costs. In addition, and specific to this grant, the following costs will be unallowable without specific prior written approval from DHS:
        1. Entertainment costs, except where specific costs that might otherwise be considered entertainment have a programmatic purpose and are authorized in the approved budget (2 CFR 200.438)
        2. Capital expenditures for general purpose equipment, including any vehicle regardless of cost, buildings, and land (2 CFR 200.439)
        3. Capital expenditures for improvements to land, buildings, or equipment which materially increase their value or useful life (2 CFR 200.439)
        4. Food, and other goods or services for personal use of the grantee's employees, contractors, or consultants of the grantee unless authorized as per diem under the State of Illinois Governor's Travel Control Board (2 CFR 200.445).
        5. Deposits for items, services, or space
      3. Limitation of Use of Award funds for Employee Compensation: With respect to any award over $250,000, recipients may not use federal funds to pay total cash compensation to any employee that exceeds 110% of the maximum annual salary payable to a member of the Federal Government's Senior Executive Service (SES) at an agency with a Certified SES Performance Appraisal System for that year. A salary table is available at the U.S. Office of Personnel Management website https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2017/ES.pdf
      4. Indirect cost requirements
        In order to charge indirect costs to this grant, the applicant organization must have a Federal or State annually negotiated indirect cost rate agreement (NICRA) or must elect to use the De Minimis Rate.
        Every organization that receives an FY2020 state award must make an indirect cost rate proposal or election in the Crowe Activity Review System (CARS), including organizations that are choosing not to claim payment for indirect costs.
        CARS URL: https://solutions.crowehorwath.com/CARS/StateofIllinoisGOMB/Login.aspx
        Indirect Cost Rate Election:
        1. Federally Negotiated Rate. Organizations that receive direct federal funding may have an indirect cost rate that was negotiated with the Federal Cognizant Agency. Illinois will accept the federally negotiated rate. The organization must provide a copy of the federal NICRA as Attachment 1.
        2. State Negotiated Rate. The organization must negotiate an indirect cost rate with the State of Illinois by completing an indirect cost rate proposal in the CARS system if they do not have Federally Negotiated Rate or elect to use the De Minimis Rate.
        3. De Minimis Rate. An organization that has never received a Federal or State Negotiated Rate may elect a de Minimis rate of 10% of modified total direct cost (MTDC). Once established, the de Minimis rate may be used indefinitely. The State of Illinois must verify the calculation of the MTDC annually in order to accept the de Minimis rate. If programs elect to use the De Minimis rate, it is critical that program budgets accurately calculate the MTDC base. Please see the regulation below and note the exclusions to MTDC.

          2 CFR § 200.68 Modified Total Direct Cost (MTDC).
          MTDC means all direct salaries and wages, applicable fringe benefits, materials and supplies, services, travel, and subawards and subcontracts up to the first $25,000 of each subaward or subcontract (regardless of the period of performance of the subawards and subcontracts under the award). MTDC excludes equipment, capital expenditures, charges for patient care, rental costs, tuition remission, scholarships and fellowships, participant support costs and the portion of each subaward and subcontract in excess of $25,000. Other items may only be excluded when necessary to avoid a serious inequity in the distribution of indirect costs, and with the approval of the cognizant agency for indirect costs.
      5. "No Rate": Grantees have discretion not to claim payment for indirect costs. Grantees that elect not to claim indirect costs cannot be reimbursed for indirect costs. The organization must record an election of "No Indirect Costs" into CARS.
        Crowe Activity Review System (CARS).
        CARS will allow your organization to document your already established federally approved indirect cost rate, complete an indirect cost rate proposal (see State Negotiated Rate above), elect to charge the De Minimis rate (10%) of modified total direct costs (MTDC), or select that no reimbursement of indirect costs will be requested. Submission requirements are located on page 2 of the Uniform Budget Template as well as 2 CFR 200 Appendices IV, V & VII.
        1. Organizations which have not previously made an indirect cost rate election must submit an election (and indirect cost rate proposal, if necessary) immediately and no later than 3 months after receiving an award notification or invitation to the CARS system.
        2. Organizations that have previously established an indirect cost rate election must submit a new indirect cost rate election immediately and no later than 6 months after the close of their
          organization's fiscal year.
        3. Every organization must make an indirect cost rate election in CARS even if the organization is choosing De Minimis Rate or "no rate". Organizations that do not make an election or submission inside the CARS system within the required timeframes will not be allowed to claim indirect cost reimbursement.
        4. For more information, see https://www.illinois.gov/sites/GATA/Pages/default.aspx.
    3. Administrative Costs
      Funding allocated under this grant is intended to provide direct services to youth. It is expected that administrative costs, both direct and indirect, will represent a small portion of the overall program budget. Program budgets and narratives will detail how all proposed expenditures are directly necessary for program implementation and will distinguish between Indirect/Direct Administrative and Direct Program expenses. Any budget deemed to include inappropriate or excessive administrative costs will not be approved. At no time may the approved negotiated indirect cost rate agreement (NICRA) be exceeded under this agreement. Documentation will be required to verify the approved NICRA.
    4. Simplified Acquisition Threshold
      Potential grantees under this funding announcement may receive an award in excess of the Simplified Acquisition Threshold, currently $250,000 (Refer to 2CFR200 Section 200.88). Therefore, the grantee must be aware of the following regarding the Simplified Acquisition Threshold as it will be applicable to any qualifying sub award:
      • That the grantee agency, prior to making a sub-award with a total amount of funds greater than the simplified acquisition threshold, is required to review and consider any information about the
        applicant that is in the designated integrity and performance system accessible through SAM (currently FAPIIS) (see 41 U.S.C. 2313);
      • That an applicant, at its option, may review information in the designated integrity and performance systems accessible through SAM and comment on any information about itself that the awarding agency previously entered and is currently in the designated integrity and performance system accessible through SAM;
      • That the awarding agency will consider any comments by the applicant, in addition to the other information in the designated integrity and performance system, in making a judgment about the applicant's integrity, business ethics, and record of performance under awards when completing the review of risk posed by applicants as described in §200.205 awarding agency review of risk posed by applicants.

Section II
The following section provides information and requirements for implementing the Community Wellness Program.

  1. Program Description/Requirements 
    The Community Wellness In-Home Visitation Project/Good Neighbor Campaign will provide coordinated non-clinical, in-home wellness visits, case management, and crisis intervention services as well as make referrals for wraparound support services to the target population. The populations targeted include Seniors, Single parent households, 1st time pregnant females, Returning Citizens to the community (Adults and youth returning from secure confinement), and high risk disengaged youth (youth ages 16-24 that are not employed or enrolled in school), and low income family/households. Those eligible for services must also be a resident of Chicago living within a 50 block radius of zip code 60651 and 60644. This program seeks to ensure that the health and social needs of these at-risk individuals are being adequately addressed by qualified health and social service providers, and are connected to their communities.
    Using existing community and faith-based infrastructure, the provider will recruit, hire, and train individuals from targeted communities to provide follow up through periodic visits to clients living in the service area. Community Wellness Workers will demonstrate a familiarity and sensitivity to the targeted client populations, and the ability to communicate and relate in a culturally competent manner. 
    A database will be maintained that will document the process of both identifying and serving these individuals. Data will assist with outreach, case management, evaluation and reporting.
    Additionally, the project will provide case management services to support targeted individuals in conjunction with DHS to address any unmet social and other needs identified during the observation process.
  2. Required Programming
    The Provider will build upon work previously completed to meet the following objectives:
    1. Provide in home non-clinical direct care and follow up to the eligible households consisting of seniors and single parents that received direct services during FY19.
    2. Provide case management, referral, and follow up services to new eligible households consisting of Seniors, Single parent households, 1st time pregnant females, Returning Citizens from secure confinement, high risk disengaged youth, and low income family/households.
    3. Assist with nonclinical care and support through referral and follow-ups.
    4. Assist in stabilizing the care through organizing caregiving among neighbors and churches.
    5. Reduce violence and other threats by mobilizing neighbors, churches and agencies.
    6. Connect eligible individuals to needed benefits through ABE and DHS Local Offices.
    7. Connect clients assessed to need increased employment to employability providers / employment.
    8. Connect clients assessed to need increased education to the appropriate school/agency and assist with enrollment, GED services, and support services.
    9. Data will be collected and managed in a provider database to assist with outreach, case management, evaluation and reporting.
    10. The Applicant Agency must agree to, over the course of this grant, to demonstrate an ongoing commitment to develop trauma informed capacity within the organization with a goal of achieving Trauma Informed Agency Status as recognized through the CBAT-O Assessment tool.
    11. Collaboration with local Family and Community Resource Centers (FCRCs): Providers will maintain a collaborative working relationship with the local DHS FCRCs. This will include outreach to FCRCs to develop awareness of the Community Wellness Program, recruit potential participants, and regularly participating in local FCRCs' service provider meetings as requested. Additionally, Providers are required to communicate agency job openings to the local FCRCs. This is not a requirement to hire, simply to share vacancy announcements.
  3. Eligible Clients/households
    1. Households existing within the defined zip code 60651 and 60644; and
    2. Household includes a senior occupant over the age of 65.
    3. Household includes a single parent with children occupants;
    4. Household includes a first time pregnant female
    5. Household includes a disengaged youth between the ages of 16-24 that are not enrolled in school, and/or unemployed, and at high risk for involvement in the justice system.
    6. Household includes a citizen returning to the community from secure confinement.
    7. Household/family identified as low-income.
  4. Performance Measures
    1. # of new eligible households receiving a wellness visit check-up.
    2. # of new eligible households with a service plan developed.
    3. # of eligible households connected to church or neighbor network
    4. # of mobilized events to reduce violence/improve safety on blocks occupied by eligible households
    5. # of eligible households with benefit needs identified in the service plan that were connected to needed benefits through ABE and DHS Local Offices.
    6. % of eligible households with employment needs identified in the service plan that gained or increased employment
    7. % of eligible households with education needs identified in the service plan that gained education level
    8. % of the previously identified clients/households with a service plan that received 1 or more follow-up visits.
    9. % of newly identified clients/households with a service plan receiving 1 or more follow-up visits.
    10. % of clients/households receiving follow-up services will identify which service plan referred services were received/followed through on.
    11. % of clients/households receiving a revised service plan to mitigate barriers to service provision.
  5. Performance Standards
    1. 100% of new eligible households will receive one or more wellness visit check-ups. Acceptable performance 90%.
    2. 65% of the new eligible households identified will have a service plan developed. Acceptable performance is 50%
    3. 100% of the new eligible households identified, not currently connected to church or neighbor volunteer network, will be connected. Acceptable performance is 75%.
    4. A minimum of 12 mobilized events to reduce violence/improve safety on blocks occupied by eligible households.
    5. 65% of eligible households with benefit needs identified in the service plan will be connected to benefits through ABE and DHS Local Offices.
    6. 100% of eligible households with increased employment needs identified in the service plan will achieve increased employment. Acceptable performance 20%
    7. 100% of eligible households with increased education needs identified in the service plan will achieve increased education. Acceptable performance 20%.
    8. 100% of the previously identified clients/households will receive 1 or more service plan follow-up visits. Acceptable performance 80%.
    9. 100% of the newly identified clients/households with service plans will receive 1 or more follow-up visits during the grant period. Acceptable performance is 25%.
    10. 100% of households receiving follow-up will identify which service plan referred services were received/followed through on. Acceptable performance is 85%.
    11. 100% of households indicating lack of referral follow through will have a revised service plan developed to mitigate barriers to service provision. Acceptable performance is 50%.
  6. Data Collection
    Data will be collected and managed in a provider database to assist with outreach, case management, evaluation and reporting. At a minimum, the following will be maintained per household:
    1. Client demographic information including eligibility demographics [name, address, age, gender, ethnicity, race, and all eligibility groups (Senior, Single Parent Household, 1st time pregnant parent, Disengaged Youth, Returning Citizen, Low Income household)]
    2. # contacts made
    3. # in-home visits
    4. # services requested
    5. # service referral
    6. # referral services received
    7. Household needs assessment
      1. Housing
      2. Income
      3. Employment
      4. Education
      5. Health
      6. Life Skills
      7. Childcare
      8. Parenting
      9. Food/nutrition
      10. Transportation
      11. Drug dependency
      12. Pre-Natal care
      13. Legal Advocacy
      14. Mental Health
      15. Current government benefits (disability, medical, TANF, SNAP, child care, WIC, etc.)
    8. New government benefits acquired (disability, medical, TANF, SNAP, child care, WIC, etc.)
    9. # of clients/households with increased employment
    10. # of clients/households with increased education
    11. Service Plan developed (Y/N)
    12. Service Plan completed (100% / 50% or more / less than 50%)
    13. % of referral services received
    14. # of clients/households that followed-up on referral services

SECTION III
The following section provides instructions for the components that must be included in a complete continuation application.

  1. Uniform Application for State Grant Assistance
    Continuation applicants must submit a completed and signed Uniform Application for State Grant Assistance. The 3 page application may be found at this link. (pdf)
  2. FY 2020 Community Wellness Continuation Plan Narrative
    Continuation applicants must submit an application that contains the information outlined below. Each section must have a heading that corresponds to the headings listed below. If the Applicant believes that the subject has been adequately addressed in another part of the application narrative, then a cross-reference to the appropriate part of the narrative must be provided. The narrative portion must be in the order requested. This application, if approved, will become the local program plan and budget. The program plan/application will be the basis for monitoring compliance by DHS. Please provide a detailed response as directed to each of the following items in an effort to fully describe how the Community Wellness Program will be implemented.
    1. Executive Summary
      The Executive Summary will serve as a stand-alone document that may be shared with various state-level stakeholders and others requesting a brief overview of each funded project. Therefore, applicants should be concise and direct in their description. At a minimum, each of the following should be addressed in the Executive Summary.
      • Description of the target community(ies) and identified needs from the Community Assessment(s)
      • Target population to be served in this program
      • Overview of services and anticipated outcomes
      • Total amount of funds requested through this grant
    2. Agency Qualifications/Organizational Capacity
      For items 1, 2 and 3, please provide any updates and include requested information where there have been changes. Describe why these changes have occurred and how the program has been/will be impacted as a result. If there have been no changes over the past year, please indicate such. Information in this section should include, but not necessarily be limited to, the following:
      1. An organizational chart of the Provider organization, showing where the program and its staff will be placed. If subcontractors will be used, include the relationship with those organizations in the chart. Please include this as Attachment 8-Organizational Chart.
      2. Identify key staff positions that will be responsible for the program. At a minimum, a Community Wellness Program coordinator must be committed to the program. Include evidence that this individual is qualified on the basis of education and experience to direct the program. Present his/her resume as Attachment A2 of your Application. If that individual has not yet been hired, present the Community Wellness Program Coordinator's job description as Attachment 9 - Coordinator's Job Description/ Resume. Please also complete the Contact Information Form(s) found in Appendix 2 and include it as Attachment 3.
      3. Job descriptions for all employee positions that will be funded with this grant, and an indication of the percent of time those employees will spend in this program. Programs must recruit and hire staff who are qualified for their positions through education, experience and/or training. Job descriptions must also be included for volunteer staff. Include the job descriptions in Attachment 4- Job Descriptions (Grant Funded).
      4. A description of your agency's current programs and activities relevant to the services described in this Funding Notive. Please describe how these programs will impact the targeted population.
      5. A description of your agency's readiness for service provision commencing July 1, 2019.
      6. A description of any certificcations or accreditations that your agency may have and how they improve your ability to provide Community Wellness activities.
      7. Describe your procedure for conducting background checks for employees and contractors of your organization.
      8. Include as attachment 6 a copy of the Applicant's current Federal Form W-9. If subcontractors are used, include a copy of the subcontractor(s)' Federal Form W-9 in Attachment 6.
    3. Need - Description of Need
      Describe the need for the Community Wellness services in the proposed service area. Include any relevant information to document identified needs fo the target populations. Please distinguish between the needs of each service group. Identify various needs assessments and sources of the information provided.
    4. Quality - Description of Program Services
      1. Services
        1. Describe the service gaps identified and how they are being targeted.
        2. Describe the services and programs that will be provided to meet the individual needs of the eligible clients/households.
        3. Describe how the services provided to each client are individualized and based upon an individualized assessments.
        4. Providers must demonstrate an ongoing commitment to developing trauma informed capacity within the organization with the goal of achieving Trauma Informed Agency Status as recognized through the CBAT-O Assessment tool. Please indicate if your organization has participated in the CBAT-O Trauma Assessment process. Describe current and planned capacity building activities designed to obtain or maintain Trauma Informed status. Note: Providers are expected to achieve this status by 6/30/2020. Consideration for an extended deadline will be determined on a case by case basis. If your organization has obtained "trauma-informed" status as determined by the CBAT-O Assessment tool/process please include as Attachment 7 supporting documentation.
      2. Program Projections
        1. What is the projected number of new eligible clients/households to be served in FY2020?
          • # of these that will have a service plan developed
        2. What is the projected number of previously identified clients/households that will receive follow up services in FY2020?
          • # of these with a service plan already in place
          • # of these that will have a service plan developed during the year
        3. # of clients with a service plan that will receive a follow-up visit.
      3. Program Outcomes
        1. Identify measurable outcomes and objectives for Community Wellness for FY2020. Include a detailed plan for achievement.
        2. Describe how your strategy for FY2020 is based on lessons learned and available data. Indicate areas of your current initiative that will be targeted for improvement and why.
        3. Describe how your program design and implementation policies will ensure that each performance measures, identified in Section II, will be met for FY2020.
    5. Evaluation
      1. Applicant must make a clear statement of their intention to participate in any formal evaluation of the program that may be conducted by the Department or any of its contractors.
      2. Applicant must include a clear statement indicating their ability to collect required participant data and report it via the data reporting system created for the Community Wellness Program.
    6. Budget Narrative
      In this section of the application/plan narrative, provide a detailed Budget Narrative of the items allocated within your proposed budget. This will include all funds budget for the program, including any match. Identify the source of those funds and detail how the specified resources and personnel are being allocated to ensure the tasks, activities, goals and objectives described in your proposal will be implemented. Illustrate the use of state or federal funds, other than Community Wellness Program grant funds, that will be used to support the program. If sub-contractors are planned, please also describe how these funds will be utilized to implement the program.
    7. Continuation Plan Narrative Attachments
      Required Attachments
      • Attachment 1: Copy Federal or State approved NICRA
      • Attachment 2: Program Staff Information
      • Attachment 3: Staff Contact Information
      • Attachment 4: Job Descriptions
      • Attachment 5: Budget Information
      • Attachment 5: Subcontractor Budgets,Narratives and agreements (if applicable)
      • Attachment 6: Copy of Applicant's current Federal Form W-9 (if using subcontractor(s) include subcontractor's W-9)
      • Attachment 7: Documentation of Trauma Informed Status
      • Attachment 8: Organizational Chart
      • Attachment 9: Coordinator/Job Description and Resume
  3. FY 2020 Community Wellness Project Continuation Budget
    In addition to the above budget narrative, Community Wellness Program continuation budgets must be submitted electronically in the CSA system (Refer to Appendix 1 for more information). The Budget entered into the CSA system will also include a narrative or detailed description/justification for each line in the budget and will describe why each expenditure is necessary for program implementation and how you arrived at the particular amount. Please include cost allocations as necessary. This narrative must also clearly identify indirect costs, direct program costs, direct administrative costs, and match within each line item as appropriate. The Budget (including MTDC base exclusions as appropriate) should clearly describe how the specified resources and personnel have been allocated for the tasks and activities described in your plan. The Budget should be electronically signed and submitted in the CSA system. The Budget must be signed by the Provider's Chief Executive Officer and/or Chief Financial Officer. If indirect costs are included in the budget, a copy of the approved NICRA must be included with the Application as Attachment 1.
    Please note, your FY 2020 contract will not be processed until your budget has been reviewed AND approved. It is critical that the budget submitted is as detailed as possible.
    Refer to Section I.B., "Funding Information & Requirements".
    Subcontractor budgets, budget narratives and actual sub-contracts must be submitted with this application as they need to be pre-approved. Refer to Appendix 1 for information regarding Subcontractor Budgets. Subcontractor agreements and budgets will be submitted as Attachment 5 of your application.
    Submit as Attachment 6 - a copy of Federal Form W9 for the Provider Agency. It is critical that the Agency name, address and FEIN number matches the information provided on the Uniform Application for State Grant Assistance submitted as part of the total Application package.
    If indirect costs are included in the budget, a copy of the approved NICRA must be included with the Application as Attachment 1.

SECTION IV
The following section provides instructions for Submitting the complete continuation application.
Application and Submission Instructions

  1. Submission Format, Location and Deadline
    1. Applications must be received at the location below no later than 12:00 p.m. (noon) on Monday, April 8, 2019. The application container will be electronically time-stamped upon receipt. The Department will ONLY accept applications submitted by electronic mail sent to DHS.YouthServicesInfo@Illinois.gov. The subject line of the email MUST state: "20-444801489 Kristen Community Wellness Program". Applications will NOT be accepted if received by fax machine, hard copy, disk or thumb drive.
    2. All Providers must submit the completed grant application in a single PDF document utilizing the CMS File Transfer Utility located at https://filet.illinois.gov/filet/PIMupload.asp  SUBMIT THE COMPLETED GRANT APPLICATION TO: DHS.YouthServicesInfo@illinois.gov The subject line of the email MUST state: "20-444801489 Kristen CWP".
    3. Please follow the instructions to attach your application. Don't forget the subject line above. Unless otherwise specified in writing, to be considered, proposals must be submitted via CMS File Transfer Utility by the designated date and time listed above. For your records, please keep a copy of your submission with the date and time the application was submitted along with the email address to which it was sent. The deadline will be strictly enforced. In the event of a dispute, the Provider bears the burden of proof that the application was received on time at the email location listed above.
  2. Other Submission Requirements.
    1. Proposal Format Requirements
      1. All applications must be typed on 8 1/2 x 11-inch paper using 12-point type and at 100% magnification. With the exception of letterhead and stationery for letter(s) of support, the entire application should be typed in black ink on white paper. The application must be typed single-spaced, on one side of the page, with 1-inch margins on all sides. The Uniform Application for State Grant Assistance, Attachments, Checklist, and Uniform Budget Template/Narrative forms are NOT included in the page limitation.
      2. The entire application, including attachments, must be sequentially page numbered and compiled in the order specified below. The complete application must be submitted in a single PDF document to DHS.YouthServicesInfo@illinois.gov  The subject line of the email MUST state: "20-444801489 Kristen CWP". Applications will ONLY be accepted by email as described herein. Hard copies, faxed copies, copies on disk or thumb drive etc. will not be accepted.
      3. The Department is under no obligation to accept applications that do not comply with the above requirements.
    2. ALL Applications MUST include the following mandatory forms/attachments in the order identified below.
      1. A Screenshot or statement indicating the applicants has completed Pre-Qualification steps and is currently Pre-Qualified.
      2. Statement indicating the ICQ and PRA have been completed
      3. Signed Uniform Application for State Grant Assistance
      4. Continuation Proposal Narrative
        • Executive Summary
        • Capacity - Agency Qualifications/Organizational Capacity
        • Quality - Description of Program Design and Services
        • Need - Description of Need
        • Budget Narrative
        • Attachments to Your Application
          • Attachment 1: Copy Federal or State approved NICRA
          • Attachment 2: Program Staff Information
          • Attachment 3: Staff Contact Information
          • Attachment 4: Job Descriptions
          • Attachment 5: Budget Information
          • Attachment 5: Subcontractor Budgets,Narratives and agreements (if applicable)
          • Attachment 6: Copy of Applicant's current Federal Form W-9 (if using subcontractor(s) include subcontractor's W-9)
          • Attachment 7: Documentation of Trauma Informed Status
          • Attachment 8: Organizational Chart
          • Attachment 9: Coordinator/Job Description and Resume
      5. Uniform Grant Budget - The proposed budget must be entered, signed and submitted in CSA and is required for the application to be considered complete. A hard copy of this signed and submitted budget must be included with the application.
  3. Unique entity identifier and System for Award Management (SAM)
    Each applicant is required to: (i) Be registered in SAM before submitting its application; (ii) provide a valid unique entity identifier in its application; and (iii) continue to maintain an active SAM registration with current information at all times during which it has an active award or an application or plan under consideration by the Department. The Department may not make an award to an applicant until the applicant has complied with all applicable unique entity identifier and SAM requirements and, if an applicant has not fully complied with the requirements by the time the Department is ready to make an award, the Department may determine that the applicant is not qualified to receive an award and use that determination as a basis for making an award to another applicant. Please refer to Section I. Eligibility Information & Grant Funding Requirements for additional information and detail regarding SAM.
  4. Intergovernmental Review
    This funding opportunity is NOT subject to Executive Order 12372, "Intergovernmental Review of Federal Programs,".
  5. Funding Restrictions
    The applicant must develop a budget consistent with program requirements as described in Section II. Program Description Overview and in accordance with Section I. C Grant Funds Use Requirements.
    The Department will not allow reimbursement of pre-award costs under this funding opportunity.

Section V
The following section provides Award, Administrative and Contact Information.

Award Administration Information

  1. State Award Notices.
    Providers recommended for continued funding under this Notice of Funding Opportunity following the above review will receive a Notice of State Award (NOSA). The NOSA shall include:
    • Grant award amount
    • The terms and condition of the award.
    • Specific conditions assigned to the grantee based on the fiscal and administrative and programmatic risk assessments.
      Upon acceptance of the grant award, announcement of the grant award shall be published by the awarding agency to Grants.Illinois.gov
      A written Notice of Denial shall be sent to the Providers not receiving awards.
      The NOSA must be signed by the grants officer (or equivalent). This signature effectively accepts the state award amount and all conditions set forth within the notice. This signed NOSA is the document authorizing the Department to proceed with issuing an agreement. The Agency signed NOSA must be remitted to the Department as instructed in the notice.
  2. Administrative and National Policy Requirements.
    The agency awarded funds shall provide services as set forth in the DHS grant agreement and shall act in accordance with all state and federal statutes and administrative rules applicable to the provision of the services.
    To review a sample of the FY2020 DHS contract/grant agreement, please visit the DHS Website at http://www.dhs.state.il.us/page.aspx?item=29741.
    The agency awarded funds through this funding notice must further agree to comply with all applicable provisions of state and federal laws and regulations pertaining to nondiscrimination, sexual harassment and equal employment opportunity including, but not limited to: The Illinois Human Rights Act (775 ILCS 5/1-101 et seq.), The Public Works Employment Discrimination Act (775 ILCS 10/1 et seq.), The United States Civil Rights Act of 1964 (as amended) (42 USC 2000a-and 2000H-6), Section 504 of the Rehabilitation Act of 1973 (29 USC 794), The Americans with Disabilities Act of 1990 (42 USC 12101 et seq.), and The Age Discrimination Act (42 USC 6101 et seq.). Additional terms and conditions may apply.
  3. Required Reporting
    1. The Provider will submit monthly expenditure documentation forms in the format prescribed by the Department. The Expenditure Documentation forms must be submitted no later than the 15th of each month for the preceding month by email.
    2. Providers must ensure all youth referred to and served in the Community Wellness Program are entered into the Data reporting system created by the applicant as required to ensure accurate reports.
    3. Quarterly Narrative and Performance data reports will be submitted by email in a format prescribed by the Department, no later than the 15th of the month immediately following the quarter for the preceding quarter.
    4. Year-End Financial, Narrative and Performance Data reports will be submitted by email in a format prescribed by the Department, no later than 30 days following the end of the fiscal year.
    5. Additional annual performance data may be collected as directed by the Department and in a format prescribed by the Department.
  4. Community Wellness Program Payment Terms
    1. An initial prospective payment of 2/12 of the State General Revenue Award amount will be issued upon execution of the agreement; and may be rounded to the nearest $100.00. Subsequent payments will be issued on a reimbursement basis and will consider all previously submitted documented expenditures.
    2. The Department will compare the amount of the prospective payments made to date with the documented expenditures provided to the Department by the Provider. In the event the documented Apservices provided by the Provider do not justify the level of award being provided to the Provider, future payments may be withheld or reduced until such time as the services documentation provided by the Provider equals the amounts previously provided to the Provider. Failure of the Provider to provide timely, accurate and sufficiently detailed documentation will result in delayed payments and may result in a reduction to the total award.
    3. The final payment from the Department under this Agreement shall be made upon the Department's determination that all requirements under this Agreement have been completed, which determination shall not be unreasonably withheld. Such final payment will be subject to adjustment after the completion of a review of the Provider's records as provided in the Agreement.
      In the event payments made by the Department to the provider exceed the total amount of provider reported and Department authorized expenditures, the provider will be required to issue a repayment to the Department in an amount equal to the overpayment.

State Awarding Agency Contact(s)
If you have questions relating to this Continuation Funding Notice, please send them via email to: DHS.YouthServicesInfo@Illinois.gov  with "CWP FUNDING NOTICE - Kristen " in the subject line of the email.

Uniform Application for State Grant Assistance (pdf)

Community Wellness Program Continuation Application