2015 RENEWAL APPLICATION [PROJECT COMPONENT]
IMPORTANT NOTE: If the Agency Application is a consolidation of 2 or more programs than the project application should reflect the consolidatedprogram outcomes.
* Note all character limits are with spaces.
Agency Name:Project Name(S): If consolidating, include in parentheses the names of all previous projects included on this application. / HUD Project Grant #:
Grant Start & End Dates:
Primary Contact Information for Application
Contact Name: / Title:
Email Address: / Phone:
Project Type:
Permanent Housing
PSH or
Rapid Rehousing
Transitional Housing
Supportive Services Only / # of Units (If applicable): ______
Identify the specific population focus for the project;
Chronic homelessness
Veterans
Youth (under 25)
Families
Domestic Violence
Substance Abuse
Mental Illness
HIV/AIDS
Other, explain
How many clients are you proposing to serve in the project contract for which you are applying? ______
How many clients were served in the project from 1/1/2014 – 12/31/2014 ______
Of those clients served in the project from 1/1/2014-12/31/2014, indicate the number reported in HMIS ______
How many chronically homeless did you propose to serve in the project(s) in your FY2013 contract? ______
How many chronically homeless individuals did you actually serve when your FY 2013project(s)contract was complete? ____
HOUSING
*Permanent Housing(PH) and Transitional Housing (TH) Projects Only - Are the units scattered site or site based?
Scattered Site
Site Based
N/A
If scattered site, is there a minimum number of units at each site?
Yes: Minimum number of units: ______
No
N/A
Location of Units (if applicable) Complex Name(s) & Zip Code(s):
*Permanent Housing and Transitional Housing Projects Only- (Check all that apply.)
The units are:
Leased by the organization
Leased by tenant on their own lease
Leased by the tenant on a master lease
Owned by the organization
2012 / 2013 / 2014
Total Units
Total Beds
Total dedicated CH Beds
Total Non-Dedicated CH Beds
Describe the community amenities that are accessible within .5 mile to project participants and (schools, libraries, houses of worship, grocery stores, Laundromats, doctors, dentists, parks, or recreational facilities) and include their proximity to their housing(max 1000 characters)
Project Threshold
1. Has the project been monitored by HUD within the last two years? If yes,
- What were HUD’s key findings?
- What was your response?
No
2. Will you make any changes from your 2015 contract in project design in the next contract? If yes, please explain. (Limit: 750 characters) / Yes
No
3. If applicable, is Energy Star used at one or more of the properties? / Yes
No
N/A
4. If you have any “leasing” line items, have you provided the HUD Field office with the required environmental reviews? / Yes
No
N/A
5. Has the project used the results of internal and external evaluations or audits within the past two years to improve project operations (this may include past Evaluation Instruments or HMIS data quality reports)?
Yes
No
N/A
If yes, please provide examples of how results were used. (Limit: 750 characters)
PROJECT OVERVIEW
Provide a clear and concise project description. Describe the community needs, target population(s) to be served, project plan for addressing the identified housing and supportive service needs, projected project outcome(s), coordination with other source(s)/partner(s), and the reason why CoC Program support is required. (Max 1500 characters)
Service Design
CASE MANAGEMENT
As ECHO continues to lead implementation of theAustin/Travis County plan to end homelessness, ECHO desiresprojects be innovative and flexible in their service delivery to meet the changing needs of all clients who access the homeless service system. This section prioritizes the innovative and flexible delivery of services to clients, focusing on housing first and harm reduction principles.
1. What is your client to case manager ratio for this project? If consolidated, please list out for each formerly individual project, if different. Describe why this is your target ratio (limit 1000 characters). / ___:______
2. Please describe the qualifications, key functions, and supervision of case managers.(Limit: 1000 characters)
3. How often do case managers meet with clients?
Weekly
Every other week
Monthly
Every other month
HOUSING FIRST
1. Does the project accept all clients regardless of substance use history or current use? If no, explain.(Limit: 750 characters) / Yes
No
2. Does the project prioritize tenant selection based on duration/chronicity of homelessness, vulnerability or high utilization of crisis services or does the project use a first come/first serve approach? / Yes
No
3. Does the project accept clients who are diagnosed with or show symptoms of a mental illness? If no, explain.(Limit: 750 characters) / Yes
No
4. Does the project accept all clients regardless of criminal history? If no, explain.(Limit: 750 characters) / Yes
No
5. Does the project accept clients regardless of rental history or past evictions?If no, explain.(Limit: 750 characters) / Yes
No
6. Does the project accept clients regardless of lack of financial resources?If no, explain.(Limit: 750 characters) / Yes
No
7. Are clients required to engage in case management or services as a condition of remaining in housing. If yes, describe / Yes
No
8. For PSH & TH Projects Only:What percentage of the client’s income is charged for rent? / ______%
9. What are grounds for eviction or involuntary dismissal from your project?
10. Consistent with the dates of your last APR, what is the project’s eviction or involuntary dismissal rate?
11. Does the project allow clients to remain in the project even if they require an absence of 90 days or less due to the reasons outlined below?
If other laws or funders of the project require less amount of time, but the project eligibility criteria does not, please select no and describe the funder policy or law in the space below.(Limit: 750 characters)
- substance use treatment intervention
- mental illness treatment intervention
- hospitalization
- Incarceration
No
12.. Do the project’s discharge policies include the following?Check all that apply.
An internal, due process hearing or investigation prior to discharging the client.
Assistance with locating other housing (for housing projects) or services (for SSO projects) options, if needed.
Make and document all reasonable attempts to avoid discharging clients onto the street without needed services.
SUPPORTIVE SERVICES
1. What supportive services are accessible to clients from your agency or through formal project agreements with partner agencies?
Supportive Service / Accessible to Clients (check all that apply) / Who Provides the service / Is a formal MOU in place?
Assessment of Service Needs
Assistance with Moving Cost
Case Management
Child Care
Education Services
Employment Assistance & Job Training
Food
Housing Search and Counseling Services
Legal Services
Life Skills Training
Mental Health Services
Outpatient Health Services
Outreach Services
Substance Abuse Treatment Services
Transportation
Utility Services
2. Does the Project use a harm reduction policy for drug and alcohol use or are clients dismissed from the program for drug and alcohol abuse? Yes/ No Explain (limit 750 characters)
HEALTHCARE
3. How does your organization assess whether client’s have access to health insurance? (limit 750 characters)
4. How does your organization connect clients’ with healthcare? (limit 750 characters)
3. What formal agreements are in place to assist clients’ access to behavioral and physical healthcare? (limit 1000 characters)
ACCESS TO MAINSTREAM BENEFITS
INCOME
- What programs or initiatives do you have in place to help clients obtain mainstream benefits except Medicaid? (Limit: 750 characters)
Identify how the project will leverage Medicaid resources, including
Identify how project will enroll clients in Medicaid-eligible programs
Identify how project will include Medicaid – financed services such as case management, tenancy supports, behavioral health supports, or other services supporting housing stability. Note these services can be provided by recipient receipt of services or through Medicaid billing at an FQHC
If there are barriers to including Medicaid-financed services - demonstrate how the project will leverage non-Medicaid services such as mental health or substance abuse prevention block grants or state behavioral health system funding
(Limit 1500 characters)
2. What programs or initiatives do you have in place to help clients increase their connections to income (Limit: 750 characters)
3. Describe what your project will do to increase the percentage of clients who are employed? (Limit: 750 characters)
4. According to your Data Score Card, did your project meet, exceed, or not meet the targets you proposed in your HUD CoC application (including the # of clients served)?If you did not meet your targets, please explain. (Limit: 1000 characters) / Met or Exceeded All
Did Not Meet
COMMUNITY PLANNING
1. Identify how this project fits within the Community Plan to End Homelessness and where it fits within the Community Funding Priorities (CFP). (Limit: 750 characters)
2. Identify how this project addresses the HUD Opening Doors priorities of:
End Chronic Homelessness by 2017
End Veteran Homelessness by 2015
End Family and Youth Homelessness by 2020
(limit 750 characters)
COORDINATED ASSESSMENT
- HUD requires all CoC Funded programs to participate in Coordinated Assessment. Is your program currently accepting prioritized referrals based on vulnerability through Coordinated Assessment?
Client Focus & Representation
ECHO recognizes that when clients are provided opportunities to contribute experiences and expertise related to the assistance and services that they need, projects and the continuum are strengthened.
1. Are there avenues for clients to provide anonymous feedback?
If yes, please describe the process that allows for clients to give anonymous feedback without negative consequences.(Limit: 750 characters) / Yes
No
2. Are clients provided with written eligibility criteria? (Limit: 750 characters) / Yes
No
Financials
1. Complete budget forms are attached.These will be scored based on reasonableness and accuracy of forms. / Yes
No
2. Based on the chart provided by HUD for FY2012 unexpended funds, did your program have unexpended funds in FY2012? If yes, how much was unexpended? Why were the funds not expended? What steps have been taken to ensure that funds are fully expended in future contracts? (Limit 1000 characters) / Yes
No
N/A (S+C)
3. What is the total cost per client (HUD funding)?
4. What is the total cost per client (total project funding)? What other resources are included in the total project funding?
5. Did you meet your project match in your last completed HUD contract? If no, explain.(Limit: 750 characters) / Yes
No
6. What dollar amount of match is required for the upcoming award year? What resources, both financial and in-kind, will be used to meet the match? / $______
7. Did you meet the leverage requirement for your last HUD contract? If no, explain. (Limit: 750 characters) / Yes
No
8. What dollar amount of leverage can the project provide for the upcoming award year? / $______
Certification
By checking this box and entering the Authorized Representative’s name in the space below, I certify that the information throughout the application is true, complete, and accurate to the best of my knowledge.
Authorized Representative
Name: ______Title: ______
Signature: ______
2015 NOFA RENEWAL [PROJECT COMPONENT]
Page 1
Must be completed annually, one per project applying for CoC funding.
HUD COC SUMMARY BUDGET
Housing Activities / Total Assistance requested for grant1a. Leased Units
1b. Leased structures
2. Short-term/Medium term Rental Assistance
3. Long-Term Rental Assistance
4. Supportive Services(please list line items in Chart A)
5. Operating Costs(please list line items in Chart B)
6. HMIS (please list line items in Chart C)
Sub-total Costs requested
Administrative Costs (up to 10 %)
Total HUD Request
Total Match Required (25% required for all costs except leasing).
Cash Match Pledged
In-Kind Match Pledged
Total Match Pledged
Total Leverage (150%) Required
Total Leverage Pledged
A. SUPPORTIVE SERVICES BUDGET LINE ITEMS
Eligible Costs / Description(max 400 characters) / Total- Assessment of Service Needs
- Moving Costs
- Case Management
- Child Care
- Education Services
- Employment Assistance
- Food
- Housing/Counseling Services
- Legal Services
- Life Skills
- Mental Health Services
- Outpatient Health Services
- Outreach Services
- Substance Abuse Treatment
- Transportation
- Utility Deposits
Total Supportive Services Request
2015 NOFA RENEWAL [PROJECT COMPONENT]
Page 1
Must be completed annually, one per project applying for CoC funding.
B. OPERATING BUDGET LINE ITEMS
Eligible Costs / Description (limit 400 characters) / Total- Maintenance/Repair
- Property Taxes and Insurance
- Replacement Reserve
- Building Security
- Electricity, Gas, and Water.
- Furniture
- Equipment (lease/buy)
Total Operating Request
C. HMIS BUDGET LINE ITEMS
HMIS Services Costs / Description (max 400 characters) / Total1. Equipment
2. Software
3. Personnel(position and budget by position)
5. HMIS Space and Operations
Total HMIS Request
2015 NOFA RENEWAL [PROJECT COMPONENT]
Page 1
Must be completed annually, one per project applying for CoC funding.
DOCUMENTATION OF EXPECTED LEVERAGED RESOURCES OR CASH MATCH
Information regarding the leveraged resource or cash match to be provided by this agency is in the chart below and provided to the CoC during the renewal/reallocation submission process. Please create additional charts for additional contributions. Note: Prior to the submission of the NOFA this information must be on the letterhead of the entity providing the resource.
MATCH – 25%
Name of organization providingcontributionType of Contribution (cash or in-kind). If in-kind, then describe the type of in-kind contribution.
Total Value of the Contribution
Date the contributionwill be available.For renewals, this date must coincide with your 2015-2016 operating year. / [______],2015 through [______],2016
Name of person authorized to commit these resources
Title of person authorized to committhese resources.
LEVERAGE – HUD Requesting 150%
Agency & Project Name (to which the contribution will apply)Name of the organization proving the contribution
Type of Contribution (cash or in-kind). If in-kind, then describe the type of in-kind contribution.
Total Value of the Contribution
Date the contributionwill be available. This date must coincide with your 2015-2016operating year. / [______],2015 through [______],2016
Name of person authorized to commit these resources
Title of person authorized to committhese resources.
Signature
2015 NOFA RENEWAL [PROJECT COMPONENT]
Page 1
Must be completed annually, one per project applying for CoC funding.