NEBRASKA PLANNING COUNCIL ON

DEVELOPMENTAL DISABILITIES

Opportunity SubawardApplication

Name of Agency/Applicant:

Address:

Contact Person: Phone number:

E-mail: Website:

Federal Tax Identification Number: DUNS #:

Council Goal:

___ Improve transition across the lifespan of more individuals with intellectual and other developmental disabilities (I/DD) of diverse identities and their families.

___ Improve advocacy, self-advocacy, and self-determination for more individuals with intellectual and other developmental disabilities (I/DD) of diverse identities and their families.

___ Influence systems change to provide increased opportunities for more individuals with intellectual and other developmental disabilities (I/DD) of diverse identities to pursue an employment path of their choice.

___ Increase community inclusion for individuals with intellectual and other developmental disabilities (I/DD) of diverse identities.

  1. Who is the target audience of your project?
  1. What is the need or concern that your proposal will address? What outcomes do you expect to achieve? (Be as specific as possible.)
  1. What do you plan to do in your project?
  1. Describe your work plan and timeline. Identify the steps or activities you will need to have in your project to reach your outcome described in #3. Be sure to include specific dates on which you anticipate these activities or steps will be reached. This section should include the numbers of people you will reach. One step must focus on activities related to sustaining the project after Councilsubaward funds end. (This response should contain enough detail that reviewers understand what you will be doing and, if the subaward is awarded, be able to monitor your project’s progress.)
  1. Who are the key people who will implement the project? If the key people are already employed by your agency, explain their current role and how it will be changed by the subaward. If you are requesting funds for their salaries, explain why you need Council funds to support them.
  1. Is this a new project or has it operated before? If previously operated, what were the results?
  1. Explain why traditional funding sources (special education funding, Medicaid, DD Services, etc.) are not available/appropriate for this project.
  1. Successful projects will consider not only how the project can be a part of the community, but how the community can be a part of the project. Examples could include involving an individual from the community who is unfamiliar with developmental disabilities as part of an advisory board to the project, or soliciting community organizations or businesses to support and/or participate in the project activity.

In what ways will this project include the general community?

  1. Identified disparities includerace, ethnicity, sexual orientation, genderand minority groups, individuals who live inunderserved geographic areas, andpeople who use assistive technology in order to participate in community life.Does your project address an identified disparity? If so, how does the project implement strategies to decrease the differences in access, service use, and outcomes among such sub populations?
  1. How will the outcomes of this project be sustained after the project is over? Include a description of the activities, features, or practices of the subaward that the applicant wants to sustain.
  1. Complete theProjected Budget section on the budget form. Leave the Expenditure section blank.Include a brief justification narrative to explain expenses listed and how you arrived at the requested amounts (Question 12). Budget Justification is limited to one page.

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Nebraska Planning Council on Developmental Disabilities

Opportunity Subaward Application 06.16

OPPORTUNITY SUBAWARD EXPENDITURE REPORT
PROJECTEDSUBAWARD ALLOCATION AND MATCH
Subaward Number: / Reporting Period: / to
Agency:
Project Title: / ______
Project Coordinator or Fiscal Officer Signature Date
Federal ID Number: / *Unsigned or electronically submitted forms are not accepted and will result in delay.
LINE ITEMS / PROJECTED BUDGET / EXPENDITURES
DD Subaward Allocation / Match / DD Subaward Allocation / Match
In-Kind / Cash / In-Kind / Cash
PERSONNEL
BENEFITS
TRAVEL
OFFICE EXPENSES
CONSULTANTS
OTHER COSTS
TOTAL / $ / $ / $
Project Revenue (registration fees, sale of subaward-developed material, etc.): $
Explain Intended Use of Project Revenue:

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Nebraska Planning Council on Developmental Disabilities

Opportunity Subaward Application 06.16

12. Budget Justification.

This section supports the figures entered in the Projected Subaward Allocation and Match section. Provide good explanations why each item is necessary for the success of the project. Identify costs for which federal funds are requested and those that will be provided by match (non-federal funds or in-kind).

When calculating Personnel costs, provide the name of the employee or the position and the percentage of time they will be working on the project.

For Match Funds, show how the amounts were determined and how they will be documented.

For costs that can only partially be allocated to the project (e.g., rent or phone), explain how the amount was determined. For example, if personnel is 20% then rent, phone, etc. would be 20% of the annual costs.

For Other Costs, identify each dollar amount and describe how it will be used both for subaward and matching funds.

  1. If your project requires coordination with another agency or agencies to meet your outcomes, you will need to submit letter(s) of commitment/support from these partners.

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Nebraska Planning Council on Developmental Disabilities

Opportunity Subaward Application 06.16