Non-Profit Eligibility Determination Form
Name of non-profit:
Name of (potential) local government applicant:
Date completed:
Part I.Eligible Non-Profit Sub-recipient
Note: A non-profit must have been in existence at least 3 years, already been designated a 501(c)(3) organization by the IRS for federal tax purposes, and have the characteristics of an eligible community based development organization (CBDO) in order to participate in the Small Cities CDBG Program as a sub-recipient.
A.Please respond to the following questions:
1. Is your non-profit association or corporation organized under State or local law to engage in community development activities within an identified geographic area of operation including the jurisdiction of the local government applicant? If yes, what was the date of incorporation?
2. Does your non-profit organization have federal tax status as a 501(c)(3) organization? If yes, what was the date the organization received its 501(c)(3)?
3. Does the non-profit have as its primary purpose the improvement of the physical, economic or social environment of its geographic area with particular attention to the needs of persons of low and moderate income? If yes, is the primary purpose stated in the organization’s by-laws? If no, provide an explanation.
4. Does the non-profit maintain at least 51% of its governing body’s membership for low and moderate-income residents of its geographic area of operation or representatives of low and moderate-income organizations located in its geographic area of operation? If yes, explain how that is done. If no, provide an explanation as to the make-up of the governing body.
5. Is the non-profit an agency or instrumentality of the local government applicant and does it permit more than one-third of the membership of its governing body to be appointed by, or to consist of, elected or other public officials or employees or officials of an ineligible entity? If yes, provide an explanation.
6. Does the non-profit require members of its governing body to be nominated and approved by the general membership of the organization, or by its permanent governing body? If yes, specify which, the general membership or the permanent governing body. If no, describe the procedure used.
7. Explain how the non-profit will be an active and substantive partner of the project development team.
8. Will the non-profit be subject to requirements under which its assets revert to the local government upon dissolution? If yes, provide an explanation.
9. Is the non-profit free to contract for goods/vendors of its own choosing? If no, provide an explanation.
10. Does the non-profit have an income stream that provides sufficient operational funds? If no, provide an explanation.
11. Can the non-profit be classified as a start-up non-profit? If yes, provide an explanation.
B. To be sure that there is a viable effort resulting in a second CDBG application, please provide the following information on your plan to accomplish this goal:
- Describe your target market.
2. Explain the way you have been working with potential applicants.
3. Describe your plans/strategy on how you will develop relationships with partners that lead to the needed additional funding sources for the future CDBG project.
4. If available, list any other funding sources for activities you plan to undertake in the future CDBG project.
C. Please check only if your non-profit meets any of the two criteria below and provide an explanation.
Non-profit is an exception to the eligible community based development organization (CBDO) sub-recipient.
A local government may be allowed on a case-by-case basis to partner with a non-profit organization on a CapacityBuilding project within its jurisdiction and ETJ when the non-profit is not locally based but meets the following conditions:
- The local government is within the boundaries of the non-profit’s service area.
- The non-profit has an ongoing relationship to provide services to the local government or to the citizens of the community.
- The objective of the partnership meets the definition of capacity building.
- The non-profit will designate or hire a staff member to work exclusively with the local unit of government to carry out activities.
- Other characteristics of an eligible sub recipient apply.
Check only if non-profit is a CHDO.
Also note that a Community Housing Development Organization (CHDO); an entity organized under the Small Business Investment Act (non-profit only); and a Small Business Administration approved Section 501 State Development Company or Section 502 Local Development Company or Section 503 Company (all non-profit only) will also qualify as a CBDO.
Part II.Building Capacity of the Non-Profit
CB grants are provided to assist non-profits in partnership with local governments who are the only eligible entity to apply for funds in developing appropriate and competitive CDBG projects. CB funds may only be used to support activities that will result in projects that are eligible for CDBG funding within 2 years. Applicants submitting CB applications must certify that a future CDBG application will be submitted within twenty-four (24) months of the grant award and that any project developed and funded as a result of the CB grant will primarily benefit low and moderate-income people. CB funds cannot be used for any on-going activities of the non-profit. Instead, CB funds are targeted to the following:
Check the box if yes.
New endeavors that will take the non-profit in a new direction
CDBG funds used to increase the level of production or expand activities
Non-profit is not a partner in an open CapacityBuilding grant
Non-profit has a clearly defined project now for which it needs capacity to undertake as the project for the future CDBG application.
Will the non-profit be able to complete all project development activities that will be specified in the CB application before the follow-up application is ready to submit?
This CapacityBuilding grant will not be used to administer or manage any current CDBG grant.
Part III.Eligible Activities
Note: The non-profit staff must be on the payroll of the non-profit as a full-time employee. CDBG funds will not pay for consultants through the salary line item. Consultants can be hired for training but must be procured by the local government according to 24CFR Part 85.
Check the box for activities the non-profit expects to undertake.
Salary of existing or new staff who will be on the payroll full-time
Training of existing or new staff
Travel of existing or new staff
Administration of grant up to 10% of total grant
Planning costs up to $3,500 with restriction (See page 7 of Guidelines for details)