PERMANENT HOUSING 2016RENEWAL 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 Expiring Project Grant #:
Grant Start & End Dates:
Primary Contact Information for Application
Contact Name: / Title:
Email Address: / Phone:
Project Type:
Permanent Housing
Permanent Supportive Housing (PSH) or
Rapid Rehousing / # of Units (If applicable): ______
Identify the specific population focus for the project;
Chronic homelessness
Veterans
Youth (under 25)
Families with children
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 your FY2014 contract (Note: FY refers to HUD contract fiscal year) ______
Of those clients served in the FY 2014 project contract indicate the number reported in HMIS ______
How many chronically homeless did you propose to serve in the project(s) in your FY2014 contract? ______
How many chronically homeless individuals did you actually serve when your FY 2014project(s)contract was complete? ____
HOUSING
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):
(Check all that apply.) Note: If applying for funding for leasing, the units must be leased by the organization.
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
2013 / 2014 / 2015
Total Units
Total Beds
Total dedicated CH Beds
Total Non-Dedicated CH Beds
1. 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)
2. Please provide evidence that the HUD site(s) meet one of the following criteria (from FY2016 NOFA Discretionary Section)
a)Site has lower transportation costs that the regional average. Demonstrated through HUD and DOT’s location Affordability Index
b)Site has a WalkScore better than the city average ascertained by searching )
c)Site is served by reliable and accessible public transportation through door to door shuttle/van service and/or a transit stop(s) within one-half mile, with headways of no more more than 30 minutes during non-peak schedule. Applicants can demonstrate this using publicly available information about local transit service.
Project Threshold
1. Has the project been monitored by HUD within the last two years? If yes,
- What were HUD’s findings?
- What was your response?
No
2. Will you make any changes from your FY2015 contract in project design in FY2016? 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 or exemption form per HUD guidance on 4/21/2016? / Yes
No
N/A
5. If you are requesting funding for leasing, do you have a Master lease with the property owner?
Note: If you do not have a Master lease then you will have to apply for rental assistance not leasing) / Yes
No
N/A
6.Does your project align with the HUD Equal Access Rule for HUD-assisted or HUD-insured Housing as per 24 CFR 5.105(a)(2)? / Yes
No
7. 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
1. Provide a project description that addresses the entire scope of the project, including a clear picture of the target population(s) to be served, the plan for addressing the identified needs/issues of the CoC target population(s), projected outcome(s), and coordination with other source(s)/partner(s). The narrative is expected to describe the project at full operational capacity. The description should be consistent with and make reference to other parts of this application. (Max 1500 characters)
2. Does the project ensure that participants are not terminated from the program for the following reasons? Select all that apply.
Failure to participate in supportive services /
Failure to make progress on a service plan /
Loss of income or failure to improve income /
Being a victim of domestic violence /
Any other activity not covered in a lease
agreement typically found in the
project's geographic area. /
None of the above /
3. Consistent with the dates of your last APR, what is the project’s eviction or involuntary dismissal rate?
If there were evictions or involuntary dismissals, what reasons caused the eviction or involuntary dismissal?
4. 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?
Yes
No
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
5. 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.
6. 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)
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
As needed or requested
4. Does the project prioritize tenant selection based on coordinated assessment? / Yes
No
5. Does the project accept clients who are diagnosed with or show symptoms of a mental illness? If no, explain.(Limit: 750 characters) / Yes
No
6. Does the project accept clients regardless of rental history or past evictions?If no, explain.(Limit: 750 characters) / Yes
No
7. What percentage of the client’s income is charged for rent? / ______%
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 / Frequency provided (As needed, weekly, biweekly, monthly, Other) / 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 Deposits
2. Do you provide transportation assistance to clients to attend mainstream benefit appointments, employment training or job?
3. Do you use a single application form for four or more mainstream programs?
Yes
No
5. Do you conduct at least annual follow ups with clients to ensure mainstream benefits are received?
Yes
No
6. Do project participants have access to SSI/SSDI technical assistance provided by the applicant, a subrecipient, or partner agency?
Yes
No
7. Has the staff person providing the technical assistance completed SOAR training in the past 24 months.
Yes
No
HEALTHCARE
1. How does your organization assess whether client’s have access to health insurance? (limit 750 characters)
2. 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
- What programs or initiatives do you have in place to help clients obtain mainstream benefits except Medicaid? (Limit: 750 characters)
2. 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)
INCOME
2. Identify what curriculum or service plan you use to increase client’s access to job readiness? (Limit: 750 characters)
(Limit: 750 characters)
3. Describe what your project will do to link participants with employers? (Limit: 750 characters)
STANDARD PERFORMANCE MEASURES
Housing Measure / Target (#) / Universe (#) / Target (%)
1a. PSH: Persons remaining in permanent housing as of the end of the operating year or exiting to permanent housing destinations (per data element 3.12 of the 2014 HMIS Data Standards) during the FY 2016 operating year.
*2. Choose one income-related performance measure from below, and specify the universe and target numbers for the goal for the FY 2016 program.
Click 'Save' to calculate the target percent (%).
Income Measure / Target (#) / Universe (#) / Target (%)
2a. Adults who maintained or increased their total income (from all sources) as of the end of the FY 2016 operating year or project exit.
OR
2b. Adults who maintained or increased their earned income as of the end of the FY 2016operating year or project exit.
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)
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
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: ______
2016 PERMANENT HOUSING 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
Cash Match
In-kind match
Total Match
TOTAL BUDGET
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
2016 PERMANENT HOUSING 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. Services
3. Personnel(position and budget by position)
5. HMIS Space and Operations
Total HMIS Request
Summary for Match
Total Value of Cash Commitments:Total Value of In-Kind Commitments:
Total Value of All Commitments:
Summary for Leverage
Total Value of Cash Commitments:Total Value of In-Kind Commitments:
Total Value of All Commitments:
2016 PERMANENT HOUSING 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 theexpected 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 dated within 60 days of NOFA deadline.
MATCH – 25% for all line items except leasing
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% of overall budget
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
2016 PERMANENT HOUSING NOFA RENEWAL [PROJECT COMPONENT]
Page 1
Must be completed annually, one per project applying for CoC funding.