Section I.: Uniform Budget and Financial Plan



Uniform Application for State Grant AssistanceAgency Completed SectionAgency InformationType of Submission□ Pre-application Application□ Changed / Corrected ApplicationType of Application New□ Continuation (i.e. multiple year grant)□ Revision (modification to initial application)Date / Time Received by State(Office Use Only) Name of the Awarding State AgencyIllinois Department on AgingCatalog of State Financial Assistance (CSFA) Number402-01-0023CSFA TitleSenior Community Service Employment ProgramCatalog of Federal Domestic Assistance (CFDA) □ Not applicable (No federal funding)CFDA Number17.325CFDA TitleSenior Community Service Employment Program (SCSEP)CFDA NumberCFDA TitleFunding Opportunity InformationFunding Opportunity Number23-1156Funding Opportunity TitleTitle V Senior Community Service Employment Program (17.235)Funding Opportunity Program FieldCompetition Identification Competition Identification NumberN/ACompetition Identification TitleN/AApplicant Completed SectionApplicant InformationUse same Legal Name as used for DUNS registration and grantee pre-qualification.Legal NameCommon Name (DBA)Employer / Taxpayer Identification Number (EIN, TIN)Organizational DUNS numberSAM Cage CodeBusiness AddressStreet address City, State County, Zip + 4Applicant’s Organizational UnitDepartment NameDivision NameApplicant’s Name and Contact Information for Person to be Contacted for Program Matters involving this ApplicationFirst NameLast NameSuffixTitleOrganizational AffiliationTelephone NumberFax NumberEmail addressApplicant’s Name and Contact Information for Person to be Contacted for Business/Administrative Office Matters involving this ApplicationFirst NameLast NameSuffixTitleOrganizational AffiliationTelephone NumberFax NumberEmail addressAreas AffectedAreas Affected by the Project (cities, counties, state-wide)List the Planning and Service Areas (PSAs) and counties you propose to serve with this grant application. You can submit the information as an attachment.*Reference the attached Statewide Provider Service Area (PSA) Map that was included as part of the grant application packet.Legislative and Congressional Districts of ApplicantList your applicable Legislative and Congressional Districts per and Congressional Districts of Program / ProjectList your applicable Legislative and Congressional Districts per ’s ProjectDescription Title of Applicant’s ProjectTitle V/Senior Community Service Employment Program GrantProposed Project TermStart Date: October 1, 2019End Date: June 30, 2020Estimated Funding (include all that apply) Amount Requested from the State:□ Applicant Contribution (e.g., in kind, matching):□ Local Contribution:□ Other Source of Contribution:□ Program Income: Total Amount: $_________ Applicant Certification: By signing this application, I certify (1) to the statements contained in the list of certifications* and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances* and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil or administrative penalties. (U.S. Code, Title 18, Section 1001)(*) The list of certification and assurances, or an internet site where you may obtain this list is contained in the Notice of Funding Opportunity. If a NOFO was not required for the award, the state agency will specify required assurances and certifications as an addendum to the application. □ I agreeAuthorized Representative First NameLast NameSuffixTitleTelephone NumberFax NumberEmail AddressSignature of Authorized RepresentativeDate SignedSection I.: Uniform Budget and Financial PlanRefer to the attached State of Illinois – Uniform Budget Section A. and B. Budget Summary and Excel Spreadsheets for Exhibit I. (Budget Worksheet and Narrative)Section II.: SCSEP Program Plan The following Section includes all data relevant to the Narrative portion of the applicant’s submission of the FY 2020/PY 2019 SCSEP Application (be sure to submit the questions in the order they are presented). Organizational, Administrative & Fiscal Capacity(See additional detailed information in the Instructions)Describe in detail your organization’s ability to administer SCSEP in the areas where you are requesting authority to provide service. Describe how your organizational, administrative, and fiscal capacity will support the SCSEP project by addressing the organizational, administrative and fiscal components listed below. For each component, include a comprehensive description of what you have done in the past and what outcomes you have achieved. Include data on your prior experience wherever applicable. Use additional sheets if needed._________________________________________________________________________________________Capacity to Manage Core Organizational Functions and Program OperationsCapacity to Manage DataFinancial Stability and Ability to Adjust to Changes in FundingReporting and AuditsStatement of NeedDescribe, in both quantitative and qualitative terms, the need for assistance for the TitleV/SCSEP-eligible population in the counties in your chosen Planning and Service Areas (PSAs) area and incorporate demographic information whenever possible. Refer to Instructions for detailed guidance on how to respond to this section. Use additional sheets if needed.__________________________________________________________________________________ Project DesignProvide a comprehensive plan of action that outlines the scope and detail of your Title V/SCSEP project and how you will accomplish the proposed employment and training activities. Describe how you will implement Title V/SCSEP by addressing the three program factors listed below. For each component, if you have had experience providing these or similar services, include a discussion of what you have done, what outcomes you have achieved, and what changes to your current program design(s), if any, you will make if awarded a grant under this competition. Describe your partnerships with One-Stop Centers, employers, host agencies, and other organizations and detail the specific roles played by each wherever possible. Include data on your prior experience wherever possible.Use additional sheets if needed.Working with Employers & Employer AssociationsRecruiting & Managing Host AgenciesProviding Quality Service to ParticipantsPartnershipsDescribe the relationships you have developed with key partners (e.g. employers, educational institutions, Area Agencies on Aging and others) to support Title V/SCSEP or similar programs and how this coordination of services supports the participants. Detail the specific roles played by each organization and tie them to your program activities and timeline. Include data on your prior experience where applicable. Do not include activities under the Workforce Innovation and Opportunity Act since this information is required on the following page of the program narrative.Use additional sheets if needed.Description of Collaboration with Key PartnersDescription of Types of Agreements & ContributionsList of Current & Future Key Partners Activities under the Workforce Innovation and Opportunity Act Applicants must include a detailed description of their efforts to partner with the Local Workforce Investment Areas (LWIAs) and One-Stop Centers where the applicant proposes to administer the Title V/SCSEP program. Use additional sheets if needed.Description of Efforts to Partner & Collaborate with LWIAs & One-Stop CentersExperience in Developing & Implementing Memorandums of Understanding PAST PERFORMANCE & PROGRAMMATIC CAPABILITYUse the following format for each performance measure.Service LevelPY 2015PY 2016PY 2017Performance Goal for each PYYTD Rate from the final SPARQ report for the PY PROPOSED JOB INVENTORYSERVICES TO THE GENERAL COMMUNITYNO.JOBSSERVICES TO THE ELDERLY COMMUNITYNO.JOBS1.Education11.Project Administration2.Health and Hospitals12.Health and Home Care3.Housing/Home Rehabilitation13.Housing/Home Rehabilitation4.Employment Assistance14.Employment Assistance5.Recreation, Parks, and Forests15.Recreation/Senior Centers6.Environmental Quality16.Nutrition Programs7.Public Works and Transportation17.Transportation8.Social Services18.Ombudsman9.Other (Specify)19.Other (Specify)10. TOTAL JOBS IN GENERAL COMMUNITY21. TOTAL JOBS IN ELDERLY COMMUNITYSection III.SCSEP Program Assurances PROGRAMMATIC ASSURANCES FOR PY 2019 FUNDSYou must certify that you will conform to these assurances throughout the period of the grant by checking each of the assurances below. These assurances apply fully to any sub-recipient, local project, or grantee staff involved in the delivery of services.You agree to:Recruitment and Selection of ParticipantsDevelop and implement methods to recruit and select eligible participants to assuremaximum participation in the program.Use income definitions and income inclusions and exclusions for SCSEP eligibility as described in TEGL No. 12-06 . gov/directives/corr doc.cfm?DOCN=2291), to determine and document participant eligibility.Develop and implement methods to recruit minority populations to ensure at least proportional representation in your assigned service area as listed in the latest Minority Report.Develop and implement strategies to recruit applicants who have priority of service asdefined in OAA section 518(b) (1)-(2) and by the Jobs for Veterans Act (NA).Individuals with priority are those who:Are covered persons in accordance with the JVA (covered persons who are SCSEP-eligible must receive services instead of or before all non-covered persons);Are 65 years or older;Have a disability;Have limited English proficiency;Have low literacy skills;Reside in a rural area;Have low employment prospects;Have failed to find employment after utilizing services provided through the American Job Center (previously referred to as the One-Stop Center);Are homeless or are at risk for homelessness.AssessmentAssess participants at least twice per 12-month period, and more frequently if appropriateUse assessment information to determine the most appropriate community serviceassignments (CSAs) for participants.Individual Employment Plan (IEP)Establish an initial goal of unsubsidized employment for all participants.Update the IEP at least as frequently as assessments occur (at least twice per 12-month period).Modify the IEP as necessary to reflect other approaches to self-sufficiency, if it becomesclear that unsubsidized employment is not feasible.For participants who will reach the individual durational limit or would not otherwiseachieve unsubsidized employment, include a provision in the IEP to reflect other approaches to self-sufficiency, transition to other services or programs. Rotate participants to a new host agency (or a different assignment within the host agency) based on a rotation policy approved by DOL in the grant agreement but only when an individualized determination determines that the rotation is in the best interest of the participant. Such rotation must further the acquisition of skills listed in the munity Service Assignment (CSA)Base the initial CSA on the assessment done at enrollment.Select only designated 501(c)(3) organizations or public agencies as host agencies.Put in place procedures to ensure adequate supervision of participants at host agencies.Ensure safe and healthy working conditions at the CSA through annual monitoring of the host agency site and annual safety consultation with the participant at the host agency site.Recertification of ParticipantsRecertify the income eligibility of each participant at least once every 12 months, or morefrequently if circumstances warrant.Physical ExaminationsOffer physical examinations to participants upon program entry, and each year thereafter,as a benefit of enrollment.Obtain a written waiver from each participant who declines a physical examination.Not obtain a copy or use the results of the physical examination to establish eligibility orfor any other purpose.Host AgenciesDevelop and implement methods for recruiting new host agencies to provide a variety oftraining options that enable participants to increase their skill level and transition tounsubsidized ply with maintenance of effort: Ensure that CSAs do not reduce the number of employment opportunities or vacancies that would otherwise be available to individuals who are not SCSEP participants. You must specifically ensure that CSAs do not:Displace currently-employed workers (including partial displacement, such as a reduction in non-overtime work, wages, or employment benefits).Impair existing contracts or result in the substitution of Federal funds for other funds in connection with work that would otherwise be performed.Assign or continue to assign a participant to perform the same work, or substantially the same work, as that performed by an individual who is on layoff.OrientationProvide orientations for its participants and host agencies, including information on:Project goals and objectivesParticipant rights and responsibilitiesCommunity Service AssignmentsOpportunities for paid training outside the CSAAvailable supportive servicesAvailability of free physical examinationsLocal staff must address the topics listed above and provide additional orientation to participants on:SCSEP goals and objectivesGrantee and local project roles, policies, and proceduresHoliday and sick leaveAssessment processDevelopment and implementation of IEPsEvaluation of participant progressHealth and safety issues related to each participant 's assignmentRole of supervisors and host agenciesMaximum individual duration policy, including the possibility of an extension, if applicable, and the documentation required to support an extensionTermination policyGrievance procedureWagesProvide participants with the highest applicable required wage (highest of federal, state,or local minimum wage) for time spent in orientation, training, and community service assignments.Participant BenefitsProvide workers' compensation, other benefits required by state or Federal law (suchas unemployment insurance), and the costs of physical examinations.Establish written policies relating to compensation for scheduled work hours duringwhich the participant's host agency is closed for Federal holidays.Establish written policies relating to approved breaks in participation and any necessarysick leave that is not part of an accumulated sick leave program.Not use grant funds to pay the cost of pension benefits, annual leave, accumulated sickleave, or bonuses.Procedures for Payroll and Workers' CompensationMake all required payments for participant payroll and pay workers' compensationpremiums on a timely basis.Ensure that host agencies do not pay workers' compensation costs for participants.Durational LimitsMaximum Average Project Duration - 27 MonthsMaintain average project duration of 27 months or lessMaximum Individual Participant Duration - 48 MonthsAllow participants to participate in the program no longer than 48 months (whether or notconsecutively)Notify participants of your policy pertaining to the maximum duration requirement, including the possibility of an extension if applicable, at the time of enrollment and each year thereafter, and whenever ETA has approved a change of policy.Provide 30-day written notice to participants prior to durational limit exit from theprogram.Transition ServicesDevelop a system to transition participants to unsubsidized employment or otherassistance before each participant's maximum enrollment duration has expired.Begin transition planning for participants who will exit for durational limit at least 3-6 months prior to their exit date.Termination PoliciesProvide a 30-day written notice for all involuntary terminations that states the reason for termination and informs the participants of grievance procedures and right to appeal.Maintain written termination policies in effect and provide to participants at enrollmentfor:Provision of false eligibility information by the participantIncorrect initial eligibility determination at enrollmentIncome ineligibility determined at recertificationParticipant has reached individual durational limitParticipant has become employed while enrolledIEP-related terminationCause (must be approved by ETA prior to implementation)Equitable Distribution (ED)Comply with the equitable distribution plan for each state in which the grantee operates andonly make changes in the location of authorized positions within a state in accordance with the state ED plan and with prior ETA ply with the authorized position allocations/ED listed in .Collaborate with all grantees authorized to serve in a state in which you operate to achieve compliance with authorized positions while minimizing disruption to the participants.Over-EnrollmentManage over-enrollment to minimize impact on participants and avoid layoffs.Collaboration and Leveraged ResourcesCollaborate with other organizations to maximize opportunities for participants to obtainworkforce development, education, and supportive services to help them move into unsubsidized employment. These organizations may include but are not limited to: workforce investment boards, American Job Centers (previously known as One-Stop Centers), vocational rehabilitation providers, disability networks, basic education and literacy providers, and community colleges.Supportive ServicesProvide supportive services, as needed, to help participants participate in theircommunity service assignment and to obtain and retain unsubsidized employment.Establish criteria to assess the need for supportive services and to determine whenparticipants will receive supportive services, including after obtaining unsubsidized plaint ResolutionEstablish and use written grievance procedures for complaint resolution for applicants,employees, and participants.Provide applicants, employees, and participants with a copy of thegrievance policy and procedures.Maintenance of Files and Privacy InformationMaintain participant files for three program years after the program year in which the participant received his/her final follow-up activity.Ensure that all participant records are securely stored by grantee or sub-recipient and access is limited to appropriate staff in order to safeguard personal identifying information.Ensure that all participant medical records are securely stored by grantee or sub-recipient separately from all other participant records and access is limited to authorized staff for authorized purposes.Establish safeguards to preclude tampering with electronic media, e.g., personal identification numbers (PINs) and SPARQ or other data system logins.Ensure that the ETA/SCSEP national office is immediately notified by grantee in theevent of any potential security breach of personal identifying information, whetherelectronic files, paper files, or equipment are involved. cc: State program managerComply with and ensure that authorized users under its grant comply with all SPARQ and other data system access and security rules.DocumentationMaintain all documentation required for compliance with record retention rule set forth in the first bullet of the prior section, Maintenance of Files and Privacy InformationMaintain documentation of waivers of physical examinations by participant.Maintain documentation of the provision of complaint procedures to participants.Maintain documentation of eligibility determinations and re-certifications.Maintain documentations of terminations and reasons for termination.Maintain records of grievances and outcomes.Maintain records required for data validation.Maintain documentation of evaluation activities conducted on host agencies.Data Collection and ReportingEnsure the collection and reporting of all SCSEP required data according to specifiedtime schedules.Ensure the use of the OMB-approved SCSEP data collection forms and the SCSEPInternet data collection and evaluation system, SPARQ, or the successor data system as designated by DOL.Ensure at the Title V/SCSEP staff and other staff that those capturing and recording data arefamiliar with the latest instructions for data collection, including ETA administrative issuances, e.g., TEGLs, Data Collection and Data Validation Handbooks, and the OlderWorker Community of Practice.Ensure data are entered directly into the WDCS/SPARQ, or the successor data system as designated by DOL. If the grantee is not in compliance with any of the assurances above, the grantee must provide information on a separate attachment indicating what specific steps the grantee is taking to conform to these standard grant requirement(s).By signing below, I certify that my organization will comply with each of the listed requirements and will remain in compliance for the program year for which we are submitting this application.100139517780000493331518097500 Signature of Authorized Representative DateASSURANCE OF COMPLIANCE WITH THE DEPARTMENT OFHEALTH AND HUMAN SERVICES UNDERTITLE VI OF THE CIVIL RIGHTS ACT OF 1964 . (Name of SCSEP sub-grantee of Name Secondary Recipient) (herein after called the "Sub-grantee") HEREBY AGREES THAT it will comply with Title VI of the Civil Rights Act of 1964 (P.L. 88-352) and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 80) issued pursuant to that title, to the end that, in accordance with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Sub-grantee receives Federal financial assistance from the Illinois Department on Aging, a recipient of Federal financial assistance from the Department (hereinafter called "Grantor"); and HEREBY GIVES ASSURANCE THAT it will immediately take any measures necessary to effectuate this agreement.If any real property or structure thereon is provided or improved with the aid of Federal financial assistance extended to the sub-grantee by the Grantor, this assurance shall obligate the Sub-grantee, or in the case of any transfer of such property, any transferee, for the period during which the real property or structure is used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. If any personal property is so provided, this assurance shall obligate the Sub-grantee for the period during which it retains ownership or possession of the property. In all other cases, this assurance shall obligate the Sub-grantee for the period during which the Federal financial assistance is extended to it by the Grantor.THIS ASSURANCE is given in consideration of and for the purpose of obtaining any and all Federal grants, loans, contracts, property, discounts or other Federal financial assistance extended after the date hereof to the Sub-grantee by the Grantor, including installment payments after such date on account of applications for Federal financial assistance which were approved before such date. The Sub-grantee recognized and agrees that such Federal financial assistance will be extended in reliance on the representations and agreements made in this assurance, and that the Grantor or the United States or both shall have the right to seek judicial enforcement of this assurance.This assurance is binding on the Sub-grantee, its successors, transferees, and assignees, and the person or persons whose signature(s) appear below is/are authorized to sign this assurance on behalf of the Sub-grantee. ______________________________________________________________ (Applicant) (Date) ______________________________________________________________(President, Chairman of Board or comparable Authorized Official)______________________________________________________________(Recipient’s Street Address)_____________________________________________________________(City, State & Zip Code +4)______________________________________________________________Typed Name and Title of Recipient)Section IV.Attachments Attachment APARTICIPANT WAGE WAIVER REQUEST Attachment B.On-the-Job Experience (OJE) Attachment C.REQUIRED ATTACHMENTS TO BE SUBMITTED BY ALL APPLICANTSAll applicants must submit the following attachments with their submitted grant applications.Most recent audited financial statements and, if applicable, the accompanying management letter with any audit finding.Memorandums of Understanding that describe services and referrals; Memorandums of Agreement that describe the relationship and obligations of each party; and Signed letters of commitment (not simply letters of support) described on the Partnership Project Narrative pageMemorandums of Understanding with LWIA organizations described on the WIOA Project Narrative page Attachment D.OTHER ATTACHMENTS SUBMITTED BY APPLICANTAll applicants should outline below the other attachments (not required) submitted with the grant application, and include a brief explanation of each attachment. ................
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