1-Form 1-Application.docx

APPLICATION FORM – HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS (HOPWA)

Contents

Office of Community Care and Empowerment – Housing Opportunities for Persons with AIDS (HOPWA) This form is intended for Applicants who are applying to serve as Subrecipients to provide . Applicants should review the NOFA Specifications to understand the required scope and services sought and for information on all required documents and submission. There are no minimum or maximum numbers of characters for any of the questions included in this form.

Organization Information

Application Contact

Secondary Contact

Section 1 – Summary of Request Identify the activities for which funding is requested in this Application. Specify the amount requested, the number of households to be served, and the number of units supported (if applicable). Confirm that the activity is included in the Work Plan and in the Budget and Budget Narrative Justification. All activities for which funding is requested must be included in the Work Plan (narrative) and the Budget and Budget Justification.

Service Category

Work Plan Included in Budget

Facility Based Housing (Long-Term, Transitional, Short-Term) ☐ Long-Term Housing Operations

☐ Long-Term Housing Support Services (with above)

☐ Transitional Housing Operations

☐ Transitional Housing Support Services (with above)

☐ Short-Term Housing Operations

☐ Short-Term Housing Support Services (with above)

Administration

Administration

Service Category

Work Plan Included in Budget

Section 2 – Application Attachments

Required Documents and Attachments

Section 3 – Historic Narrative Provide the following information:

· Brief Agency Description, including mission and purpose of organization, target populations, and types of services provided

· History of organization, including number of years of served

· Does the organization have at least 12 months experience of providing services similar to those sought in the solicitation?

· Past participation with the City on past or present City contracts

· List of past 5 years of contracts with the City

· Demographic information on past and current client population

· Experience working with the population to be served

· Leveraging resources supporting populations to be served

· Collaborations and partnerships supporting populations to be served Brief Agency Description Include mission and purpose of organization, target population(s), and type(s) of services provided Click or tap here to enter text.

History, Track Record, and Collaborations of Organization Click or tap here to enter text.

Application Evaluation Considerations for this Section:

· Does the organization demonstrate a track record sufficient to undertake the program?

· Does the organization have experience operating a grants administration program or grantmaking?

· Does the organization have the required minimum experience outlined in the solicitation?

· Does the organization’s prior performance on City contracts demonstrate that the organization is likely to be successful?

· Does the organization have experience working with the population that it intends to serve?

· Does the organization articulate the necessary collaborations and partners necessary for successful program implementation?

Section 4 – Organizational Capacity Attach an agency-level organizational chart for your entire agency (if large or administering in multiple sites and locations) and a more detailed chart for program-level administration. For some agencies, a single chart may be sufficient. The organizational chart(s) document(s) should only list titles/functions and need not include individual staff names.

Provide the following information:

· Staff that are responsible for administering program and their qualifications (Required for consideration)

· How the organization or staff is uniquely qualified to provide the services

· Plan to fill any positions that need to be filled in order to administer programming

· Whether there are any state and/or local licenses required for the agency and/or staff to operate

· What training is required of and/or offered to the staff members providing services

· How the staff and leadership of the organization reflect the population being served

· Organization’s measures (including cybersecurity) to safeguard protected personally identifiable information and other types of information (e.g., information that the Organization considers sensitive or for which the Organization is responsible for maintaining confidentiality).

· Describe how the Organization mitigates risks relating to fraud, waste, abuse, conflict of interest, or other misconduct. Please include responses to the following questions:

· Does the organization have a Code of Conduct, Code of Ethics, or other similar ethical policy in place for its Board of Directors and staff? How are Board members and employees made aware of this policy? Provide a copy of the policy.

· Does the organization have a conflict of interest policy in place for its Board of Directors and staff? How are Board members and employees made aware of this policy? Provide a copy of the policy.

· Does the organization have an internal and external process for reporting and responding to fraud, waste, abuse, conflict of interest, or other misconduct? How are Board members, employees, and others made aware of this policy? Provide a copy of the policy.

· Does the organization have policies and procedures in place for business, financial, and program operations? If so, please describe those policies and procedures (but do not attach). Do those policies and procedures include internal controls (e.g., segregation of duties, authorizations, etc.) designed to mitigate the risk of fraud, waste, abuse, conflict of interest, or other misconduct?

· Is the organization aware of any instances within the last 36 months in which fraud, waste, abuse, conflict of interest, or other misconduct has occurred within, or related to, the organization? If so, please explain.

Click or tap here to enter text.

Application Evaluation Considerations for this Section:

· Does the organization have experience operating programming similar to that for which they are seeking funds?

· Does the organization have the professional staff capacity to undertake and support the program services outlined in the application?

· Does the organization’s staff and leadership reflect the population that it intends to serve?

· Does the organization demonstrate measures (including cybersecurity) to safeguard protected personally identifiable information and other types of information?

· Does the organization have policies and processes in place to deter and detect fraud, waste, abuse, conflict of interest, or other misconduct?

Section 5 – Work Plan Provide a narrative of the proposed Work Plan that includes the following information. Each proposed service must have a separate Work Plan narrative below; however, it is acceptable to cross-reference information between the narratives.

· What are the program activities?

· What services will be delivered, and how do they align with the services sought in the NOFA?

· Will service delivery prioritize any target populations?

· What are the best practice service delivery model(s) or research-based service delivery model(s) for the selected program design, and how does the selected model(s) best meet the needs of the population?

· How will client eligibility requirements, required documentation, and processes ensure services are delivered only to eligible clients?

· How will the organization layer or leverage funding received through this Application?

· Marketing and/or outreach plan to ensure client awareness of available programming – emphasize what steps the Organization will take to reach hard-to-reach populations Emergency/Tenant Based Rental Assistance (if requesting funding for this category) Should address Short-Term Rent, Mortgage, and Utility Assistance (STRMU), Tenant Based Rental Assistance (TBRA), Permanent Housing Placement (PHP), Supportive Services (provided with housing), and Administration (as applicable per request) Click or tap here to enter text.

Facility Based Housing (if requesting funding for this category) Should address Long-Term Housing, Transitional Housing, and/or Short-Term Housing, Supportive Services (provided with housing), and Administration (as applicable per request) Click or tap here to enter text.

Emergency Vouchers (if request funding for this category) Should address Emergency Hotel/Motel Vouchers and Administration (as applicable per request) Click or tap here to enter text.

Master Leasing (if request funding for this category) Should address Master Leasing (identify properties by address and unit sizes), Supportive Services (provided with housing), and Administration (as applicable per request) Click or tap here to enter text.

Housing Information Services (if request funding for this category) Should address Housing Information Services and Administration (as applicable per request) Click or tap here to enter text.

Supportive Services Only (SSO) (if request funding for this category) Should address Supportive Services (not provided with housing) by identifying and discussing each service separately and Administration (as applicable per request) Click or tap here to enter text.

Application Evaluation Considerations for this Section:

· Do the program activities and work plan demonstrate a plan that is reasonable and appropriate to deliver the proposed program services?

· Is it clear that the programming will deliver the desired scope of services for the benefit of eligible persons (including target populations)?

· Does the organization demonstrate utilization of best practice service delivery model(s) or research-based service delivery model(s) for the selected program design, and does the selected model(s) best meet the needs of the population?

· Does the organization outline clear eligibility criteria aligned with grant requirements and a process to determine client and/or site eligibility?

· Does the organization demonstrate a plan for collection and maintenance of eligibility and service records sufficient to ensure compliance with grant requirements?

· Does the organization articulate a plan for outreach to potentially eligible persons?

· Does the organization articulate how the program will minimize barriers to accessing assistance?

· Does the organization have the necessary partnerships and collaborations for successful program implementation?

· Does the organization articulate how it will apply data to drive outreach and service delivery?

Section 6 – Program Evaluation Organization may choose to attach evaluation tools, intake forms and other documents in support of this section, including intake or client eligibility form. Additionally, the City will provide subrecipients with monthly and quarterly reporting forms.

Provide the following information:

· A table or chart that includes Applicant’s numeric target goal for required performance measures for each proposed service. Applicant must include numeric goals for all required performance measures included in this NOFA for each proposed service

· Narrative to explain how those numeric goals are reasonable and appropriate for the proposed services

· An explanation of the data collection and evaluation process for each proposed target and for the program overall, including:

· Who is responsible for collection, analysis and reporting of data

· Frequency with which data is collected and analyzed or a timeline for collecting, analyzing and reporting program data

· The Organization’s plan to evaluate the effectiveness and impact of services.

Click or tap here to enter text.

Application Evaluation Considerations for this Section:

· Did the organization clearly specify numeric target goals for the required performance measures for each proposed service (in table or chart format)? Did the organization demonstrate that those goals are reasonable and appropriate for the proposed services?

· Did the organization include a plan for data collection and evaluation for the target goals and the program overall, including who is responsible for the collection, analysis, and reporting of data, and the frequency or timetable for data collection, analysis and reporting?

· Is it clear that the organization has the staffing, systems, and expertise in place to effectively deliver services and to track and report all required performance goals and outcome measures?

· Does the organization demonstrate a plan to use the data to evaluate the effectiveness and impact of services, and make improvements where needed?

Section 7 – Budget and Budget Narrative Please provide the following information:

· Attach program budget (Exhibit 2) separately for each service category for which funding is requested

· Include a written budget narrative that explains or justifies by line item for service category (including justifications for all staff fully or partially included within the budget). This narrative may be included here or as a separate document.

· Document budget alignment with outlined eligible expenses and applicable caps

· Include an estimated cost per client (funded by HOPWA compared to total cost)

· Include a narrative that describes the Organization’s leveraged resources for the project.

· Include a narrative that describes the Organization’s financial management systems, including financial records; preparation of reports; tracking budgets and expenditures; identification of federal awards in financial records; and internal controls and accountability for all funds, property, and assets.

· Include a narrative that describes the types of audits that the Organization undergoes. Provide a copy of the Organization’s latest Single Audit or other financial audit.

Click or tap here to enter text.

Application Evaluation Considerations for this Section:

· is the budget reasonable and appropriate to undertake and support the program services outlined in the Application?

· Does the budget narrative adequately account for and explain/justify the costs included with the submitted Budget?

· Based on the estimated cost per client (funded by the grant compared to total cost), is the program a good value for the expected impact, considering clients reached and services delivered and leveraged resources?

· Does the Organization have adequate financial management systems in place to operate the program, track the budget, and submit timely and accurate billing?

· Does the Organization undergo regular financial or other audits?

Section 8 – Additional Acknowledgements In order to enable the aggregation of data across all partners and programs and to meet all applicable HUD reporting requirements, all Providers are required to report in multiple formats with varying frequencies. Similarly, the City is seeking to simplify outreach and application processes by utilizing a shared intake and application platform. The City will work with each Provider on the following items. Please check each to affirm:

Required Acknowledgements