3 Applicant Transmittal Cover Page OAA HPDP F.docx
DOCX document 24 KB Posted
- Solicitation number
- PE-29016-NONST-2024-000000006
- Issued by
- Cherokee County, Georgia
About this file
This document is the Applicant Transmittal Cover Page for the Atlanta Regional Commission's (ARC) FY2025 Notification of Funding Availability (NOFA) for OAA Title III-D Health Promotion and Disease Prevention (HPDP) services. The NOFA is seeking proposals from organizations capable of providing a menu of eight evidence-based HPDP program workshops for older adults, adults with disabilities, and/or informal caregivers across the 10-county ARC Planning and Service Area, which includes Cherokee, Clayton, Cobb, DeKalb, Douglas, Fayette, Fulton, Gwinnett, Henry, and Rockdale counties. The services are required to be provided from July 1, 2024, to June 30, 2025.
The transmittal cover page requires the applicant to provide agency details, indicate which HPDP services they are applying for, and confirm the counties they will serve. Applicants must also submit various financial and organizational documents, including a proposal response template, financial components workbook, organizational chart, risk assessment form, liability insurance, policies, audited financials, and references. Applicants must certify the accuracy of the information and their ability to manage the services in compliance with federal and state regulations.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| ARCOAA_1.PDF | ||
| 4 Financial Components Workbook OAA HPDP FY25.xlsx | XLSX spreadsheet | |
| 2 Narrative Response Form OAA HPDP NOFA FY25 .xlsx | XLSX spreadsheet | |
| 6 UCM Training Manual.pdf | ||
| 5 DHS pre award risk assessment form.xlsx | XLSX spreadsheet | |
| Directions for Responding.pdf | ||
| Addendum _ Questions and Answers.pdf | ||
| NOFA Packet.pdf |
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Text version
Atlanta Regional Commission FY2025 Applicant Transmittal Cover Page for OAA HPDP Services *No individuals may apply*
AGENCY NAME:
County:
Address:
City/State/Zip Code:
EXECUTIVE DIRECTOR:
Email & phone:
FINANCIAL CONTACT:
Email & Phone:
| SERVICES |
| Are you applying for ARC funding for this service? (Yes/No) |
| Do you provide this service with non-ARC funding? (Yes/No) |
Aging Mastery Program*
Bingocize*
Chronic Disease Self Management Program*
Chronic Pain Self Management Program*
Diabetes Self Management Program*
Matter of Balance*
Powerful Tools for Caregivers*
Tai Chi for Arthritis and Falls Prevention*
Other (please explain)
Other (please explain)
Other (please explain)
Complete the following table for all Evidence-Based Programs included in your proposal (those with an * are the minimum required services to be included in all proposals):
COMPLETE THE FOLLOWING TABLE INDICATING COUNTIES OF SERVICE (MARK WITH ‘X’)
| SERVICES |
| Cherokee |
| Clayton |
| Cobb |
| DeKalb |
| Douglas |
| Fayette |
| Fulton |
| Gwinnett |
| Henry |
| Rockdale |
Aging Mastery Program
Bingocize
Chronic Disease Self Management Program
Chronic Pain Self Management Program
Diabetes Self Management Program
Matter of Balance
Powerful Tools for Caregivers
Tai Chi for Arthritis and Falls Prevention
Other (please explain)
Other (please explain)
Other (please explain)
Checklist of Required Items at Submittal:
☐ Signed Transmittal Cover Page ☐ Proposal Response Template ☐ Financial Components Workbook ☐ Organizational Chart with staff names, job titles and job descriptions ☐ DHS Pre Award Risk Assessment Form ☐ Copy of liability insurance for all programs and facilities ☐ Cost Share Policy ☐ Client Contribution Policy ☐ Complaint Policy and Procedures ☐ Most recent audit’s Financial Statement & Current Budget of Applicant Organization(s)
☐ Three references from entities that have previous or current business relationships with the applicant, wherein the role of the applicant in the relationship is clearly stated
APPLICATION SIGNATURE:
I certify, to the best of my knowledge, that the information submitted in the attached proposal is true and accurate and that this organization has the necessary fiscal, data collection, and managerial capability to implement and manage the services bid on in this proposal in accordance with both federal regulations and Georgia Department of Human Services, Division of Aging regulations.
Signature
Date
Printed Name and Title
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