ESBD_383500_1732791162051_RFP Narrative Forms.docx

South Texas Development Council Competitive RFP for HIV Care RFP No.: HIV 25-01.02.03.

Narrative Forms

Ryan White Part B Service Delivery (RWSD) HIV State Services (SS) Housing Opportunities for Persons with AIDS (HOPWA)

PROPOSAL TABLE OF CONTENTS AND CHECKLIST

RYAN WHITE SECTION:

STATE SERVICES SECTION:

FORM A: FACE PAGE – PROPOSAL FOR

FINANCIAL ASSISTANCE – RFP 25.01.02.03.

This form requests basic information about the respondent and project, including the signature of the authorized representative. The face page is the cover page of the renewal and shall be completed in its entirety.

RESPONDENT INFORMATION

Street:

City:

State:

Zip Code:

County:

Street:

City:

State:

Zip Code:

County:

Texas Comptroller Vendor ID or Social Security Number*:

*The respondent acknowledges, understands, and agrees that the respondent's choice to use a social security number as the vendor identification number for the contract, may result in the social security number being made public via state open records requests.

Total Funds Requested

Do respondent’s projected federal expenditures exceed $750,000, or its projected state expenditures exceed $750,000, for respondent’s current fiscal year (excluding amount requested in line 9 above)?** |_| Yes |_| No

**Projected expenditures should include anticipated expenditures under all federal grants including “pass through” federal funds from all state agencies, or all anticipated expenditures under state grants, as applicable.

The facts affirmed by me in this proposal are truthful and I warrant the respondent is in compliance with the assurances and certifications contained in Appendix H: Assurances and Certifications. I understand the truthfulness of the facts affirmed herein and the continuing compliance with these requirements are conditions precedent to the award of a contract. This document has been duly authorized by the governing body of the respondent and I am authorized to represent the respondent.

FORM B: CONTACT PERSON INFORMATION

This form provides information about the appropriate program contacts in the applicant’s organization in addition to those on Form A: Face Page. If any of the following information changes during the term of the contract, please notify, HIV Program Manager, in writing within (10) ten days.

Clinical Services Contact:

FORM C: ADMINISTRATIVE INFORMATION

This form provides information regarding identification and contract history of the respondent, executive management, project management, governing board members, and/or principal officers. Respond to each request for information or provide the required supplemental document behind this form. If responses require multiple pages, identify the supporting pages/documentation with the applicable request.

NOTE: Administrative Information may be used in screening and/or evaluating proposals.

Legal Name of Respondent:

Identifying Information

If a Governmental Entity

· Names (last, first, middle) and addresses for the officials who are authorized to enter into a contract on behalf of the respondent.

If a Nonprofit or For profit Corporation

· Full names (last, first, middle), addresses, telephone numbers, titles and occupation of members of the Board of Directors or any other principal officers. Indicate the office held by each member (e.g. chairperson, president, vice-president, treasurer, etc.).

· Full names (last, first, middle), and addresses for each partner, officer, and director as well as the full names and addresses for each person who owns five percent (5%) or more of the stock if respondent is a for-profit corporation.

If YES, respondent must include evidence of its nonprofit status with the proposal. Any one of the following is acceptable evidence. Check the appropriate box for the attached evidence or complete the “Previously Filed” section, whichever is applicable.

FORM C: ADMINISTRATIVE INFORMATION Continued

Conflict of Interest and Contract History The respondent must disclose any existing or potential conflict of interest relative to the performance of the requirements of this RFP. Examples of potential conflicts include an existing or potential business or personal relationship between the respondent, its principal, or any affiliate or subcontractor, with STDC or any other entity or person involved in any way in any project that is the subject of this RFP. Similarly, any existing or potential personal or business relationship between the respondent, the principals, or any affiliate or subcontractor, with any employee of STDC must be disclosed. Any such relationship that might be perceived, or represented as a conflict, must be disclosed. Failure to disclose any such relationship may be cause for contract termination or disqualification of the proposal. If, following a review of this information, it is determined by STDC that a conflict of interest exists the respondent may be disqualified from further consideration for the award of a contract.

Pursuant to Texas Government Code Section 2155.004, a respondent is ineligible to receive an award under this RFP if the bid includes financial participation with the respondent by a person who received compensation from STDC to participate in preparing the specifications or the RFP on which the bid is based.

If YES, detail any such relationship(s) that might be perceived or represented as a conflict. (Attach no more than one additional page.)

If YES, indicate his/her name, social security number, job title, agency employed by, separation date, and reason for separation.

If YES, indicate his/her name, social security number, job title, agency employed by, separation date, and reason for separation.

If YES, indicate the contract number(s):

STDC Contract Number(s)

5.

Is respondent or any member of respondent’s executive management, project management, board members or principal officers:

· Delinquent on any state, federal or other debt;

· Affiliated with an organization which is delinquent on any state, federal or other debt; or

· In default on an agreed repayment schedule with any funding organization?

If YES, please explain. (Attach no more than one additional page.)

If YES, indicate the reason for such action that includes the name and contact information of the local, state, or federal department or agency, the date of the contract and a contract reference number, and provide copies of any and all decisions or orders related to the suspension, termination, or non-renewal by the contracting entity.

Additional Information for Non-Profit Agencies Non-profit applicants must be able to demonstrate fiscal solvency. Applicants shall submit a copy of the organization’s most recent audited balance sheet with management letters and audit notes, and a statement of income and expenses. If the applicant does not have an audited balance sheet and statement of income and expenses, the applicant must attach the most recent unaudited balance sheet and statement of income and expenses and explain why audited documents are not available (Attach no more than one additional page). The STDC will evaluate the financial statements and may, at its sole discretion, reject the proposal on the grounds of the applicant’s financial capability.

If the applicant is a nonprofit entity, respond to the following:

g. What date did the applicant’s Board of Directors adopt the current operating budget of the agency?

Signature of Authorized Official

Title

Typed Name of Authorized Representative

Date

FORM D: ORGANIZATIONAL CAPACITY AND EXPERIENCE

Respondents must provide a narrative description answering the questions below. Respondents should leave the section headings and numbered questions in their response, exactly as shown below, inserting their responses below each question. Respondents should answer each question completely, but succinctly, without adding any additional or unnecessary information. A maximum of twenty (20) pages may be used for this section.

A. Statement of Intent

1. What is respondent’s mission statement, and how does becoming an HIV service provider fit with the respondent’s mission?

B. Historical Background

1. Describe the history of respondent organization and the types of services or activities in which the organization has participated.

2. Has the respondent been under sanction from any funding source during the twenty-four months prior to issuance of this RFP? If there has been a sanction placed on the respondent since this date, provide details and the current status of sanctions.

3. Describe respondent’s experience, training, certifications, and licensures that promotes high quality HIV care in accordance with the criteria developed by HIVMA for qualified providers available at https://www.hivma.org/clinical-practice/defining-hiv-expertise

4. Describe respondent’s relationship to other organizations within the HIV Service Delivery Area. Specifically describe respondent’s linkages to health and social service agencies, including those that serve people living with HIV or those who are at risk for contracting HIV. Include experience respondent has working with local medical providers.

C. Program Background

1. Describe respondent’s current programs and activities that are relevant to fulfillment of the functions required by this RFP. Discuss how the current structure of the agency is suited to carrying out the duties of an HIV Service Provider.

2. Describe what resources your agency has to perform the project, who will deliver the services and how they will be delivered; include a description of the infrastructure available to achieve service delivery and policy-making activities, as well as a description of the workforce you have or plan to have to perform these duties. Also describe the types of training agency staff will receive on a regular basis (including annual trainings, case management, HOPWA, etc.)

3. Describe respondent’s organizational structure, such as board of directors, officers, advisory councils or committees. Attach a current organizational chart showing proposed positions for this project.

4. Describe respondent’s experience in handling and protecting confidential client information.

5. How does your agency involve clients, customers, or stakeholders in the decision-making processes?

6. Describe how your agency has used program data to improve program functioning.

7. What is respondent’s experience in submitting progress program reports for delivery of services? Describe staff position(s) responsible for reporting program activities and progress to funding sources.

8. Describe respondent’s experience and ability to provide HIV services to the entire geographic area that you are proposing to serve.

9. Describe the current or proposed plan for the following goals and objectives within the HIV Service Delivery Area.

· Increase timely linkage to treatment for those newly diagnosed with HIV.

· Increase Viral Suppression among PLWH.

· Reduce Health Disparities and Health Inequities.

· Cultivate a Stigma-Free environment for PLWH.

D. Financial Capacity of Respondent

1. What is respondent’s current total operating budget?

2. What experience and expertise does respondent have in grants and contracts management? Provide a list of current grants and contracts respondent manages, including project periods for each.

3. What is respondent’s experience in submitting financial reports to funding sources? Describe staff position(s) responsible for reporting financial activities and progress to funding sources.

4. Describe the financial management staff, including any financial management performed by volunteers and outside accountants.

5. What accounting software does respondent utilize and how well suited is it to fund accounting for multiple funding sources?

6. If your organization is a nonprofit agency, describe the role your Board of Directors takes in approving an annual agency budget, in approving grant application budgets, in monitoring agency expenditures compared to the budget, in approving budget amendments and variances, and in determining appropriate salary levels for the Executive Director.

7. If respondent is a nonprofit agency, describe the role of the Board of Directors in examining agency financial statements, in addressing financial concerns, and in raising funds for the respondent agency.

8. For both nonprofit and government agency respondents, describe the mechanisms and procedures in place to ensure that respondent is capable of submitting vouchers on a monthly basis to STDC for contract expenditures.

9. Describe the mechanisms in place to ensure that the respondent is capable of reimbursing subcontractors or fee-for-service providers rapidly after receipt of acceptable invoices or vouchers from those providers.

10. Describe the current and anticipated status of cash flow of respondent agency.

11. Does the respondent receive program income? What is respondent’s experience with the additive method of grant accounting in relation to program income?

FORM E-1: RYAN WHITE PERFORMANCE MEASURES

In the event a contract is awarded respondent agrees that performance measures will be used to assess, in part, the respondent’s effectiveness in providing the services described. Address all the requirements (see Performance Measures Guidelines) associated with the services proposed in this proposal. A maximum of one (1) page may be used this form.

Performance Measure 1: The (Respondent’s name) shall use Ryan White funds to provide at least one service to (insert #) unduplicated clients and (insert #) units to be delivered during FY25 (04/01/25-03/31/26). Objectives related to the # of persons and units to be provided must be reflected on Table 1: Services Priorities, Allocations, and Objectives.

Performance Measure 2: The (Respondent’s name) shall engage (insert #) people living with HIV (PLWH) that know their HIV status and are not in care, bring them into care and to keep them in care to ensure that all efforts are being made to engage, bring, and keep them in care during FY25. The (Respondent’s name) shall revise the proposed Strategic Plan annually and provide updates to STDC.

Performance Measure 3: The (Respondent’s name) shall deliver and monitor services to clients as negotiated on Table 1 and contract in TCT. The (Respondent’s name) shall adequately complete and report progress on required Program Reports explaining allocations or services that exceeded or fell short of projections.

Performance Measure 4: The (Respondent’s name) shall submit completed semi-annual and annual reports according to the Reporting Due Dates listed in the contract for this RFP.

Performance Measure 5: The (Respondent’s name) shall ensure that no more than ten percent of the Ryan White allocation is expended by service provider for administrative costs.

Performance Measure 6: The (Respondent’s name) shall increase enrollment in Health Plans of eligible persons in the (name of HSDA) HSDA by no less than 10% for persons that fall between 100% and 200% of the federal poverty level (FPL). This measure is a minimum required for enrollment and FPL levels locally.

Performance Measure 7: The (Respondent’s name) shall submit a program income allocation plan for Ryan White Part B in the (name of HSDA) HSDA by no later than March 15, 2025, to the STDC Fiscal Monitor.

Performance Measure 8: The (Respondent’s name) ADAP Enrollment Worker’s (AEWs) shall accomplish or surpass all required performance measures:

1. ≥ 90% of new enrollee and recertification ADAP applications are accepted by the Texas HIV Medication Program (THMP) as complete upon initial submission.

2. ≥90% of ADAP eligibility recertifications and self-attestations are completed on or before the lapse of ADAP program benefits.

3. >90% of applications submitted by AEW as Expedite were correctly identified as Expedite.

4. >90% of application entries in the “about you” demographic, relationship, household, client financial, insurance, and case notes in TCT are correct and complete.

AEWS must adhere to these performance measures:

· Review all THMP applications in TCT.

· Communicate with clients, as needed, to support a timely, complete, and correct application submission to THMP. Clients that only require THMP application assistance will be assigned to subgrantees by an algorithm based on client residence. All THMP applications assigned to a subgrantee must undergo quality assurance by an AEW before submission.

· Submit THMP-ADAP Application Monthly Tracking Sheets (THMP-ADAP Tracker Revised 2024).

· Work on Incomplete Applications. Review new list sent by the ADAP Liaison.

· Notify ADAP Liaison of any staff that leaves your organization or any new staff submitting any type of application that should be added to the contact sheet.

· All new staff who submit applications must meet with the ADAP Liaison for training before submitting any applications.

· Attend required regional calls, meetings, and trainings.

FORM E-1: STATE SERVICES PERFORMANCE MEASURES

In the event a contract is awarded respondent agrees that performance measures will be used to assess, in part, the respondent’s effectiveness in providing the services described. Address all the requirements (see Performance Measures Guidelines) associated with the services proposed in this proposal. A maximum of one (1) page may be used this form.

Performance Measure 1: The (Respondent’s name) shall use State Services funds to provide at least one service to (insert #) unduplicated clients and (insert #) units to be delivered during FY25 (09/01/25-08/31/26). Objectives related to the # of persons and units to be provided must be reflected on Table 1: Services Priorities, Allocations, and Objectives.

Performance Measure 2: The (Respondent’s name) shall engage (insert #) people living with HIV (PLWH) that know their HIV status and are not in care, bring them into care and to keep them in care to ensure that all efforts are being made to engage, bring, and keep them in care during FY25. The (Respondent’s name) shall revise the proposed Strategic Plan annually and provide updates to STDC.

Performance Measure 3: The (Respondent’s name) shall deliver and monitor services to clients as negotiated on Table 1 and contract in TCT. The (Respondent’s name) shall adequately complete and report progress on required Program Reports explaining allocations or services that exceeded or fell short of projections.

Performance Measure 4: The (Respondent’s name) shall submit completed semi-annual and annual reports according to the Reporting Due Dates listed in the contract for this RFP.

Performance Measure 5: The (Respondent’s name) shall ensure that no more than ten percent of the State Services allocation is expended by service provider for administrative costs.

Performance Measure 6: The (Respondent’s name) shall increase enrollment in Health Plans of eligible persons in the (name of HSDA) HSDA by no less than 10% for persons that fall between 100% and 200% of the federal poverty level (FPL). This measure is a minimum required for enrollment and FPL levels locally.

Performance Measure 7: The (Respondent’s name) shall submit a program income allocation plan for State Services in the (name of HSDA) HSDA by no later than March 15, 2025, to the STDC Fiscal Monitor.

Performance Measure 8: The (Respondent’s name) ADAP Enrollment Worker’s (AEWs) shall accomplish or surpass all required performance measures:

1. ≥ 90% of new enrollee and recertification ADAP applications are accepted by the Texas HIV Medication Program (THMP) as complete upon initial submission.

2. ≥90% of ADAP eligibility recertifications and self-attestations are completed on or before the lapse of ADAP program benefits.

3. >90% of applications submitted by AEW as Expedite were correctly identified as Expedite.

4. >90% of application entries in the “about you” demographic, relationship, household, client financial, insurance, and case notes in TCT are correct and complete.

AEWS must adhere to these performance measures:

· Review all THMP applications in TCT.

· Communicate with clients, as needed, to support a timely, complete, and correct application submission to THMP. Clients that only require THMP application assistance will be assigned to subgrantees by an algorithm based on client residence. All THMP applications assigned to a subgrantee must undergo quality assurance by an AEW before submission.

· Submit THMP-ADAP Application Monthly Tracking Sheets (THMP-ADAP Tracker Revised 2024).

· Work on Incomplete Applications. Review new list sent by the ADAP Liaison.

· Notify ADAP Liaison of any staff that leaves your organization or any new staff submitting any type of application that should be added to the contact sheet.

· All new staff who submit applications must meet with the ADAP Liaison for training before submitting any applications.

· Attend required regional calls, meetings, and trainings.

FORM E-2: RYAN WHITE AND STATE SERVICES WORK PLAN (PART 1)

Applicant shall describe its plan for service delivery to the population in the proposed service area(s) and include timelines for accomplishments. Respondents should leave the numbered questions in their response, exactly as shown, below, inserting the responses below each question. Respondents should answer each question completely, but succinctly, without adding any additional or unnecessary information. If applying for Ryan White and State Services, just submit one work plan for both. A maximum of fifteen (15) pages may be used for this work plan.

1. Summarize the proposed services, population to be served, location (counties to be served), etc. Describe what resources your agency will utilize to perform the project; who will deliver services and how they will be delivered; include a description of the infrastructure available to achieve service delivery and policy-making activities, as well as a description of the workforce you have or plan to have in place to perform these services.

2. Describe how services will be coordinated with other health and human services providers in the area (FQHCs, local health departments, etc.),

· How availability is maximized, and duplication reduced or avoided.

· Describe respondent’s linkages to non-Ryan White funded community support services.

· Describe respondent’s current referral system.

· Describe any strategies you have for collaboration within the HIV service delivery area to standardize client eligibility.

· Describe how you will ensure other community agencies are aware of the services you provide, including what types of outreach activities you will implement to ensure community agencies know what you do, how to contact you, and how to refer clients for your services.

· Describe specific barriers to providing services within the counties served by the agency.

3. Include your organization’s policies and procedures for implementing the DSHS Third Party Payor policy 590.001 (http://www.dshs.texas.gov/hivstd/policy/policies/590-001.shtm?terms=DSHS%20policy% 20590.001 ).

· Describe your organization’s experience or capacity for billing third party payors (e.g., Medicaid, Medicare, private health insurance) for medical services, or for working directly with medical providers who bill third party payors.

· Outline your agency’s plan for maximizing Ryan White and State Services funds by either billing third party payors or contracting with a provider who has that capacity.

· Discuss your agency’s experience or plan/capacity to collect fees from clients for medical care.

4. How will your agency collect and assess HIV client-level data? Ensure your response includes the following information:

· Discuss who is responsible for the data collection entry and reporting as well as who is responsible for quality assurance of the data.

· Include the frequency of data collection and data quality measures that will be integrated into your overall quality improvement activities.

· If any data policies have been developed by the agency, please list them.

· Lastly, please ensure that you discuss how your agency will ensure physical and electronic data security.

5. To address the goals and objectives of the South Texas Development Council’s HIV Comprehensive Services Plan, please respond to the following:

1. Describe respondent’s plan to increase viral suppression. Include plan to reduce any gaps to achieving viral suppression and focusing on adherence that includes clients, clinicians and supportive service providers.

1. Describe respondent’s plan to increase retention in care. Include plan to reduce any barriers including engagement in care, ensuring treatment systems are included and access to supportive services, especially mental health and substance use treatment. Discuss the integration of innovative technologies and telehealth services which enhance service delivery and engagement, particularly in remote or underserved areas.

1. Describe respondent’s plan that addresses the ongoing aim to improve quality of care, access to care and needed services, and elimination of barriers. Include the following in your response.

· Collaboration between service providers, healthcare providers, community organizations, and government agencies to create a more integrated and efficient service delivery system that addresses the multifaceted needs of PLWH.

· Expansion of core services such as medical care, mental health support, health insurance and housing assistance.

· Address social determinants of health, such as poverty, education, and social stigma, which significantly impact HIV outcomes.

6. Describe respondent’s internal Quality Assurance/Quality Improvement/Quality Management (QA/QI/QM) plan or process utilized to assess performance and monitor services. Identify staff who use them and who are responsible for ensuring they are updated. The description shall include the following:

· The role of the QA/QI/QM Committee.

· Activities utilized to identify trends of needed improvement and the frequency of those activities.

· Activities to ensure correction and follow-up to findings identified. In all cases, the respondent must participate in the resolution of quality issues and corrective action requirements.

· Process for documenting progress and completion of goals outlined in the plan.

· Process for identifying and reporting outcome measures.

· Participation in quality improvement projects.

· Utilization and frequency of client satisfaction surveys.

· System utilized to identify, report, and monitor adverse outcomes.

FORM E-3: RYAN WHITE WORK PLAN (PART 2)

Address the required elements (see WORK PLAN Guidelines) associated with the services proposed in this RFP. A maximum of five (5) pages may be used for this work plan.

Units to be Provided Total Number of Clients to be Served

Narrative:

FORM E-3: STATE SERVICES WORK PLAN (PART 2)

Address the required elements (see WORK PLAN Guidelines) associated with the services proposed in this RFP. A maximum of five (5) pages may be used for this work plan.

Clients to be Served

Narrative:

FORM E-1: HOPWA PEFORMANCE MEASURES

Respondents should indicate the proposed number of households for each program activity in the proposed service area.

FORM E-2: HOPWA WORK PLAN

Respondents should leave the numbered questions in their response, exactly as shown below, inserting the responses below each question. Respondents should answer each question completely, but succinctly, without adding any additional or unnecessary information. Address the required elements (see WORK PLAN Guidelines) associated with the services proposed in this RFP. A maximum of ten (10) pages may be used for this work plan.

1. How does becoming a HOPWA Project Sponsor fit with the respondent’s mission?

2. Summarize the proposed service area.

3. Describe respondent’s plan that covers the scope of the program.

· Help eligible persons living with HIV and their households establish or maintain affordable and stable housing,

· Reduce their risk of homelessness, and

· Improve their access to health care and support services.

4. Summarize the housing needs and all available housing resources in the proposed service area. Discuss whether the current allocations to the HIV service area are adequate to meet the housing need. Provide a justification for why you believe the allocation is or is not adequate.

5. Describe delivery system and your workforce (attach organizational chart). This should include policies, support systems (i.e., training, technical assistance, financial, program and administrative systems) and other infrastructure available to achieve service delivery and policy-making activities.

6. Describe efforts for coordination with other health and human services providers and local area housing authorities in the service area(s) and delineate how duplication of services is to be avoided.

7. Describe the applicant’s ability to provide services to culturally diverse populations (e.g., use of interpreter services, language translation, compliance with ADA requirements, and other means to ensure accessibility for the defined population).

8. How will your agency handle a waitlist for HOPWA (i.e.., TBRA, STRMU and FBHA)? What resources will you utilize when clients need assistance and housing?

7. Describe affirmative outreach, furthered fair housing and how information will be disseminated to the community that HOPWA is available for eligible persons living with HIV?

8. Describe how you communicate HOPWA housing to clients? What information do you provide to discuss being a good tenant, a good neighbor, the importance of not allowing anyone to move in with you and consequences. What information do you give clients on the grievance policy and when/how they can be terminated.

9. Describe respondent’s policies and person responsible for enforcing confidentiality, privacy and security measures.

Form E-3: HOPWA Project Sponsor Data Sheet Respondents should complete this form for the term of 09/01/25-08/31/26 with this RFP.

Does the Project Sponsor maintain a waitlist?

If yes, attach current waitlist policies and procedures.

Assurances

I certify that this Project has not:

☐ Been suspended by DSHS or is delinquent on a repayment agreement to DSHS;

☐ Had a contract terminated by DSHS for cause;

☐ Had a required license or certification revoked that is required to carry out the terms of the subcontract; and

☐ Voluntarily surrendered any license issued by DSHS within the past three (3) years.

I certify that the following is in place:

☐ Subcontract is in writing, developed to be consistent with the DSHS contract, and signed by both parties;

☐ Programmatic/financial review of Project is conducted in accordance with 2 CFR § 200 et seq.;

☐ Procedures used to advertise and award these funds meet the minimum standards required by 2 CFR § 200 et seq.;

☐ Subcontractor receives a written report of the results of all monitoring activities conducted; and

☐ Appropriate corrective action steps are taken when subcontractor is not in compliance with contract terms.

* Minority Organization: Board of Directors has 50% racial/ethnic minority members. ** Minority Provider: a) history of targeting racial/ethnic minorities; b) located in/near racial/ethnic minority communities; c) offers culturally/linguistically appropriate services to reduce disparities.

FORM F: HOPWA CERTIFICATION OF CATEGORICAL EXCLUSION

Determination of activities listed at 24 CFR §58.35(b) (not subject to §58.5)

May be subject to provisions of §58.6, as applicable

Respondents must complete one certification for the HSDA.

· Tenant-Based Rental Assistance

· Short-Term Rent, Mortgage, and Utility

· Facility-Based Housing Assistance

· Permanent Housing Placement

· Housing Case Management

· Housing Information Services

· Resource Identification

· Project Sponsor Administration

I hereby certify that the abovementioned project has been reviewed and determined to be a Categorically Excluded activity per 24 CFR §58.35(b) (not subject to §58.5) as follows:

☒ 1. Tenant-based rental assistance;

☒ 2. Supportive services including, but not limited to, health care, housing services, permanent housing placement, day care, nutritional services, short-term payments for rent/mortgage/utility costs, and assistance in gaining access to local, State, and Federal government benefits and services;

☒ 3. Operating costs including maintenance, security, operation, utilities, furnishings, equipment, supplies, staff training and recruitment and other incidental costs;

☐ 4. Economic development activities, including but not limited to, equipment purchase, inventory financing, interest subsidy, operating expenses and similar costs not associated with construction or expansion of existing operations;

☐ 5. Activities to assist homebuyers to purchase existing dwelling units or dwelling units under construction, including closing costs and down payment assistance, interest buydowns, and similar activities that result in the transfer of title.

☐ 6. Affordable housing pre-development costs including legal, consulting, developer and other costs related to obtaining site options, project financing, administrative costs and fees for loan commitments, zoning approvals, and other related activities which do not have a physical impact.

☐ 7. Approval of supplemental assistance (including insurance or guarantee) to a project previously approved under this part, if the approval is made by the same responsible entity that conducted the environmental review on the original project and re-evaluation of the environmental findings is not required under §58.47.

If your project falls into any of the above categories, no Request for Release of Funds (RROF) is required, and no further environmental approval from HUD will be needed by the recipient for the draw-down of funds to carry out exempt activities and projects. The responsible entity must maintain this document as a written record of the environmental review undertaken under this part for each project. By signing below the Responsible Entity certifies in writing that each activity or project is Categorically Excluded (not subject to §58.5) and meets the conditions specified for such determination per section 24 CFR §58.35(b). Please keep a copy of this determination in your project files.

BUDGET FORMS G AND TABLE 2

Budget forms are in separate Microsoft Excel format for each funding source. Required budget forms must be completed in Excel format. Do not convert forms to PDF.

Please follow the instructions in the RFP guidance document when preparing your budgets. Also see the RFP, as well as the Proposal Checklist, to determine which budget forms are needed for each funding source.

Microsoft Excel Attachments:

Ryan White:

· Categorical Budget Justification for Total Request by Funding Source

· Budget Allocation Form by Funding Source

· Table 2: Subcontractor Data Sheet by Funding Source

HIV State Services:

· Categorical Budget Justification for Total Request by Funding Source

· Budget Allocation Form by Funding Source

· Table 2: Subcontractor Data Sheet by Funding Source

Housing Opportunities for Persons with AIDS (HOPWA):

· Categorical Budget Justification for Total Request by Funding Source

ASSURANCE FORMS

All Assurance Forms are in separate Microsoft Word file. See Appendix F – Assurances.

Complete one (1) set of assurances, Form H through Form P. Specify the funding which the respondent is applying for under funding source.

Microsoft Word Attachment:

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