uniform application for state grant assistance scsep... · 2019. 6. 12. · scsep fy 2020/py 2019...
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Illinois Department on Aging
Title V/Senior Community Service Employment Program (SCSEP)
SCSEP FY 2020/PY 2019 Application Page 1
Uniform Application for State Grant Assistance
Agency Completed Section Agency Information
1. Type of Submission
□ Pre-application Application □ Changed / Corrected Application
2. Type of Application
New □ Continuation (i.e. multiple year grant) □ Revision (modification to initial application)
3. Date / Time Received by State
(Office Use Only)
4. Name of the Awarding State Agency
Illinois Department on Aging
5. Catalog of State Financial Assistance (CSFA) Number
402-01-0023
6. CSFA Title
Senior Community Service Employment Program
Catalog of Federal Domestic Assistance (CFDA) □ Not applicable (No federal funding)
7. CFDA Number 17.325
8. CFDA Title Senior Community Service Employment Program (SCSEP)
9. CFDA Number
10. CFDA Title
Funding Opportunity Information
11. Funding Opportunity Number
12. Funding Opportunity Title
13. Funding Opportunity Program Field
Competition Identification
14. Competition Identification Number
15. Competition Identification Title
Illinois Department on Aging
Title V/Senior Community Service Employment Program (SCSEP)
SCSEP FY 2020/PY 2019 Application Page 2
Applicant Completed Section
Applicant Information Use same Legal Name as used for DUNS registration and grantee pre-qualification.
16. Legal Name
17. Common Name (DBA)
18. Employer / Taxpayer Identification Number (EIN, TIN)
19. Organizational DUNS number
20. SAM Cage Code
21. Business Address Street address City, State County, Zip + 4
Applicant’s Organizational Unit
22. Department Name
23. Division Name
Applicant’s Name and Contact Information for Person to be Contacted for Program Matters involving this Application
24. First Name
25. Last Name
26. Suffix
27. Title
28. Organizational Affiliation
29. Telephone Number
30. Fax Number
31. Email address
Applicant’s Name and Contact Information for Person to be Contacted for Business/Administrative Office Matters involving this Application
32. First Name
33. Last Name
34. Suffix
35. Title
36. Organizational Affiliation
37. Telephone Number
38. Fax Number
39. Email address
Areas Affected
40. Areas 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.
Illinois Department on Aging
Title V/Senior Community Service Employment Program (SCSEP)
SCSEP FY 2020/PY 2019 Application Page 3
*Reference the attached Statewide Provider Service Area (PSA) Map that was included as part of the grant application packet.
41. Legislative and Congressional Districts of Applicant
List your applicable Legislative and Congressional Districts per https://www.elections.il.gov/votinginformation/CongRepDist.aspx
42. Legislative and Congressional Districts of Program / Project
List your applicable Legislative and Congressional Districts per https://www.elections.il.gov/votinginformation/CongRepDist.aspx
Applicant’s Project
43. Description Title of Applicant’s Project
Title V/Senior Community Service Employment Program Grant
44. Proposed Project Term Start Date: October 1, 2019 End Date: June 30, 2020
45. Estimated 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 agree
Authorized Representative
46. First Name
47. Last Name
48. Suffix
49. Title
50. Telephone Number
51. Fax Number
52. Email Address
53. Signature of Authorized Representative
54. Date Signed
SCSEP FY 2020/PY 2019 Application Page 4
Section I.: Uniform Budget and Financial Plan
Refer to the attached State of Illinois – Uniform Budget Section A. and B. Budget Summary
and Excel Spreadsheets for Exhibit I. (Budget Worksheet and Narrative)
Exhibit II.A
SCSEP FY 2020/PY 2019 Application Page 5
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).
Exhibit II.A
SCSEP FY 2020/PY 2019 Application Page 6
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 Operations
Capacity to Manage Data
Financial Stability and Ability to Adjust to Changes in Funding
Reporting and Audits
Exhibits II.B
SCSEP FY 2020/PY 2019 Application Page 7
STATEMENT OF NEED
Describe, 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.
__________________________________________________________________________________
Exhibits II.B
SCSEP FY 2020/PY 2019 Application Page 8
PROJECT DESIGN
Provide 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 Associations
Recruiting & Managing Host Agencies
Providing Quality Service to Participants
Exhibits II.B
SCSEP FY 2020/PY 2019 Application Page 9
PARTNERSHIPS
Describe 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 Partners
Description of Types of Agreements & Contributions
List of Current & Future Key Partners
Exhibits II.B
SCSEP FY 2020/PY 2019 Application Page 10
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 Centers
Experience in Developing & Implementing Memorandums of Understanding
Exhibit II.C
SCSEP FY 2020/PY 2019 Application Page 11
PAST PERFORMANCE & PROGRAMMATIC CAPABILITY
Use the following format for each performance measure.
Service Level
PY 2015 PY 2016 PY 2017
Performance Goal for each PY
YTD Rate from the final SPARQ report for the PY
Exhibit II.D
SCSEP FY 2020/PY 2019 Application Page 12
PROPOSED JOB INVENTORY
SERVICES TO THE GENERAL COMMUNITY NO.
JOBS
SERVICES TO THE ELDERLY COMMUNITY NO.
JOBS
1. Education
11. Project Administration
2. Health and Hospitals
12. Health and Home Care
3. Housing/Home Rehabilitation
13. Housing/Home Rehabilitation
4. Employment Assistance
14. Employment Assistance
5. Recreation, Parks, and Forests
15. Recreation/Senior Centers
6. Environmental Quality
16. Nutrition Programs
7. Public Works and Transportation
17. Transportation
8. Social Services
18. Ombudsman
9. Other (Specify)
19. Other (Specify)
10. TOTAL JOBS IN GENERAL COMMUNITY
21. TOTAL JOBS IN ELDERLY COMMUNITY
SCSEP FY 2020/PY 2019 Application Page 13
Section III.
SCSEP Program Assurances
SCSEP FY 2020/PY 2019 Application Page 14
PROGRAMMATIC ASSURANCES FOR PY 2019 FUNDS
You 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 Participants Develop and implement methods to recruit and select eligible participants to assure
maximum participation in the program.
Use income definitions and income inclusions and exclusions for SCSEP eligibility as described in TEGL No. 12-06 https://wdr.doleta. 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 as defined 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.
Assessment
Assess participants at least twice per 12-month period, and more frequently if appropriate
Use assessment information to determine the most appropriate community service
assignments (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 becomes clear that unsubsidized employment is not feasible.
For participants who will reach the individual durational limit or would not otherwise
achieve unsubsidized employment, include a provision in the IEP to reflect other
approaches to self-sufficiency, transition to other services or programs.
SCSEP FY 2020/PY 2019 Application Page 15
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 IEP.
Community 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 Participants
Recertify the income eligibility of each participant at least once every 12 months, or more
frequently if circumstances warrant.
Physical Examinations
Offer 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 or
for any other purpose.
Host Agencies
Develop and implement methods for recruiting new host agencies to provide a variety of
training options that enable participants to increase their skill level and transition to unsubsidized employment.
Comply 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.
Orientation
Provide orientations for its participants and host agencies, including information on:
Project goals and objectives
Participant rights and responsibilities
Community Service Assignments
Opportunities for paid training outside the CSA
Available supportive services
Availability of free physical examinations
SCSEP FY 2020/PY 2019 Application Page 16
Local staff must address the topics listed above and provide additional orientation to
participants on:
SCSEP goals and objectives
Grantee and local project roles, policies, and procedures
Holiday and sick leave
Assessment process
Development and implementation of IEPs
Evaluation of participant progress
Health and safety issues related to each participant 's assignment
Role of supervisors and host agencies
Maximum individual duration policy, including the possibility of an extension, if
applicable, and the documentation required to support an extension
Termination policy
Grievance procedure
Wages
Provide 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 Benefits
Provide workers' compensation, other benefits required by state or Federal law (such as unemployment insurance), and the costs of physical examinations.
Establish written policies relating to compensation for scheduled work hours during which the participant's host agency is closed for Federal holidays.
Establish written policies relating to approved breaks in participation and any necessary sick 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 sick
leave, or bonuses.
Procedures for Payroll and Workers' Compensation
Make all required payments for participant payroll and pay workers' compensation premiums on a timely basis.
Ensure that host agencies do not pay workers' compensation costs for participants.
Durational Limits Maximum Average Project Duration - 27 Months
Maintain average project duration of 27 months or less
Maximum Individual Participant Duration - 48 Months
Allow participants to participate in the program no longer than 48 months (whether or not
consecutively)
SCSEP FY 2020/PY 2019 Application Page 17
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 the
program.
Transition Services
Develop a system to transition participants to unsubsidized employment or other
assistance 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 Policies
Provide 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 enrollment
for:
Provision of false eligibility information by the participant
Incorrect initial eligibility determination at enrollment
Income ineligibility determined at recertification
Participant has reached individual durational limit
Participant has become employed while enrolled
IEP-related termination
Cause (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 and
only make changes in the location of authorized positions within a state in accordance with the state ED plan
and with prior ETA approval.
Comply with the authorized position allocations/ED listed in www.scseped.org.
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-Enrollment
Manage over-enrollment to minimize impact on participants and avoid layoffs.
Collaboration and Leveraged Resources
Collaborate with other organizations to maximize opportunities for participants to obtain
workforce 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 Services
Provide supportive services, as needed, to help participants participate in their community service assignment and to obtain and retain unsubsidized employment.
Establish criteria to assess the need for supportive services and to determine when
participants will receive supportive services, including after obtaining unsubsidized employment.
SCSEP FY 2020/PY 2019 Application Page 18
Complaint Resolution
Establish and use written grievance procedures for complaint resolution for applicants, employees, and participants.
Provide applicants, employees, and participants with a copy of the
grievance policy and procedures.
Maintenance of Files and Privacy Information Maintain 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 the event of any potential security breach of personal identifying information, whether
electronic files, paper files, or equipment are involved. cc: State program manager Comply with and ensure that authorized users under its grant comply with all SPARQ and other data system
access and security rules.
Documentation
Maintain all documentation required for compliance with record retention rule set forth in the first bullet of the prior
section, Maintenance of Files and Privacy Information
Maintain 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 Reporting Ensure the collection and reporting of all SCSEP required data according to specified
time schedules. Ensure the use of the OMB-approved SCSEP data collection forms and the SCSEP
Internet 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 are familiar with the latest instructions for data collection, including ETA administrative issuances, e.g., TEGLs, Data Collection and Data Validation Handbooks, and the Older Worker Community of Practice.
Ensure data are entered directly into the WDCS/SPARQ, or the successor data system as designated by DOL.
SCSEP FY 2020/PY 2019 Application Page 19
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.
Signature of Authorized Representative Date
SCSEP FY 2020/PY 2019 Application Page 20
ASSURANCE OF COMPLIANCE WITH THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES UNDER
TITLE 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.
1This 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)
SCSEP FY 2020/PY 2019 Application Page 21
Section IV.
Attachments
SCSEP FY 2020/PY 2019 Application Page 22
Attachment A
PARTICIPANT WAGE WAIVER REQUEST
SCSEP FY 2020/PY 2019 Application Page 23
Attachment B.
On-the-Job Experience (OJE)
SCSEP FY 2020/PY 2019 Application Page 24
Attachment C.
REQUIRED ATTACHMENTS TO BE SUBMITTED BY ALL APPLICANTS
All 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 page
▪ Memorandums of Understanding with LWIA organizations described on the WIOA Project Narrative page
SCSEP FY 2020/PY 2019 Application Page 25
Attachment D.
OTHER ATTACHMENTS SUBMITTED BY APPLICANT
All 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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