# OMB Approval No. 0985-0018

> Expiration 3/31/2007

# 

# 

**Model Approaches to Statewide Legal Assistance Systems**

# Program Announcement and Grant Application Instructions 

# 

# 

# U.S. Administration on Aging

*2006*

**Department of Health and Human Services (HHS)**

**Administration on Aging (AoA)**

**AoA Center: Center for Wellness and Community-Based Services**

######## Funding Opportunity Title: Model Approaches to Statewide Legal Assistance 

########  Systems

######## 

######## Announcement Type: Initial 

**Funding Opportunity Number: HHS-2006-AoA-SL-0609**

**Catalog of Federal Domestic Assistance (CFDA) Number: 93.048**

**Key Dates: The deadline date for receipt of applications is July 24,
2006**

**Executive Summary:**

Older Americans Act (OAA) Title IV Legal Assistance Grants provide
states with a cost-effective way to increase the number of seniors who
receive quality legal services. These low-cost mechanisms for delivery
of legal services have been tested and shown to produce increased access
to legal services for underserved seniors in an efficient, streamlined
and measurable manner. The Administration on Aging (AoA) wishes to
improve the efficiency of the OAA legal services program by increasing
the utilization of low-cost legal services mechanisms. AoA will award
four cooperative agreements to eligible states (as defined below) to
develop model systems for incorporating low-cost legal assistance
mechanisms into the statewide legal services development and delivery
program. The awards will be cooperative agreements because AoA will be
substantially involved in the development and execution of the
activities of the projects.

Each project will be funded at a federal share of approximately
\$100,000 per year for a project period of three years, contingent upon
the availability of federal funds. Awards will be made to the agency
within each eligible state that currently houses (or proposes to house)
the Legal Services Developer. This agency must partner with an entity
experienced in providing legal services to older persons within that
state through a low-cost service delivery mechanism, such as the senior
legal helpline model, funded by AoA under the Title IV Legal Assistance
Grants Program.

Eligible states include all those not currently receiving AoA Title IV
Legal Assistance Grants initially awarded in 2005 (Connecticut, Florida,
Michigan, Nebraska, New York, Pennsylvania, and Vermont). This is in
keeping with AoA's goal of maximizing the number of states utilizing
low-cost legal assistance mechanisms as part of their statewide legal
services development and delivery program.

**I. FUNDING OPPORTUNITY DESCRIPTION**

**[Background]{.underline}**

Under Title IV of the OAA, the Administration on Aging (AoA) has
provided grants in a number of states to support low-cost legal service
delivery mechanisms such as the senior legal helpline model. These
low-cost models have been shown to be valuable and effective in
providing older Americans and their caregivers with important
information in areas such as consumer protection, public benefits, and
health and financial advance planning.

AoA\'s overall goal for legal services under both Titles III and IV of
the OAA is to protect the rights and financial security of older
persons, and enhance their choice and independence. As called for in the
OAA, these services are to be targeted particularly to those in greatest
social and economic need. AoA sees the low-cost legal delivery models as
a critical component in an overall legal delivery system designed to
provide maximum benefit from limited legal services resources.

What has been lacking however, in many states, has been statewide
planning and coordination to make the best possible use of the combined
resources of the state Legal Services Developer, Title III-B legal
services, Title IV low-cost delivery models, and other resources that
are available in a state, such as the private bar and law school
clinics.

The purpose of these cooperative agreements is to use the leadership of
the agency housing the State Legal Services Developer, in partnership
with an entity experienced in low-cost delivery mechanisms, to develop
models for coordinated statewide delivery systems. Such coordinated
models can insure maximum impact from limited resources by (1) directing
low-cost services such as helplines to those elders who are capable of
putting the advice and information to use to protect their rights and
independence; (2) directing Title III-B resources to those who are the
most needy, who require special outreach, who need in-depth
assistance/representation and who have very limited capacity to advocate
on their own behalf; and (3) developing and promoting other resources
such as pro-bono or reduced-fee wills panels in ways that supplement and
reduce demands on the OAA resources.

The Older Americans Act is one of the top funding sources for senior
legal assistance for those in social and economic need. Title III-B
funding provides support to approximately 1,000 legal services providers
nationwide who work to ensure that older Americans in greatest need of
help receive legal assistance, advice, and representation. These
providers help to address critical threats to independence (such as loss
of one\'s home through predatory lending and consumer scams), and
protect and enhance essential benefits such as food stamps, supplemental
security income and other public benefits that promote safety, health,
and independence.

AoA also supports five (5) national legal resource centers that work to
improve the quality and accessibility of the legal assistance provided
to older people across the United States. The grantees provide state and
area agencies, elder law attorneys and aging services providers with
training, fact sheets, and other written materials, case consultations,
and help with service delivery issues.

In an effort to prevent duplication of effort and enhance protections
for seniors, many legal providers coordinate their activities with other
members of the aging network. For example, legal providers offer
training to case managers on how seniors can avoid being victimized by
predatory lenders, and area agencies on aging (AAAs) arrange
transportation to legal programs for elder abuse victims who need to
file restraining orders. Legal providers also provide training to aging
network staff and seniors on elder law topics such as guardianship,
Medicare, and reverse mortgages. These coordination efforts could be
even more effective if done statewide rather than by individual
providers and if the Title III-B legal providers were always coordinated
with the low-cost delivery models.

To promote and enhance this type of coordination, the OAA requires each
state to appoint a legal assistance developer. Similar to a state
long-term care ombudsman, this person enhances and coordinates the
state's legal services and elder rights programs. Specific duties can
include:

-   providing technical assistance and training to local legal
    assistance programs;

-   developing statewide reporting and outcome measurement systems;

-   coordinating the activities of legal programs with AAAs and other
    elder rights programs such as ombudsmen, legal hotlines, APS, and
    public guardians; and

-   developing statewide standards that define what a quality legal
    assistance system is for the state and that help ensure that legal
    services are targeted to minorities, non-English speakers, rural
    seniors and other underserved groups.

Though technology has improved the quality and quantity of elder rights
information and services for many, there remains a great need to enhance
seniors' access to legal services, particularly for the underserved, and
most vulnerable older adults. It is for this reason that AoA has
supported efforts to provide states with a cost-effective way to
increase the number of seniors who receive low-cost legal assistance,
particularly through the statewide senior legal helpline model.

In FY 2003, AoA broadened its Senior Legal Helplines Program (currently
referred to as Legal Assistance Grants) by encouraging states to build
upon innovative methods to reach previously underserved populations to
augment the services of the traditional statewide helpline model, such
as self-help offices, interactive websites, and collaborative efforts.
In addition, a focus on linkages with AoA's Eldercare Locator and elder
rights resource centers facilitated streamlined access to senior legal
services and encouraged coordination and integration of delivery.

These low-cost mechanisms for delivery of senior legal services have
been tested and shown to produce increased access to needed information
and assistance for many seniors in an efficient, cost-effective,
streamlined, and measurable manner.

-   A 1990's evaluation showed that the initial group of senior legal
    helplines and corresponding referral services resolved 81% of older
    consumers' legal questions and 50% of their legal problems.

-   Since between 50 and 75% of calls to legal services entities seek an
    answer to a legal question, rather than representation on a legal
    matter, the average percentage of cases closed by the helpline
    component of a full-service program is 69%[^1].

-   The costs of reaching resolution for the cases handled under these
    grants are extremely low. In 2005, the average cost per call handled
    by senior legal helplines in was \$42.23, and the average cost per
    case was \$62.22.[^2]

-   There is an increase in access to quality legal services for an
    increased number of seniors. For example, in FY 2005, the Legal
    Assistance Grants Program:

    -   handled over 96,000 calls;

    -   closed nearly 65,000 cases with telephone advice or additional
        brief service; and

    -   reached more than 43,605 seniors through workshops and outreach
        events.[^3]

-   The types of services provided by Legal Assistance Grants are
    greatly desired by seniors. In 2004, Utah conducted the first
    statewide survey of senior legal needs. A majority of seniors (69%)
    cited a legal helpline as the most desired service.[^4]

-   Client satisfaction and problem resolution rates are very high. In
    the *2002 AARP Foundation Senior Legal Hotline Outcome Survey*, it
    was reported that 87% of respondents rated the helpline advice as
    helpful or very helpful, and that 84% of respondents would call the
    helpline again.

**[Project Objectives and Activities]{.underline}**

While the Legal Assistance Grants have demonstrated efficient and
effective models for increasing access to legal information and
assistance, many of these are stand-alone programs, not fully
coordinated with full-service legal services programs or with the aging
or other networks within the state. Ideally, such low-cost mechanisms
for delivering legal information and assistance are a fully integrated
component of the state legal services program. There are numerous states
which offer examples of an effective, integrated approach to meeting the
legal needs of their senior population. There are others that have
identified gaps in their service delivery systems but have been unable
to address them due to limited resources or other reasons. With this
grant opportunity, AoA supports state leadership efforts to develop
integrated, coordinated state legal services delivery systems that
incorporate low-cost delivery mechanisms with Title III-B legal services
and other available legal resources to match the type and level of
information or service needed with the most appropriate delivery
mechanism, in order to provide maximum benefit and minimum
overlap/duplication of effort from the combined legal resources for
elders in the state. Activities under this cooperative agreement promote
AoA's 2006 Legal Assistance Program objectives to:

-   Identify the components and levels of integration, funding,
    performance, and results that comprise the current legal services
    delivery system within the states;

-   Improve the overall efficiency of OAA legal services by increasing
    the utilization of low-cost legal services mechanisms;

-   Develop and demonstrate model legal services delivery systems that
    integrate Title III-B legal services, low-cost delivery mechanisms
    and other legal resources; and

-   Expand the adoption of model legal services delivery approaches by
    states.

AoA plans to award funds to support states in developing approaches that
will maximize the use of federal, state, and other funds by
incorporating the utilization of low-cost legal services mechanisms into
the state legal services planning and development. It is expected that
awardees will conduct an assessment of the current legal needs of
seniors within their state, evaluate their present legal services
planning and management structures at the state and local area levels,
and develop a plan that effectively and efficiently incorporates the use
of low-cost mechanisms to address identified needs. Upon completion of
the cooperative agreement, grantees will be able to present
cost-effective examples of integrated service systems that increase
overall access to services within their states by:

-   Developing new approaches to fully incorporate legal helplines and
    other low-cost mechanisms into the state's legal services system;

-   Demonstrating how to effectively use Title III-B funding to provide
    legal services to those in greatest social and economic need in a
    cost-effective and efficient manner that avoids overlap with
    low-cost services; and

-   Improving statewide legal services program consistency and
    accountability.

**[General Proposal Requirements]{.underline}**

Grants will be awarded to states who can demonstrate the need for
preparing their own legal services delivery system to more fully
incorporate and coordinate the low-cost mechanisms with the Title III-B
services. Applicants should identify the components and levels of
integration, sources of current and potential support, and performance
measurements and results that comprise the current legal services
delivery system within their states. Successful applicants will have
identified a need which they have not as yet been able to meet, or
current activities upon which they wish to improve.

Applicants preparing proposals under this program announcement must
submit a statewide plan for legal services program integration,
incorporating low-cost legal assistance mechanisms into the statewide
legal services development and delivery program, with the ultimate goal
of providing a comprehensive and cost-effective means of enhancing
access to senior legal services, particularly to those targeted under
the OAA, and making the most efficient use of the various legal
resources.

Each applicant must provide:

-   discussion of its current legal services delivery system (Title
    III-B programs, low-cost programs and other resources), including a
    discussion of effective approaches, uses and services provided,
    methods used for outreach to and targeting of the hard-to-reach,
    program costs, clients served, demographics of program coverage
    throughout the state, system gaps, needs, and proposed approaches
    for addressing identified weaknesses;

-   a comprehensive plan for incorporating helplines and other low-cost
    mechanisms into the statewide legal services system, including:

    -   targeted strategies for reaching low-income, rural, non-English
        speaking or other important target groups in the state facing
        ethnic or cultural barriers to access of legal services;

    -   a plan for providing statewide coverage; and

    -   outreach strategies, particularly to target groups, to promote
        awareness and understanding of the types and levels of services
        available from the various components of the state\'s legal
        services system.

-   strategies for enhancement of the state\'s overall legal services
    system and for accountability through development or implementation
    of statewide standards to ensure:

    -   high quality, accessible, and targeted legal services;

    -   a range of types and levels of service from self-help materials
        and information to in-depth one-on-one assistance, and
        coordination of services so overall resources are used most
        efficiently;

    -   measures of system improvement, including:

        -   outcome measures, particularly the impact of legal services
            on the health, security, and well-being of older persons;
            and

        -   program efficiency measures, including program costs
            relative to clients served; and

    -   a statewide system to collect data and report performance
        results.

Each cooperative agreement will be funded at a federal share of
approximately \$100,000 per year for a project period of three years,
contingent upon the availability of federal funds. The OAA requires the
State Legal Services Developer to act as the lead person to develop and
coordinate legal services for the elderly for each state. Therefore,
awards will be made to the agency within each state that currently
houses, or proposes to house, the State Legal Services Developer. Under
this cooperative agreement, it is expected that the State Legal Services
Developer will have a central role in developing a state-appropriate
approach for ensuring the integration of various legal services delivery
systems---including low-cost mechanisms---into an overall state legal
services system plan. This agency must also partner with an entity
experienced in providing legal services to older persons within that
state through a low-cost service delivery mechanism, such as the senior
legal helpline model, funded by AoA under the Legal Assistance Grants
Program, other statewide legal hotlines, or similar programs.

Applicants preparing proposals under this program announcement must:

-   demonstrate knowledge of the history and policy considerations
    surrounding access to and delivery of legal services to older
    Americans, particularly target populations;

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-   demonstrate a thorough understanding of the current components,
    plans, and programs used within the state to provide senior legal
    services;

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-   submit a statewide plan for a comprehensive, integrated, and
    cost-effective means of ensuring outreach and access to services by
    those in greatest social and economic need and enhancing overall
    access to senior legal services that incorporates the use of
    low-cost delivery mechanisms;

-   propose activities that are supported by identified needs that will
    be required to close identified gaps in service, and ensure a
    consistency and uniformity of the various levels and types of
    services provided statewide; and

-   provide strategies for targeting the needy and hard-to-reach
    populations within the state, and those currently underserved.

> In addition, applicants are expected to fully describe the nature of
> the activities to be undertaken to develop a coordinated, integrated
> service delivery system and to address system gaps and identified
> issues, as well as how they will assist in achieving overall project
> goals and objectives. Applicants may discuss the reasons specific
> activities were included in the proposal (for example: Has this
> approach been successful in other settings? Do research, prior
> studies, or technical assistance documents from legal services experts
> suggest this approach or direction?).
>
> Applicants should demonstrate familiarity with previously established
> models of access and delivery, such as the statewide legal helplines,
> and the AoA-funded Technical Assistance Project for Statewide Legal
> Hotlines. Applications should reflect the knowledge of legal services
> delivery models implemented in states. The Borchard Center on Law &
> Aging's *State Legal Assistance Development Program Study* (2003)[^5]
> provides one source of such information.
>
> Applicants must also:

-   demonstrate how the proposal expands and improves access to legal
    services for older Americans, particularly targeted groups;

-   demonstrate how the proposal contributes to the overall integration
    and coordination of the delivery of senior legal services;

-   further the State Legal Services Developer's efforts to ensure
    consistency and uniformity of statewide legal services delivery;

-   encourage the involvement of pro bono attorneys, the private bar,
    and law schools, among others, in the coordinated service delivery
    system;

-   include community-based and/or faith-based organizations in the
    planning and development of this project;

-   include disadvantaged populations, including limited-English
    speaking populations, as a target population for their proposed
    legal delivery system;

-   provide details about the goals, implementation strategies, and
    outcomes of their proposal;

-   provide a timeline chart or its equivalent to list project
    activities in chronological order and show the target dates for the
    projected accomplishments;

-   present proposals that are cost-effective and programmatically
    efficient, maximizing Federal, state and local resources;

-   provide adequate program development support and leadership. AoA
    expects that throughout the grant period, the Project Director will
    have involvement in and substantial knowledge about all aspects of
    the project;

-   provide an outreach plan detailing use of promotional and
    informational materials and technology to advertise legal programs
    and services for seniors, including strategies for targeting
    isolated, rural, limited-English speaking, and other hard-to-reach
    populations;

-   demonstrate plans to foster linkages with community-based aging
    services providers and elder rights professionals;

-   describe the method that will be used to disseminate the project's
    successful products and practices in a timely manner to other states
    and to legal services professionals who might be interested in
    replicating the model; and

-   include plans to develop and track measurable outcomes to determine
    the impact of these activities on the effectiveness and efficiency
    of the statewide legal delivery system, as well as on the
    lives/well-being of vulnerable older adults.

**[Statutory Authority]{.underline}**

> The statutory authority for grants under this program announcement is
> contained in Title IV of the Older Americans Act (OAA) (42U.S.C.
> 3032), as amended by the Older Americans Act Amendments of 2000, P.L.
> 106-501 (Catalog of Federal Domestic Assistance 93.048, Title IV
> Discretionary Projects).

######## II. AWARD INFORMATION 

AoA plans to fund four cooperative agreements through this competition.
Each project will be funded at a federal share of approximately
\$100,000 per year for a project period of up to three years, contingent
upon the availability of federal funds.

The award is a cooperative agreement because the Administration on Aging
(AoA) will be substantially involved in the development and execution of
the activities of the projects. The cooperative agreement will describe
the technical assistance and support to be provided by the AoA project
officer. The cooperative agreement will also specify project performance
criteria and measures relative to the 2006 AoA Legal Assistance Program
goal and objectives. The AoA project officer for these new cooperative
agreements will provide technical assistance and support on grant
management and implementation issues, including execution of the
cooperative agreement.

The grantees and the Administration on Aging will work cooperatively to
determine the priority activities to be completed by the project and
develop the work plan for each year of the project. Within 45 days of
the award and 45 days of each continuation award, the grantee will agree
upon and adhere to a work plan that details expectations for major
activities, products, and reports during the current budget period. The
work plan will include a timetable for project and activity
implementation, staff assignments, and other areas that require
Administration on Aging consultation, review, and/or prior approval.
Either the Administration on Aging or the project can propose a revision
of the final work plan at any time.

The Administration on Aging will define project performance criteria and
expectations, and will monitor, evaluate, and support the projects'
efforts in achieving performance goals through mentoring, listserv
communications, and other technical support. The Administration on Aging
will assist the project leadership in understanding the strategic goals
and objectives, policy perspectives, and priorities of the Assistant
Secretary for Aging and the Department of Health and Human Services by
sharing such information via e-mail, conference calls, briefings and
other consultations. The Administration on Aging will also share
information with the project about other federally sponsored projects
and activities relevant to the interests of the AoA Legal Assistance
Program.

**III. ELIGIBILITY INFORMATION**

**1. Eligible Applicants**

Awards will be made to the agency within each eligible state that
currently houses (or proposes to house) the Legal Services Developer.
This agency must partner with an entity experienced in providing legal
services to older persons within that state through a low-cost service
delivery mechanism, such as the senior legal helpline model, funded by
AoA under the Title IV Legal Assistance Grants Program.

Eligible states include all those not currently receiving AoA Title IV
Legal Assistance Grants initially awarded in 2005 (Connecticut, Florida,
Michigan, Nebraska, New York, Pennsylvania, and Vermont). This is in
keeping with AoA's goal of maximizing the number of states utilizing
low-cost legal assistance mechanisms as part of their statewide legal
services development and delivery program.

**2.** **Cost Sharing or Matching**

Under this Older Americans Act (OAA) program, AoA will fund no more than
75% of the project's total cost, which means the applicant must cover at
least 25% of the project's total cost with non-federal resources. In
other words, for every three (3) dollars received in federal funding,
the applicant must contribute at least one (1) dollar in non-federal
resources toward the project's total cost (i.e., the amount on line 18g
of the SF 424). This "three-to-one" ratio is reflected in the formula
included under Item 18 in Attachment A. You can use this formula to
calculate your minimum required match. A common error applicants make is
to match 25% of the federal share, rather than 25% of the project's
total cost.

**Application Screening Criteria**

All applications will be screened to assure a level playing field for
all applicants. Applications that fail to meet the screening criteria
described below will **[not]{.underline}** be reviewed and will receive
**[no]{.underline}** further consideration.

In order for an application to be reviewed, it must meet the following
screening requirements:

1.  Applications must be submitted electronically via
    [www.grants.gov](http://www.grants.gov/) by midnight July 24, 2006.
    All other hard copy submissions for which approval has been
    requested and received (per Section IV(6)) must be received in AoA
    by 5:30 PM Eastern time on July 24, 2006.

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1.  The Project Narrative section of the Application must be
    double-spaced, on 8 ½" x 11" plain white paper with 1" margins on
    both sides, and a font size of not less than 11.

2.  The Project Narrative must [not]{.underline} exceed 20 pages. NOTE:
    The Project Work Plan, Letters of Commitment, and Vitae of Key
    Project Personnel **[are not counted]{.underline}** as part of the
    Project Narrative for purposes of the 20-page limit.

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IV. **APPLICATION AND SUBMISSION INFORMATION**

All applicants are required to submit electronically through
[http://www.grants.gov](http://www.grants.gov/) by midnight July 24,
2006.

EXCEPTIONS TO THIS REQUIREMENT MAY ONLY BY MADE BY THE AOA GRANTS
OFFICE; STEPHEN DANIELS (202-357-3464). EXCEPTIONS MAY ONLY BE MADE TO
ALLOW FOR CATASTROPIC EVENTS SUCH AS TORNADOES, FLOODS, ETC.

PLEASE NOTE THAT APPLICANTS ARE RESPONSIBLE FOR MAILING OR HAND
DELIVERING APPLICATIONS TO AOA IN SUFFICIENT TIME TO BE RECEIVED BY 5:00
PM EASTERN TIME JULY 24, 2006.

## 1. Address to Request Application Package 

> Application materials can be obtained from
> [http://www.grants.gov](http://www.grants.gov/) or
> <http://www.aoa.gov/doingbus/fundopp/fundopp.asp>.

Applicants with prior approval may write for materials to:

U.S. Department of Health and Human Services

Administration on Aging

Valerie Soroka

Center for Wellness and Community Based Services

Washington, D.C. 20201

Or by calling: 202-357-3531

Or e-mailing: valerie.soroka@aoa.hhs.gov

Please note, AoA is requiring applications for this announcement to be
submitted electronically through
[www.grants.gov](http://www.grants.gov/). The Grants.gov registration
process can take several days. If your organization is not currently
registered with [www.grants.gov](http://www.grants.gov/), please begin
this process immediately. **For assistance with
[www.grants.gov](http://www.grants.gov/), please contact Arthur Miller
at AoA's Grants.gov helpdesk at 202-357-3438.** At
[www.grants.gov](http://www.grants.gov/), you will be able to download a
copy of the application packet, complete it off-line, and then upload
and submit the application via the Grants.gov website.

Applications submitted via [www.grants.gov](http://www.grants.gov/) :

-   You may access the electronic application for this program on
    [www.Grants.gov](http://www.grants.gov/). You must search the
    downloadable application page by the CFDA number (93.048).

-   At the www.grants.gov website, you will find information about
    submitting an application electronically through the site, including
    the hours of operation. AoA strongly recommends that you do not wait
    until the application due date to begin the application process
    through [www.grants.gov](http://www.grants.gov/) because of the time
    delay.

-   All applicants must have a Dun and Bradstreet (D&B) Data Universal
    Numbering System number and register in the Central Contractor
    Registry (CCR). You should allow a minimum of **five days** to
    complete the CCR registration.

-   You may submit all documents electronically, including all
    information included on the SF 424 and all necessary assurances and
    certifications.

-   Your application must comply with any page limitation requirements
    described in this program announcement.

-   After you electronically submit your application, you will receive
    an automatic acknowledgement from www.grants.gov that contains a
    Grants.gov tracking number. The Administration on Aging will
    retrieve your application form from Grants.gov.

-   We may request that you provide original signatures on forms at a
    later date.

###### Content and Form of Application Submission 

> **a. DUNS Number**
>
> The Office of Management and Budget requires applicants to provide a
> Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number
> when applying for Federal grants or cooperative agreements on or after
> October 1, 2003. It is entered on the SF 424. It is a unique,
> **nine-digit identification number**, which provides unique
> identifiers of single business entities. The DUNS number is *free and
> easy* to obtain.
>
> Organizations can receive a DUNS number at no cost by calling the
> dedicated toll-free DUNS Number request line at 1-866-705-5711 or by
> using this link:
> https://www.whitehouse.gov/omb/grants/duns_num_guide.pdf**.**
>
> **b. Project Narrative**

##  

> The Project Narrative must be double-spaced, on 8 ½" x 11" paper with
> 1" margins on both sides, and a font size of not less than 11. You can
> use smaller font sizes to fill in the Standard Forms and Sample
> Formats. The suggested length for the Project Narrative is ten to
> twenty pages; twenty pages is the maximum length allowed. AoA will not
> accept applications with a Project Narrative that exceeds 20 pages.
> The Project Work Plan, Letters of Cooperation, and Vitae of Key
> Personnel are not counted as part of the Project Narrative for
> purposes of the 20-page limit, but all of the other sections noted
> below are included in the limit.
>
> The components counted as part of the 20 page limit include:

-   Summary/Abstract

-   Problem Statement

-   Goal(s) and Objective(s)

-   Proposed Intervention

-   Special Target Populations and Organizations

-   Outcomes

-   Project Management

-   Evaluation

-   Dissemination

-   Organizational Capability

> The Project Narrative is the most important part of the application,
> since it will be used as the primary basis to determine whether or not
> your project meets the minimum requirements for grants under Title IV
> of the Older Americans Act. The Project Narrative should provide a
> **clear and concise** description of your project. AoA recommends that
> your project narrative include the following components:
>
> **Summary/Abstract.** This section should include a one page - 300
> words maximum - description of the proposed project, including: the
> goal, priority area(s), target population, activities, products and
> measurable outcomes. Detailed instructions for completing the
> summary/abstract are included in Attachment E of this document.
>
> **Problem Statement.** This section should describe, in both
> quantitative and qualitative terms, the nature and scope of the
> particular problem or issue the proposed intervention is designed to
> address, including how the project will potentially affect the
> targeted elderly population and/or their caregivers (including
> specific subgroups within those populations), and possibly the health
> care and social services systems (e.g., the use of health care and/or
> nursing home services.)
>
> **Goals and Objectives.** This section should consist of a description
> of the project's goal(s) and major objectives in terms of the priority
> area(s). Unless the project involves multiple, complex interventions,
> we recommend you have only one overall goal.
>
> **Proposed Intervention.** This section should provide a clear and
> concise description of the intervention you are proposing to use to
> address the problem described in the "Problem Statement". You should
> also describe the rationale for using the particular intervention,
> including factors such as: "lessons learned" for similar projects
> previously tested in your community, or in other areas of the country;
> factors in the larger environment that have created the "right
> conditions" for the intervention (e.g., existing social, economic or
> political factors that you'll be able to take advantage of, etc.).
> Also note any major barriers you anticipate encountering, and how your
> project will be able to overcome those barriers. Be sure to describe
> the role and makeup of strategic partnerships you plan to involve in
> implementing the intervention, including other organizations, funders,
> and/or consumer groups.
>
> **Special Target Populations and Organizations.** This section should
> describe how you plan to systematically involve community-based
> organizations experienced with the target population in the planning
> and implementation of the proposed statewide project. Specifically,
> your application should discuss proposed strategies for targeting
> minority and hard-to-reach populations, including low-income, rural,
> isolated, and limited English-speaking individuals. (Suggested length:
> one to two pages.)
>
> **Outcomes**. This section of the project narrative must clearly
> identify the [measurable]{.underline} outcome(s) that will result from
> the project. (NOTE: AoA will not fund any project that does not
> include measurable outcomes). This section should also describe how
> the project's findings might benefit the field at large, (e.g., how
> the findings could help other organizations throughout the nation to
> address the same or similar problems). List measurable outcomes in the
> attached Work Plan Grid (Attachment D) under "Measurable Outcomes" in
> addition to any discussion included in the narrative along with a
> description of how the project might benefit the field at large.
> (Suggested Length: one to two pages.)
>
> A "measurable outcome" is an observable end-result that describes how
> a particular intervention benefits consumers. It can describe a change
> in the degree of customer satisfaction; a change in the responsiveness
> or cost-effectiveness of a service delivery system; a measurable
> increase in awareness, skills, and behaviors that result in protection
> of financial security and of elder and consumer rights a measurable
> improvement in seniors' financial, emotional, physical, and mental
> well-being.
>
> A measurable outcome is not a measurable "output" such as: the number
> of clients served; the number of training sessions held; the number of
> informational materials disseminated, or the number of service units
> provided.
>
> You should keep the focus of this section on describing
> [what]{.underline} outcome(s) will be produced by the project. You
> should use the Evaluation section noted below to describe
> [how]{.underline} the outcome(s) will be measured and reported. Your
> application will be scored on the clarity and nature of your proposed
> outcomes, not on the number of outcomes cited.
>
> **Project Management**. This section should include a clear
> delineation of the roles and responsibilities of project staff,
> consultants and partner organizations, and how they will contribute to
> achieving the project's objectives and outcomes. It should specify who
> would have day-to-day responsibility for key tasks such as: leadership
> of project; monitoring the project's on-going progress, preparation of
> reports; communications with other partners and AoA. It should also
> describe the approach that will be used to monitor and track progress
> on the project's tasks and objectives. (Suggested Length: one to two
> pages.)
>
> **Evaluation**. This section should describe the method(s), techniques
> and tools that will be used to: 1) measure the success of the proposed
> intervention, products and practices in achieving anticipated
> outcomes; and 2) document project "lessons learned" (both positive and
> negative) that will be useful to other Legal Assistance grantees, as
> well as other senior legal services and elder rights professionals
> interested in replicating the intervention. (Suggested Length: one to
> two pages.)
>
> **Dissemination.** This section should describe the method that will
> be used to disseminate the project's successful products and practices
> in a timely manner and in easily understandable formats, to legal
> services professionals who might be interested in using these as
> models to improve practice, service delivery, program and partnership
> development. (Suggested Length: one to two pages.)

## Organizational Capability Statement. Each application should include an organizational capability statement and vitae for key project personnel. The organizational capability statement should describe how the applicant agency (or the particular division of a larger agency which will have responsibility for this project) is organized, the nature and scope of its work and/or the capabilities it possesses. This description should cover capabilities of the applicant agency not included in the program narrative, such as any current or previous relevant experience and/or the record of the project team in preparing cogent and useful reports, publications, and other products. If appropriate, include an organization chart showing the relationship of the project to the current organization. Please attach short vitae for key project staff only. Neither vitas nor an organizational chart will count towards the narrative page limit. Also include information about any contractual organization(s) that will have a significant role(s) in implementing project and achieving project goals. 

> **Work Plan**. The Project Work Plan should reflect and be consistent
> with the Project Narrative and Budget. It should include a statement
> of the project's overall goal, anticipated outcome(s), key objectives,
> and the major tasks / action steps that will be pursued to achieve the
> goal and outcome(s). For each major task / action step, the work plan
> should identify the timeframes (including start- and end-dates), and
> the lead person/partner or collaborator responsible for completing the
> task. The work plan must clearly identify the actions and timetable to
> implement statewide program coverage. Please use the sample work plan
> format included in Attachment D. (Suggested Length and Format: use the
> sample grid; alternatively, not more than two pages preferably
> presented in bulleted format.)
>
> **Letters of Commitment from Key Participating Organizations and
> Agencies.**
>
> Include confirmation of the commitments to the project (should it be
> funded) made by [key]{.underline} collaborating organizations and
> agencies in this part of the application. Any organization that is
> specifically named to have a significant role in carrying out the
> project should be considered an essential collaborator. The signed
> letters of collaboration must specify the commitment, role, and
> resources/activities that will be provided in support of the
> applicant. Strategies to reach targeted populations must be documented
> with letters of commitment that detail the specific role/function in
> support of the project's effort that will be played by the
> collaborating organization. The organization's expertise, experience,
> and access to the targeted population(s) should also be described in
> the letter of commitment.
>
> For applications submitted electronically via Grants.gov, signed
> letters of commitment should be scanned and included as attachments.
> Applicants unable to scan the signed letters of commitment may fax
> them to the AoA Grants Management Office at 202-357-3466 by the
> application submission deadline. The Program Announcement number
> should appear at the top of each page faxed.

**3. Submission Dates and Times**

> The deadline for the submission of applications under this program
> announcement is July 24, 2006. Applications must be: submitted
> electronically by midnight on this date; other hard copy submissions
> for which approval has been requested and received (per Section IV(6))
> must be received by 5:00 PM Eastern Time.
>
> Applications that fail to meet the application due date will be
> returned without review and will receive no further consideration.
>
> Applicants applying through Grants.gov will automatically receive a
> tracking number and date of receipt verification electronically once
> the application has been successfully received and validated in
> Grants.gov.

**4. Intergovernmental Review**

> This funding opportunity announcement is not subject to the
> requirements of Executive Order 12372, "Intergovernmental Review of
> Federal Programs."

**5. Funding Restrictions**

> The following activities are not fundable:

-   Construction and/or major rehabilitation of buildings

-   Basic research (e.g. scientific or medical experiments)

-   Continuation of existing projects without expansion or new and
    innovative

> approaches

**6. Other Submission Requirements**

> Electronic submissions must be sent to: http://www.grants.gov.
>
> Applicants submitting their application through
> [www.grants.gov](http://www.grants.gov/) must register in the Central
> Contractor Registry (CCR) database in order to be able to submit the
> application. One element of the CCR is the DUNS number (see section
> IV.2), which must be obtained separately from CCR registration.
> Information about CCR is available at
> <http://www.grants.gov/CCRRegister>. You must also register with a
> Credential Provider to receive a username and password to securely
> submit your grant application. Information is available at
> <http://www.grants.gov/CredentialProvider> .
>
> Applicants unable to submit their application via
> [www.grants.gov](http://www.grants.gov/) may request permission to
> submit a hard copy from the AoA Grants Management Officer, Stephen
> Daniels, 202) 357-3464, <Stephen.Daniels@aoa.hhs.gov>.
>
> If you mail or hand deliver your application, you must submit **one
> original application and two copies**, plus a completed application
> checklist to AoA. The application deadline for receipt of applications
> by mail or hand-delivered is 5:00 PM Eastern Time on July 24, 2006.
>
> Submissions using the regular, U.S. Postal Service must be addressed
> to:
>
> Department of Health and Human Services
>
> Administration on Aging
>
> Grants Management Division
>
> Washington, DC 20201
>
> Attention: Stephen Daniels
>
> Submissions by courier, overnight delivery, or delivered in person
> should be addressed to:
>
> Department of Health and Human Services
>
> Administration on Aging
>
> Grants Management Division
>
> One Massachusetts Avenue, NW, Room 4606
>
> Washington, DC 20001
>
> Attention: Stephen Daniels
>
> It is the responsibility of all applicants using mail or hand delivery
> of materials to do so in sufficient time to be received by the
> deadline date of July 24, 2006, 5:00 PM Eastern Time.

V.  **APPLICATION REVIEW INFORMATION**

**Criteria**

### Applications are scored by assigning a maximum of 100 points across four criteria:

### Purpose and Need for Assistance - (20 points); 

### Approach/Method -- Workplan and Activities - (30 points);

### Outcomes/Evaluation/Dissemination - (30 points); and 

### Level of Effort - (20 points).

> a\. [Purpose and Need for Assistance]{.underline} [Weight: 20
> points]{.underline}

-   Does the proposed project clearly identify and adequately respond to
    the priority area, and is it consistent with the AoA program
    purpose, as described in this Program Announcement? (10 points)

-   Does the applicant identify and prioritize those target populations
    within its state region and substantiate their need for increased
    access to senior services? Is the problem identified for target
    populations consistent with the AoA program's purpose and
    objectives? (5 points)

-   Does the application adequately and appropriately describe and
    document the key problem(s)/condition(s) relevant to its purposes?
    Is the proposed

> project justified in terms of the most recent, relevant, and available
>
> information and knowledge? (5 points)
>
> b\. [Approach, Work Plan and Activities]{.underline} [Weight: 30
> points]{.underline}

-   Is the intervention clearly defined? Does it reflect a coherent and
    feasible approach for successfully addressing the identified problem
    and achieving the identified outcome(s)? Has the applicant
    demonstrated a thorough familiarity with the objectives, work and
    accomplishments of the Legal Assistance Grants program? Does the
    project take into account barriers and opportunities that may impact
    on the project's success? Does the proposal include plans to explore
    models of legal services delivery currently implemented in states?
    Does the intervention optimize the use of potential partnerships
    with other organizations and/or consumer groups, as appropriate? (10
    points)

-   Is the project work plan clear and comprehensive? Does it include
    sensible and feasible timeframes for the accomplishment of tasks
    presented? Does the work plan include specific objectives and tasks
    that are linked to measurable outcomes? Does the proposal include a
    clear and coherent management plan? Are the roles and
    responsibilities of project staff, consultants and partners clearly
    defined and linked to specific objectives and tasks? Are the
    qualifications of the project staff, consultants and/or partners,
    and the proposed level of effort, adequate to carry out the project?
    (10 points)

-   Has the applicant identified well-defined outreach and service
    delivery strategies for reaching the target populations identified
    (such as isolated, disadvantaged, and limited-English speaking
    seniors)? Are the proposed strategies cost-effective and appropriate
    to the areas and clients served? Has the applicant identified
    appropriate aging, federal, state and community-based organizations,
    and specified the roles of these partner organizations in
    implementing the project? (10 points)

    c\. [Project Outcomes, Evaluation and Dissemination]{.underline}
    [Weight: 30 points]{.underline}

-   Are the expected project outcomes directly linked to the AoA program

> objectives? Are the benefits/results clear, realistic, and consistent
> with the purpose of the project? Are the proposed outcomes
> quantifiable and measurable, consistent with the definition of a
> project outcome contained in Section II of the Program Announcement?
> (10 points)

-   Does the project evaluation reflect a thoughtful and well-designed
    approach that will be able to successfully measure whether or not
    the project has achieved its proposed outcome(s)? Does the plan
    include the qualitative and/or quantitative methods necessary to
    reliably measure outcomes? Is the evaluation also designed to
    capture "lessons learned" from the overall effort that might be of
    use to others in the field of senior legal services delivery,
    especially those who might be interested in replicating the project?
    (10 points)

-   Will the dissemination plan get relevant and easy to use information
    in a timely manner to parties that might be interested in making use
    of its findings, particularly to those who might want to replicate
    the project? (10 points)

    d\. [Level of Effort]{.underline}: [Weight: 20 points]{.underline}

```{=html}
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```
-   Do the proposed project director(s), key staff and consultants have
    the

> background, experience, and other qualifications required to carry out
> their
>
> designated roles? Has the applicant demonstrated capacity and
>
> experience in using quantitative performance outcome information to
>
> support their activity and management decisions? (5 points)

-   Are letters from participating organizations included, as
    appropriate, and do they express the clear commitment and areas of

> responsibility of those organizations, consistent with the work plan
>
> description of their intended roles and contributions? (5 points)

-   Is the budget justified with respect to the adequacy and
    reasonableness of resources requested? Is the time commitment of the
    proposed director and

> other key project personnel sufficient to assure proper direction,
>
> management and timely completion of the project? Are budget line items
>
> clearly delineated and consistent with work plan objectives? (10
> points)

**2. Review and Selection Process**

> An independent review panel of at least three individuals will
> evaluate applications that pass the screening. These reviewers are
> experts in their field, and are drawn from academic institutions,
> non-profit organizations, state and local government, and federal
> government agencies other than AoA. Based on the specific programmatic
> considerations as outlined under section I, Funding Opportunity
> Description, the reviewers will comment on and score the applications,
> focusing their comments and scoring decisions on the criteria
> identified above.
>
> Final award decisions will be made by the Assistant Secretary for
> Aging (ASA). In making these decisions, the ASA will take into
> consideration: recommendations of the review panel; reviews for
> programmatic and grants management compliance; the reasonableness of
> the estimated cost to the government considering the available funding
> and anticipated results; and the likelihood that the proposed project
> will result in the benefits expected.

## Applicants have the option of omitting from the application copies (not the original) specific salary rates or amounts for individuals specified in the application budget and Social Security Numbers. The copies may include summary salary information.

## VI. AWARD ADMINISTRATION INFORMATION

##  

###### 1. Award Notices 

> Successful applicants will receive an Approval letter, and a Notice of
> Financial Assistance Award. The Notice of Financial Assistance Award
> is the authorizing document, and will be signed by the AoA grants
> officer, the AoA authorizing official, and the AoA budget office.
> Unsuccessful applicants will be notified in writing within 30 days.

###### 2. Administrative and National Policy Requirements 

> The award is subject to DHHS Administrative Requirements, which can be
> found in 45CFR Part 74 and 92 and AoA Standard Terms and Conditions
> which are included with each grant Award Packet.

**3. Reporting**

> An original and two copies of the SF-269 (Financial Status Report) and
> the AoA program progress report are due semi-annually. Awardees will
> receive a copy of the required program progress report form with their
> Notice of Financial Assistance Award. Final performance and SF-269
> reports are due 90 days after the end of the project period. For more
> information see DHHS / AoA Standard Terms and Conditions.

## 

## 

## VII. AGENCY CONTACTS 

> [Project Officer:]{.underline}
>
> U.S. Department of Health and Human Services
>
> Administration on Aging
>
> Washington, DC 20201
>
> Attn: Valerie Soroka
>
> Telephone: (202) 357-3531, e-mail: <Valerie.Soroka@aoa.hhs.gov>
>
> [Grants Management Specialist:]{.underline}
>
> U.S. Department of Health and Human Services
>
> Administration on Aging
>
> Washington, DC 20201
>
> Attn: Stephen Daniels
>
> Telephone: (202) 357-3464, e-mail: <Stephen.Daniels@aoa.hhs.gov>

## VIII. OTHER INFORMATION

###### A. Order of Application Elements

a)  To expedite the processing of applications, we request that you
    arrange the components of your application in the following order:

> 1\. SF 424 -- Application for Federal Assistance.

2.  SF 424A -- Budget Information.

> 3\. Separate Budget Narrative/Justification (See Attachments for
> Sample Format).
>
> 4\. SF 424B -- Assurances. Note: Be sure to complete this form
> according to
>
> instructions and have it signed and dated by the authorized
> representative (see
>
> item 18d on the SF 424).
>
> 5\. Certification
>
> 6\. Proof of non-profit status
>
> 7\. Copy of the applicant\'s most recent indirect cost agreement, as
> necessary.
>
> 8\. Project Narrative with Work Plan (See Attachment for Sample Work
> Plan
>
> Format).
>
> 9\. Organizational Capability Statement and Vitae for Key Project
> Personnel.
>
> 10\. Letters of Commitment from Key Partners.
>
> 11\. "Survey on Ensuring Equal Opportunity for Applicants" (Optional
> non-profit applicants)
>
> B. The Paperwork Reduction Act of 1995 (P.L. 104-13)
>
> An agency may not conduct or sponsor, and a person is not required to
> respond to, a collection of information unless it displays a currently
> valid OMB control number.
>
> The project description and budget justification is approved under OMB
> control number 0985-0018 which expires on 3/31/07.
>
> Public reporting burden for this collection of information is
> estimated to average 10 hours per response, including the time for
> reviewing instructions, gathering and maintaining the data needed and
> reviewing the collection information.

**ATTACHMENTS**

**Attachment A:**

**Instructions for completing the SF 424, Budget (SF 424A), Budget
Narrative and Other Required Forms**

**Attachment B:**

**Budget Justification Format -- Sample Format with Examples**

**Attachment C:**

**Budget Justification -- Sample Format**

**Attachment D:**

**Project Work Plan - Sample Format**

**Attachment E:**

**Instructions for Completing the Summary/Abstract**

**Attachment F:**

**"Survey on Ensuring Equal Opportunity for Applicants"**

#  Attachment A

# Instructions for completing the SF 424, Budget (SF 424A), Budget Narrative, and Other Required Forms

  -----------------------------------------------------------------------
  This section provides step-by-step instructions for completing the four
  (4) standard federal forms required as part of your grant application,
  including special instructions for completing Standard Budget Forms 424
  and 424A. Standard Forms 424 and 424A are used for a wide variety of
  federal grant programs, and federal agencies have the discretion to
  require some or all of the information on these forms. AoA does not
  require all the information on these Standard Forms. Accordingly,
  please use the instructions below in lieu of the standard instructions
  attached to SF 424 and 424A to complete these forms. Please note that
  in FY 2006, a new version of the SF 424 is being used for new grants.

  -----------------------------------------------------------------------

###### a. Standard Form 424

1\. **Type of Submission:** (Required): Select one type of submission in
accordance with agency instructions.

• Preapplication • Application • Changed/Corrected Application -- If AoA
requests, check if this submission is to change or correct a previously
submitted application.

2\. **Type of Application**: (Required) Select one type of application
in accordance with agency instructions.

• New . • Continuation • Revision

3\. **Date Received:** Leave this field blank.

4\. **Applicant Identifier**: Leave this field blank

5a **Federal Entity Identifier**: Leave this field blank

5b. **Federal Award Identifier**: For new applications leave blank. For
a continuation or revision to an existing award, enter the previously
assigned Federal award (grant) number.

6\. **Date Received by State:** Leave this field blank.

7\. **State Application Identifier:** Leave this field blank.

8\. **Applicant Information**: Enter the following in accordance with
agency instructions:

**a. Legal Name**: (Required): Enter the name that the organization has
registered with the Central Contractor Registry. Information on
registering with CCR may be obtained by visiting the Grants.gov website.

**b. Employer/Taxpayer Number (EIN/TIN):** (Required): Enter the
Employer or Taxpayer Identification Number (EIN or TIN) as assigned by
the Internal Revenue Service.

**c. Organizational DUNS**: (Required) Enter the organization's DUNS or
DUNS+4 number received from Dun and Bradstreet. Information on obtaining
a DUNS number may be obtained by visiting the Grants.gov website.

**d. Address**: (Required) Enter the complete address including the
county.

**e. Organizational Unit:** Enter the name of the primary organizational
unit (and department or division, if applicable**)** that will undertake
the project.

**f. Name and contact information of person to be contacted on matters
involving this application**: Enter the name (First and last name
required), organizational affiliation (if affiliated with an
organization other than the applicant organization), telephone number
(Required), fax number, and email address (Required) of the person to
contact on

matters related to this application.

9\. **Type of Applicant:** (Required) Select the applicant organization
"type" from the following drop down list.

A. State Government B. County Government C. City or Township Government
D. Special District Government E. Regional Organization F. U.S.
Territory or Possession G. Independent School District H. Public/State
Controlled Institution of Higher Education I. Indian/Native American
Tribal Government (Federally Recognized) J. Indian/Native American
Tribal Government (Other than Federally Recognized) K. Indian/Native
American Tribally Designated Organization L. Public/Indian Housing
Authority M. Nonprofit with 501C3 IRS Status (Other than Institution of
Higher Education) N. Nonprofit without 501C3 IRS Status (Other than
Institution of Higher Education) O. Private Institution of Higher
Education P. Individual Q. For-Profit Organization (Other than Small
Business) R. Small Business S. Hispanic-serving Institution T.
Historically Black Colleges and Universities (HBCUs) U. Tribally
Controlled Colleges and Universities (TCCUs) V. Alaska Native and Native
Hawaiian Serving Institutions W. Non-domestic (non-US) Entity X. Other
(specify)

10\. **Name Of Federal Agency**: (Required) Enter U.S. Administration on
Aging

11\. **Catalog Of Federal Domestic Assistance Number/Title:** The CFDA
number can be found on page one of the Program Announcement.

12\. **Funding Opportunity Number/Title:** (Required) The Funding
Opportunity Number and title of the opportunity can be found on page one
of the program announcement.

13\. **Competition Identification Number/Title:** Leave this field
blank.

14\. **Areas Affected By Project:** List the largest political entity
affected (cities, counties, state etc).

15\. **Descriptive Title of Applicant's Project:** (Required) Enter a
brief descriptive title of the project.

16\. **Congressional Districts Of**: (Required) 16a. Enter the
applicant's Congressional District, and 16b. Enter all district(s)
affected by the program or project. Enter in the format: 2 characters
State Abbreviation -- 3 characters District Number, e.g., CA-005 for
California 5th district, CA-012 for California 12^th^ district, NC-103
for North Carolina's 103rd district. • If all congressional districts in
a state are affected, enter "all" for the district number, e.g., MD-all
for all congressional districts in Maryland. • If nationwide, i.e. all
districts within all states are affected, enter US-all.

17\. **Proposed Project Start and End Dates**: (Required) Enter the
proposed start date and end date of the project.

18\. **Estimated Funding:** (Required) Enter the amount requested or to
be contributed during the first funding/budget period by each
contributor. Value of in-kind contributions should be included on
appropriate lines, as applicable. If the action will result in a dollar
change to an existing award, indicate only the amount of the change. For
decreases, enclose the amounts in parentheses.

**NOTE:** Applicants should review cost sharing or matching principles
contained in Subpart C of 45 CFR Part 74 or 45 CFR Part 92 before
completing Item 18 and the Budget Information Sections A, B and C noted
below.

All budget information entered under item 18 should cover the upcoming
budget period. For sub-item 18a, enter the federal funds being
requested. Sub-items 18b-18e is considered matching funds. The dollar
amounts entered in sub-items 18b-18f must total at least 1/3^rd^ of the
amount of federal funds being requested (the amount in 18a). For a full
explanation of AoA's match requirements, see the information in the box
below. For sub-item 18f, enter only the amount, if any, that is going to
be used as part of the required match.

There are three types of match: 1.) non-federal cash; 2.) non-federal
non-cash (i.e., in-kind); and 3.) program income. In general, costs
borne by the applicant and cash contributions of any and all third
parties involved in the project, including sub-grantees, contractors and
consultants, are considered [cash matching funds]{.underline}.
Generally, most contributions from third parties will be non-cash (i.e.,
in-kind) matching funds. Examples of [non-cash (in-kind)
match]{.underline} include: volunteered time and use of facilities to
hold meetings or conduct project activities. A third form of non-federal
match is projected [program income]{.underline} derived from activities
of the project such as participant fees and sale of publications. [Only
program income that is to be used as part of the required match should
be shown on Line 18.]{.underline}

NOTE: **Indirect charges** may only be requested if: (1) the applicant
has a current indirect cost rate agreement approved by the Department of
Health and Human Services or another federal agency; or (2) the
applicant is a state or local government agency. State governments
should enter the amount of indirect costs determined in accordance with
DHHS requirements. **If indirect costs are to be included in the
application, a copy of the approved indirect cost agreement must be
included with the application.**

19\. **Is Application Subject to Review by State Under Executive Order
12372 Process?** Check c. Program is not covered by E.O. 12372

20\. **Is the Applicant Delinquent on any Federal Debt?** (Required)
This question applies to the applicant organization, not the person who
signs as the authorized representative. If yes, include an explanation
on the continuation sheet.

21\. **Authorized Representative**: (Required) To be signed and dated by
the authorized representative of the applicant organization. Enter the
name (First and last name required) title (Required), telephone number
(Required), fax number, and email address (Required) of the person
authorized to sign for the applicant. A copy of the governing body's
authorization for you to sign this application as the official
representative must be on file in the applicant's office. (Certain
Federal agencies may require that this authorization be submitted as
part of the application.)

**b. Standard Form 424A**

+-----------------------------------------------------------------------+
| > NOTE: Standard Form 424A is designed to accommodate applications    |
| > for multiple grant programs; thus, for purposes of this AoA         |
| > program, many of the budget item columns and rows are not           |
| > applicable. You should only consider and respond to the budget      |
| > items for which guidance is provided below. Unless otherwise        |
| > indicated, the SF 424A should reflect a one year budget.            |
+-----------------------------------------------------------------------+

##### Section A ‑ Budget Summary

> [Line 5]{.underline}: Leave columns (c) and (d) blank. Enter TOTAL
> federal costs in column (e) and total non‑federal costs (including
> third party in‑kind contributions and any program income to be used as
> part of the grantee match) in column (f). Enter the sum of columns (e)
> and (f) in column (g).

##### Section B ‑ Budget Categories

> Column 3: Enter the breakdown of how you plan to use the federal funds
> being
>
> requested by object class category (see instructions for each object
> class category below).
>
> Column 4: Enter the breakdown of how you plan to use the non-federal
> share by object class category.
>
> Column 5: Enter the total funds required for the project (the sum of
> Columns 3 and 4) by object class category.

+-----------------------------------------------------------------------+
| ###### Separate Budget Narrative/Justification Requirement            |
|                                                                       |
| > You must submit a separate budget narrative as part of your         |
| > application. **A blank sample format (and one with examples) has    |
| > been included in the attachments for your use in developing and     |
| > presenting your Budget Narrative.** In your budget justification,   |
| > you should include a breakdown of the budget which shows the costs  |
| > for all of the object class categories noted in Section B, across   |
| > three columns: federal; non-federal cash; and non-federal in-kind.  |
| > The justification should fully explain and justify the costs in     |
| > each of the major budget items for each of the object class         |
| > categories, as described below. Third party in-kind contributions   |
| > and program income designated as non-federal match contributions    |
| > should be clearly identified and justified separately from the      |
| > justification for the budget line items. The full budget            |
| > justification should be included in the application immediately     |
| > following the SF 424 forms. **The budget justification should       |
| > provide a detailed breakdown of large dollar values.**              |
+-----------------------------------------------------------------------+

> [Line 6a]{.underline}: [Personnel]{.underline}: Enter total costs of
> salaries and wages of applicant/grantee staff. Do not include the
> costs of consultants; consultant costs should be included under 6h ‑
> Other. [In the Justification]{.underline}: Identify the project
> director, if known. Specify the key staff, their titles, brief summary
> of project related duties, and the percent of their time commitments
> to the project in the budget justification.
>
> [Line 6b]{.underline}: [Fringe Benefits]{.underline}: Enter the total
> costs of fringe benefits unless treated as part of an approved
> indirect cost rate. [In the Justification]{.underline}: Provide a
> break‑down of amounts and percentages that comprise fringe benefit
> costs, such as health insurance, FICA, retirement insurance, etc.
>
> [Line 6c]{.underline}: [Travel]{.underline}: Enter total costs of
> [out‑of‑town travel]{.underline} (travel requiring per diem) for staff
> of the project. Do not enter costs for consultant\'s travel - this
> should be included in line 6h. [In the Justification]{.underline}:
> Include the total number of trips, destinations, purpose, length of
> stay, subsistence allowances and transportation costs (including
> mileage rates).
>
> [Line 6d]{.underline}: [Equipment]{.underline}: Enter the total costs
> of all equipment to be acquired by the project. For all grantees,
> \"equipment\" is non‑expendable tangible personal property having a
> useful life of more than one year and an acquisition cost of \$5,000
> or more per unit. If the item does not meet the \$5,000 threshold,
> include it in your budget under Supplies, line 6e. [In the
> Justification]{.underline}: Equipment to be purchased with federal
> funds must be justified as necessary for the conduct of the project.
> The equipment must be used for project-related functions; the
> equipment, or a reasonable facsimile, must not be otherwise available
> to the applicant or its sub‑grantees. The justification also must
> contain plans for the use or disposal of the equipment after the
> project ends.
>
> [Line 6e]{.underline}: [Supplies:]{.underline} Enter the total costs
> of all tangible expendable personal property
>
> (supplies) other than those included on line 6d. [In the
> Justification:]{.underline} Provide general description of types of
> items included.
>
> [Line 6f]{.underline}: [Contractual]{.underline}: Enter the total
> costs of all contracts, including (1) procurement
>
> contracts (except those, which belong on other lines such as
> equipment, supplies, etc.). Also include any contracts with
> organizations for the provision of technical assistance. Do not
> include payments to individuals on this line. [In the
> Justification]{.underline}: Attach a list of contractors indicating
> the name of the organization, the purpose of the contract, and the
> estimated dollar amount. If the name of the contractor, scope of work,
> and estimated costs are not available or have not been negotiated,
> indicate when this information will be available. Whenever the
> applicant/grantee intends to delegate a substantial part (one-third,
> or more) of the project work to another agency, the applicant/grantee
> must provide a completed copy of Section B, Budget Categories for each
> contractor, along with supporting information and justifications.
>
> [Line 6g]{.underline}: [Construction]{.underline}: Leave blank since
> construction is not an allowable cost under this AoA program.
>
> [Line 6h]{.underline}: [Other]{.underline}: Enter the total of all
> other costs. Such costs, where applicable, may
>
> include, but are not limited to: insurance, medical and dental costs
> (i.e. for project volunteers this is different from personnel fringe
> benefits); non-contractual fees and travel paid directly to
> *individual* consultants; [local]{.underline} transportation (all
> travel which does not require per diem is considered local travel);
> postage; space and equipment rentals/lease; printing and publication;
> computer use; training and staff development costs (i.e. registration
> fees). If a cost does not clearly fit under another category, and it
> qualifies as an allowable cost, then rest assured this is where it
> belongs. [In the Justification:]{.underline} Provide a reasonable
> explanation for items in this category. For individual consultants,
> explain the nature of services provided and the relation to activities
> in the work plan. Describe the types of activities for staff
> development costs.
>
> [Line 6i]{.underline}: [Total Direct Charges]{.underline}: Show the
> totals of Lines 6a through 6h.
>
> [Line 6j]{.underline}: [Indirect Charges]{.underline}: Enter the total
> amount of indirect charges (costs), if any. If no indirect costs are
> requested, enter \"none.\" Indirect charges may be requested if: (1)
> the applicant has a current indirect cost rate agreement approved by
> the Department of Health and Human Services or another federal agency;
> or (2) the applicant is a state or local government agency.
>
> Justification: [State governments should enter the amount of indirect
> costs determined in accordance with DHHS requirements]{.underline}. An
> applicant that will charge indirect costs to the grant must enclose a
> copy of the current rate agreement. If the applicant organization is
> in the process of initially developing or renegotiating a rate, it
> should immediately upon notification that an award will be made,
> develop a tentative indirect cost rate proposal based on its most
> recently completed fiscal year in accordance with the principles set
> forth in the cognizant agency\'s guidelines for establishing indirect
> cost rates, and submit it to the cognizant agency. Applicants awaiting
> approval of their indirect cost proposals may also request indirect
> costs. It should be noted that when an indirect cost rate is
> requested, those costs included in the indirect cost pool should not
> also be charged as direct costs to the grant. Also, if the applicant
> is requesting a rate which is less than what is allowed under the
> program, the authorized representative of the applicant organization
> must submit a signed acknowledgement that the applicant is accepting a
> lower rate than allowed.
>
> [Line 6k]{.underline}: [Total]{.underline}: Enter the total amounts of
> Lines 6i and 6j.
>
> [Line 7]{.underline}: [Program Income]{.underline}: As appropriate,
> include the estimated amount of income, if any, you expect to be
> generated from this project that you wish to designate as match (equal
> to the amount shown for Item 15(f) on Form 424). [Note]{.underline}:
> Any program income indicated at the bottom of Section B and for item
> 15(f) on the face sheet of Form 424 will be included as part of
> non-Federal match and will be subject to the rules for documenting
> completion of this pledge. If program income is expected, but is not
> needed to achieve matching funds, do not include that portion here or
> on Item 15(f) of the Form 424 face sheet. Any anticipated program
> income that will not be applied as grantee match should be described
> in the Level of Effort section of the Program Narrative.

##### Section C ‑ Non‑Federal Resources

> [Line 12]{.underline}: Enter the amounts of non‑Federal resources that
> will be used in carrying out the proposed project, by source
> (Applicant; State; Other) and enter the total amount in Column (e). Do
> not include program income unless it is used to meet the match
> requirement. Keep in mind that if program income used to meet the
> match requirement and the projected level of program income is not
> met, thereby decreasing the level of match, the amount of federal
> funds available to the grantee may be reduced if the match falls below
> required levels.
>
> [Section D ‑ Forecasted Cash Needs]{.underline} - Not applicable.
>
> [Section E ‑ Budget Estimate of Federal Funds Needed for Balance of
> the Project]{.underline}
>
> [Line 20]{.underline}: NOTE: Leave this line blank. Section E is
> relevant only for multi-year grant applications, where the project
> period is 24 months or longer. This section does not apply to grant
> awards where the project period is less than 17 months.

###### Section F ‑ Other Budget Information

> [Line 22]{.underline}: [Indirect Charges]{.underline}: Enter the type
> of indirect rate (provisional, predetermined, final or fixed) to be in
> effect during the funding period, the base to which the rate is
> applied, and the total indirect costs. Include a copy of your current
> Indirect Cost Rate Agreement.
>
> [Line 23]{.underline}: [Remarks]{.underline}: Provide any other
> comments deemed necessary.

###### c. Standard Form 424B - Assurances

> This form contains assurances required of applicants under the
> discretionary funds programs administered by the Administration on
> Aging. Please note that a duly authorized representative of the
> applicant organization must certify that the organization is in
> compliance with these assurances.

###### d. Certification Regarding Lobbying

> This form contains certifications that are required of the applicant
> organization regarding (a) lobbying; (b) debarment, suspension, and
> other responsibility matters; and (c) drug-free workplace
> requirements. Please note that a duly authorized representative of the
> applicant organization must attest to the applicant's compliance with
> these certifications.

###### e. Other Application Components

Survey on Ensuring Equal Opportunity for Applicants

> The Office of Management and Budget (OMB) has approved an HHS form to
> collect information on the number of faith-based groups applying for a
> HHS grant. Non-profit organizations, excluding private universities,
> are asked to include a completed survey with their grant application
> packet. Attached you will find the OMB approved HHS "Survey on
> Ensuring Equal Opportunity for Applicants" form (Attachment G). Your
> help in this data collection process is greatly appreciated.

**Proof of Non-Profit Status**

> Non-profit applicants must submit proof of non-profit status. Any of
> the following constitutes acceptable proof of such status:
>
> A copy of a currently valid IRS tax exemption certificate.
>
> A statement from a State taxing body, State attorney general, or other
> appropriate State official certifying that the applicant organization
> has a non-profit status and that none of the net earnings accrue to
> any private shareholders or individuals.
>
> A certified copy of the organization's certificate of incorporation or
> similar document that clearly establishes non-profit status.

## Indirect Cost Agreement

> Applicants that have included indirect costs in their budgets must
> include a copy of the current indirect cost rate agreement approved by
> the Department of Health and Human Services or another federal agency.
> This is optional for applicants that have not included indirect costs
> in their budgets.

**Attachment B: Budget Narrative, Page 1 -- Sample Format with
EXAMPLES**

+----------+-------+------+------+------+-----------------------------+
| >        | **Fe  | **N  | **N  | # T  | ### Justification           |
| **Object | deral | on-F | on-F | OTAL |                             |
| > Class  | Fu    | eder | eder |      |                             |
| > Ca     | nds** | al** | al** |      |                             |
| tegory** |       |      |      |      |                             |
|          |       | **Ca | **I  |      |                             |
|          |       | sh** | n-Ki |      |                             |
|          |       |      | nd** |      |                             |
+----------+-------+------+------+------+-----------------------------+
| **Per    | \$4   |      | \$5  | \$45 | Project Supervisor (name) = |
| sonnel** | 0,000 |      | ,000 | ,000 | .3FTE @ \$50,000/yr =       |
|          |       |      |      |      | \$15,000                    |
|          |       |      |      |      |                             |
|          |       |      |      |      | Project Director (name) =   |
|          |       |      |      |      | 1FTE @ \$30,000 = \$30,000  |
+----------+-------+------+------+------+-----------------------------+
| **Fringe | \$1   | 0    | 0    | \$12 | Fringes on Supervisor and   |
| Be       | 2,600 |      |      | ,600 | Director @ 28% of salary.   |
| nefits** |       |      |      |      |                             |
|          |       |      |      |      | FICA (7.65%) = \$3,442      |
|          |       |      |      |      |                             |
|          |       |      |      |      | Health (12%) = \$5,400      |
|          |       |      |      |      |                             |
|          |       |      |      |      | Dental (5%) = \$2,250       |
|          |       |      |      |      |                             |
|          |       |      |      |      | Life (2%) = \$ 900          |
|          |       |      |      |      |                             |
|          |       |      |      |      | Workers Comp Insurance      |
|          |       |      |      |      | (.75%) = \$ 338             |
|          |       |      |      |      |                             |
|          |       |      |      |      | Unemployment Insurance      |
|          |       |      |      |      | (.6%) = \$ 270              |
+----------+-------+------+------+------+-----------------------------+
| **       | \$    | 0    | \$   | \$3  | Travel to Annual Grantee    |
| Travel** | 3,000 |      | 967  | ,967 | Meeting:                    |
|          |       |      |      |      |                             |
|          |       |      |      |      | Airfare: 1 RT x 2 people x  |
|          |       |      |      |      | \$750/RT = \$1,500          |
|          |       |      |      |      |                             |
|          |       |      |      |      | Lodging: 3 nights x 2       |
|          |       |      |      |      | people x \$100/night = \$   |
|          |       |      |      |      | 600                         |
|          |       |      |      |      |                             |
|          |       |      |      |      | Per Diem: 4 days x 2 people |
|          |       |      |      |      | x \$40/day = \$ 320         |
|          |       |      |      |      |                             |
|          |       |      |      |      | Out-of-Town Project Site    |
|          |       |      |      |      | Visits                      |
|          |       |      |      |      |                             |
|          |       |      |      |      | Car mileage: 3 trips x 2    |
|          |       |      |      |      | people x 350 miles/trip     |
|          |       |      |      |      |                             |
|          |       |      |      |      | x \$ .365/mile = \$ 767     |
|          |       |      |      |      |                             |
|          |       |      |      |      | Lodging: 3 trips x 2 people |
|          |       |      |      |      | x 1 night/ trip             |
|          |       |      |      |      |                             |
|          |       |      |      |      | x \$50/night = \$300        |
|          |       |      |      |      |                             |
|          |       |      |      |      | Per Diem: 3 trips x 2       |
|          |       |      |      |      | people x 2days/trip         |
|          |       |      |      |      |                             |
|          |       |      |      |      | x \$40/day = \$480          |
+----------+-------+------+------+------+-----------------------------+

Attachment B: Budget Narrative, Page 2 - Sample Format with EXAMPLES

+-----+-----+------+------+------+-----------------------------------+
| **  | **  | ###  | *    | ##   | ### Justification                 |
| Obj | Fed | ## * | *Non | ## * |                                   |
| ect | era | Non- | -Fed | [TOT |                                   |
| C   | l** | Fede | eral | AL]{ |                                   |
| las |     | ral* | I    | .und |                                   |
| s** | #   |      | n-Ki | erli |                                   |
|     |  Fu | #### | nd** | ne}* |                                   |
| **C | nds | # *C |      |      |                                   |
| ate |     | ash* |      |      |                                   |
| gor |     |      |      |      |                                   |
| y** |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+
| *   | 0   | 0    | 0    | 0    | No equipment requested            |
| *Eq |     |      |      |      |                                   |
| uip |     |      |      |      |                                   |
| men |     |      |      |      |                                   |
| t** |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+
| **S | \   |      | \$2  | \$3  | Laptop computer for use in client |
| upp | $1, |      | ,000 | ,500 | intakes = \$1,340                 |
| lie | 500 |      |      |      |                                   |
| s** |     |      |      |      | Consumable supplies (paper, pens, |
|     |     |      |      |      | etc.)                             |
|     |     |      |      |      |                                   |
|     |     |      |      |      | \$100/mo x 12 months = \$1,200    |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Copying \$80/mo x 12 months = \$  |
|     |     |      |      |      | 960                               |
+-----+-----+------+------+------+-----------------------------------+
| **C | \$2 | \$50 | 0    | \    | Contracts to A,B,C direct service |
| ont | 00, | ,000 |      | $250 | providers (name providers)        |
| rac | 000 |      |      | ,000 |                                   |
| tua |     |      |      |      | adult day care contractor =       |
| l** |     |      |      |      | \$75,000                          |
|     |     |      |      |      |                                   |
|     |     |      |      |      | respite care contractor in home=  |
|     |     |      |      |      | \$75,000                          |
|     |     |      |      |      |                                   |
|     |     |      |      |      | respite care contractor-NF =      |
|     |     |      |      |      | \$50,000                          |
|     |     |      |      |      |                                   |
|     |     |      |      |      | personal care/companion provider  |
|     |     |      |      |      | = \$50,000                        |
|     |     |      |      |      |                                   |
|     |     |      |      |      | See detailed budget justification |
|     |     |      |      |      | for each provider (and then       |
|     |     |      |      |      | provide it!)                      |
+-----+-----+------+------+------+-----------------------------------+

+-----+-----+------+------+------+-----------------------------------+
| A   |     |      |      |      |                                   |
| tta |     |      |      |      |                                   |
| chm |     |      |      |      |                                   |
| ent |     |      |      |      |                                   |
| B:  |     |      |      |      |                                   |
| Bud |     |      |      |      |                                   |
| get |     |      |      |      |                                   |
| N   |     |      |      |      |                                   |
| arr |     |      |      |      |                                   |
| ati |     |      |      |      |                                   |
| ve, |     |      |      |      |                                   |
| P   |     |      |      |      |                                   |
| age |     |      |      |      |                                   |
| 3   |     |      |      |      |                                   |
| --  |     |      |      |      |                                   |
| Sam |     |      |      |      |                                   |
| ple |     |      |      |      |                                   |
| For |     |      |      |      |                                   |
| mat |     |      |      |      |                                   |
| w   |     |      |      |      |                                   |
| ith |     |      |      |      |                                   |
| EX  |     |      |      |      |                                   |
| AMP |     |      |      |      |                                   |
| LES |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+
| **O | \$  | \$8  | \$19 | \$37 | Local conference registration fee |
| the | 10, | ,000 | ,800 | ,800 | (name conference) = \$ 200        |
| r** | 000 |      |      |      |                                   |
|     |     |      |      |      | Printing brochures (50,000 @ \$   |
|     |     |      |      |      | .05 ea) = \$ 2,500                |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Video production = \$19,800       |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Video Reproduction = \$ 3,500     |
|     |     |      |      |      |                                   |
|     |     |      |      |      | NF Respite Training Manual        |
|     |     |      |      |      | reproduction                      |
|     |     |      |      |      |                                   |
|     |     |      |      |      | \$3/manual x \$2000 manuals = \$  |
|     |     |      |      |      | 6,000                             |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Postage \$150/mo x 12 months = \$ |
|     |     |      |      |      | 1,800                             |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Caregiver Forum meeting room      |
|     |     |      |      |      | rentals                           |
|     |     |      |      |      |                                   |
|     |     |      |      |      | \$200/day x 12 forums = \$ 2,400  |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Respite Training Scholarships =   |
|     |     |      |      |      | \$1,600                           |
+-----+-----+------+------+------+-----------------------------------+
| *   | 0   | 0    | 0    | 0    | None                              |
| *In |     |      |      |      |                                   |
| dir |     |      |      |      |                                   |
| ect |     |      |      |      |                                   |
| Cha |     |      |      |      |                                   |
| rge |     |      |      |      |                                   |
| s** |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+
| ##  | \$2 | \$60 | \$27 | \    |                                   |
| ### | 65, | ,800 | ,767 | $354 |                                   |
|  TO | 700 |      |      | ,267 |                                   |
| TAL |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+

Attachment C: Budget Narrative -- Page 1 -- Sample Format

+-----+------+------+------+------+-----------------------------------+
| >   | *    | **N  | **N  | # T  | ### Justification                 |
|  ** | *Fed | on-F | on-F | OTAL |                                   |
| Obj | eral | eder | eder |      |                                   |
| ect | Fun  | al** | al** |      |                                   |
| >   | ds** |      |      |      |                                   |
|  Cl |      | **Ca | **I  |      |                                   |
| ass |      | sh** | n-Ki |      |                                   |
| > C |      |      | nd** |      |                                   |
| ate |      |      |      |      |                                   |
| gor |      |      |      |      |                                   |
| y** |      |      |      |      |                                   |
+-----+------+------+------+------+-----------------------------------+
| *   |      |      |      |      |                                   |
| *Pe |      |      |      |      |                                   |
| rso |      |      |      |      |                                   |
| nne |      |      |      |      |                                   |
| l** |      |      |      |      |                                   |
+-----+------+------+------+------+-----------------------------------+
| **  |      |      |      |      |                                   |
| Fri |      |      |      |      |                                   |
| nge |      |      |      |      |                                   |
| B   |      |      |      |      |                                   |
| ene |      |      |      |      |                                   |
| fit |      |      |      |      |                                   |
| s** |      |      |      |      |                                   |
+-----+------+------+------+------+-----------------------------------+
| *   |      |      |      |      |                                   |
| *Tr |      |      |      |      |                                   |
| ave |      |      |      |      |                                   |
| l** |      |      |      |      |                                   |
+-----+------+------+------+------+-----------------------------------+
| *   |      |      |      |      |                                   |
| *Eq |      |      |      |      |                                   |
| uip |      |      |      |      |                                   |
| men |      |      |      |      |                                   |
| t** |      |      |      |      |                                   |
+-----+------+------+------+------+-----------------------------------+

**Attachment C: Budget Narrative -- Page 2 -- Sample Format**

+------+------+------+----+------+-----------------------------------+
| >    | *    | **N  | *  | # T  | ### Justification                 |
| **Ob | *Fed | on-F | *N | OTAL |                                   |
| ject | eral | eder | on |      |                                   |
| > C  | Fun  | al** | -F |      |                                   |
| lass | ds** |      | ed |      |                                   |
| > Ca |      | **Ca | er |      |                                   |
| tego |      | sh** | al |      |                                   |
| ry** |      |      | ** |      |                                   |
|      |      |      |    |      |                                   |
|      |      |      | *  |      |                                   |
|      |      |      | *I |      |                                   |
|      |      |      | n- |      |                                   |
|      |      |      | Ki |      |                                   |
|      |      |      | nd |      |                                   |
|      |      |      | ** |      |                                   |
+------+------+------+----+------+-----------------------------------+
| **Su |      |      |    |      |                                   |
| ppli |      |      |    |      |                                   |
| es** |      |      |    |      |                                   |
+------+------+------+----+------+-----------------------------------+
| **C  |      |      |    |      |                                   |
| ontr |      |      |    |      |                                   |
| actu |      |      |    |      |                                   |
| al** |      |      |    |      |                                   |
+------+------+------+----+------+-----------------------------------+
| *    |      |      |    |      |                                   |
| *Oth |      |      |    |      |                                   |
| er** |      |      |    |      |                                   |
+------+------+------+----+------+-----------------------------------+
| **   |      |      |    |      |                                   |
| Indi |      |      |    |      |                                   |
| rect |      |      |    |      |                                   |
| C    |      |      |    |      |                                   |
| harg |      |      |    |      |                                   |
| es** |      |      |    |      |                                   |
+------+------+------+----+------+-----------------------------------+
| #    |      |      |    |      |                                   |
| #### |      |      |    |      |                                   |
|  *TO |      |      |    |      |                                   |
| TAL* |      |      |    |      |                                   |
+------+------+------+----+------+-----------------------------------+

Attachment D: Project Work Plan, Page 1 -- Sample Format

  --------------- ------------------------------- ---------- ------------- -- -- -- -- -- -- -- -- -- -- --
  **Goal:**                                                                                              

  **Measurable                                                                                           
  Outcome(s):**                                                                                          

  **Major         **Key Tasks**                   **Lead     **Timeframe                                 
  Objectives**                                    Person**   (Start and                                  
                                                             End Date by                                 
                                                             Month)**                                    

  1\.                                                                                                    

                                                                                                         

                                                                                                         

                                                                                                         

  2\.                                                                                                    

                                                                                                         

                                                                                                         

                                                                                                         
  --------------- ------------------------------- ---------- ------------- -- -- -- -- -- -- -- -- -- -- --

Attachment D: Project Work Plan, Page 2 -- Sample Format

  -------------- ------------------------------- ---------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- -------- -------- --------
  **Major        **Key Tasks**                   **Lead     **Timeframe                                                                                     
  Objectives**                                   Person**   (Start and                                                                                      
                                                            End Date by                                                                                     
                                                            Month)**                                                                                        

                                                            **1**         **2**   **3**   **4**   **5**   **6**   **7**   **8**   **9**   **10**   **11**   **12**

  3\.                                                                                                                                                       

                                                                                                                                                            

                                                                                                                                                            

                                                                                                                                                            

  4\.                                                                                                                                                       

                                                                                                                                                            

                                                                                                                                                            

                                                                                                                                                            
  -------------- ------------------------------- ---------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- -------- -------- --------

Attachment D: Project Work Plan, Page 3 -- Sample Format

  -------------- ------------------------------- ---------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- -------- -------- --------
  **Major        **Key Tasks**                   **Lead     **Timeframe                                                                                     
  Objectives**                                   Person**   (Start and                                                                                      
                                                            End Date by                                                                                     
                                                            Month)**                                                                                        

                                                            **1**         **2**   **3**   **4**   **5**   **6**   **7**   **8**   **9**   **10**   **11**   **12**

  5\.                                                                                                                                                       

                                                                                                                                                            

                                                                                                                                                            

                                                                                                                                                            

  6\.                                                                                                                                                       

                                                                                                                                                            

                                                                                                                                                            

                                                                                                                                                            
  -------------- ------------------------------- ---------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- -------- -------- --------

NOTE: Please do note infer from this sample format that your work plan
must have 6 major objectives. If you need more pages, simply repeat this
format on additional pages.

**Attachment E**

Instructions for Completing the Project Summary/Abstract

-   All applications for grant funding must include a Summary/Abstract
    that concisely describes the proposed project. It should be written
    for the general public.

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-   To ensure uniformity, please limit the length to no more than 300
    words on a single page with a font size of not less than 11,
    doubled-spaced.

-   The abstract must include the project's goal(s), objectives, overall
    approach (including target population and significant partnerships),
    anticipated outcomes, products, and duration. The following are very
    simple descriptions of these terms, and a sample Compendium
    abstract.

> **Goal(s)** -- broad, overall purpose, usually in a mission statement,
> i.e. what you want to do, where you want to be
>
> **Objective(s)** -- narrow, more specific, identifiable or measurable
> steps toward a goal. Part of the planning process or sequence (the
> "how"). Specific performances which will result in the attainment of a
> goal.
>
> **Outcomes -** measurable results of a project. Positive benefits or
> negative changes, or measurable characteristics that occur as a result
> of an organization's or program's activities. (outcomes are the
> end-point)

**Products --** materials, deliverables.

-   A model abstract/summary is provided below:

The grantee, Okoboji University, supports this three year Dementia
Disease demonstration (DD) project in collaboration with the local
Alzheimer's Association and related Dementias groups. The
[goal]{.underline} of the project is to provide comprehensive,
coordinated care to individuals with memory concerns and to their
caregivers. The approach is to expand the services and to integrate the
bio-psycho-social aspects of care. The [objectives]{.underline} are: 1)
to provide dementia specific care, i.e., care management fully
integrated into the services provided; 2) to train staff, students and
volunteers; 3) to establish a system infrastructure to support services
to individuals with early stage dementia and to their caregivers; 4) to
develop linkages with community agencies; 5) to expand the assessment
and intervention services; 6) to evaluate the impact of the added
services; 7) to disseminate project information. The expected
[outcomes]{.underline} of this DD project are: patients will maintain as
high a level of mental function and physical functions (thru Yoga) as
possible; caregivers will increase ability to cope with changes; and pre
and post -- project patient evaluation will reflect positive results
from expanded and integrated services. The [products]{.underline} from
this project are: a final report, including evaluation results; a
website; articles for publication; data on driver assessment and in-home
cognitive retraining; abstracts for national conferences.

**Applicant's (Organization) Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Applicant's DUNS Number:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Grant Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_CFDA
Number: \_\_\_\_\_\_\_\_\_\_\_\_\_**

1\. Does the applicant have 501(c)(3) status?

Yes No

2\. How many full-time equivalent employees does the applicant have?
*(Check only one box).*

> 3 or Fewer 15-50
>
> 4-5 51-100
>
> 6-14 over 100

3\. What is the size of the applicant's annual budget? *(Check only one
box.)*

Less Than \$150,000

\$150,000 - \$299,999

\$300,000 - \$499,999

\$500,000 - \$999,999

\$1,000,000 - \$4,999,999

\$5,000,000 or more

4\. Is the applicant a faith-based/religious\
organization?

Yes No

5\. Is the applicant a non-religious community-based organization?

Yes No

6\. Is the applicant an intermediary that will manage the grant on
behalf of other organizations?

> Yes No

7\. Has the applicant ever received a government grant or contract
(Federal, State, or local )?

Yes No

8\. Is the applicant a local affiliate of a national\
organization?

Yes No

# Survey Instructions on Ensuring Equal Opportunity for Applicants

**Provide the applicant's (organization) name and DUNS number and the
grant name and CFDA number.**

1\. 501(c)(3) status is a legal designation provided on application to
the Internal Revenue Service by eligible organizations. Some grant
programs may require nonprofit applicants to have 501(c)(3) status.
Other grant programs do not.

2\. For example, two part-time employees who each work half-time equal
one full-time equivalent employee. If the applicant is a local affiliate
of a national organization, the responses to survey questions 2 and 3
should reflect the staff and budget size of the local affiliate.

3\. Annual budget means the amount of money your organization spends
each year on all of its activities.

4\. Self-identify.

5\. An organization is considered a community-based organization if its
headquarters/service location shares the same zip code as the clients
you serve.

6\. An "intermediary" is an organization that enables a group of small
organizations to receive and manage government funds by administering
the grant on their behalf.

7.  Self-explanatory.

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7.  Self-explanatory.

**Paperwork Burden Statement**

According to the Paperwork Reduction Act of 1995, no persons are
required to respond to a collection of information unless such
collection displays a valid OMB control number. The valid OMB control
number for this information collection is 1890-0014. The time required
to complete this information collection is estimated to average five (5)
minutes per response, including the time to review instructions, search
existing data resources, gather the data needed, and complete and review
the information collection. **If you have any comments concerning the
accuracy of the time estimate(s) or suggestions for improving this form,
please write to:** U.S. Department of Education, Washington, D.C.
2202-4651.

**If you have comments or concerns regarding the status of your
individual submission of this form, write directly to:** Joyce I. Mays,
Application Control Center, U.S. Department of Education, 7^th^ and D
Streets, SW, ROB-3, Room 3671, Washington, D.C. 20202-4725

> OMB No. 1890-0014 Exp. 1/31/20

[^1]: *Legal Hotlines Self Evaluation Measures Report 2003*
    ([www.legalhotlines.org](http://www.legalhotlines.org/))

[^2]: *2005 Annual Report, Technical Support for Legal Hotlines Project*
    ([www.legalhotlines.org](http://www.legalhotlines.org/))

[^3]: *Senior Legal Hotlines Annual Report 2005*
    ([www.legalhotlines.org](http://www.legalhotlines.org/))

[^4]: *Planning for the Legal Needs of Utah's Seniors*, *2004
    (*[[http://www.tcsg.org/finalreport1018_04.pdf]{.underline}](http://www.tcsg.org/finalreport1018_04.pdf))

[^5]: *State Legal Assistance Development Program Study, 2003*
    (<http://www.tcsg.org/borchardstudy_01.pdf>)