U.S. Department of Housing and Urban Development

PUBLIC AND INDIAN HOUSING

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Special Attention of: Notice PIH 95-21 (HA)

Public Housing Directors;

Administrators, Offices of

Native American Programs; Issued: April 14, 1995

Housing Authorities; Expires: April 30, 1996

Resident Management Corporations;
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Resident Councils Cross References:

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Subject: Processing of Applications for the FY 1995 Family Investment
Centers (FIC Program)

1.  Purpose. This Notice provides instructions for processing
    applications submitted for funding under the Fiscal Year (FY) 1995
    Family Investment Centers Program.

2\. Background.

A. A Notice of Funding Availability (NOFA) announcing

\$44,529,629,000 in grant funds was published in the

Federal Register on Wednesday, February 15, 1995.

B. Family Investment Centers was created by the Cranston-Gonzales

National Affordable Housing Act (P.L. 101-625,

enacted November 1990) and authorized by Section 22 of

the United States Housing Act of 1937 (42 U.S.C.

1437t ). Although Section 22 is phrased in terms of

families living in public housing, the program is also

available to Indian Housing Authorities (IHAs), because

of section 527 of the National Affordable Housing Act

(104 Stat. 4216; 42 U.S.C. 1437aa note) (NAHA).

Section 527 extends the applicability of many NAHA

provisions affecting Title I of the 1937 Act (including

section 515, which added Section 22) to housing

operated by an IHA.

3\. Eligible activities.

Eligible activities are described in Section I.E. of the

NOFA. Public Housing Agencies and Indian Housing

Authorities are the only eligible applicants under FIC.

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PR : Distribution: W-3-1, W-2(H), R-3-1(PIH), R-6, R-7, R-9, 138-2,
138-7,

RMC-2

HUD 21B (3-80)

Previous Editions Are Obsolete HB 000.2

4\. Application requirements.

To receive funding, PHAs/IHAs must submit a grant application to HUD

using an application package as described in Section II.A. of the

NOFA. The application package (kit) contains information on all

exhibits and certifications required under the NOFA. Applications are

due no later than 3:00 p.m. (local time), Thursday, June 15, 1995.

5\. Selective rating criteria.

Application selection criteria are listed in Section I.G. of the NOFA.

6\. Application distribution for FY 1995.

Headquarters printed and distributed the application kit to the

State/Area Office Public Housing Divisions, Offices of Native American

Programs (ONAP), and PHAs/IHAs. The application kit is also available

through HUD\'s Resident Initiatives Clearinghouse (1-800-955-2232).

7\. Distribution of funds.

HUD will award grants to the two highest ranked eligible applications

in each funding category per HUD Field (not State/Area) Office. In

addition, grants will be awarded to the two highest ranked, eligible

IHA applications in each funding category on a nationwide basis. All

of the remaining funds will be awarded based on project size and

geographical diversity. HUD reserves the right to select lower rated

applications, if necessary to achieve geographic diversity or to meet

the need for services. (For example, the Department retains the

authority to fund additional IHAs in rank order, even though they

scored less than PHAs that have not been selected for funding.)

8\. Processing panel sites.

The following HUD State Offices will be used as FY 1995 Processing

Panel sites:

For Public Housing Authority Applications:

Texas State Office

Fort Worth, Texas

For Indian Housing Authority Applications:

Illinois State Office

Chicago, Illinois

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9\. Headquarters responsibilities.

A. Headquarters, Office of Community Relations and Involvement

(OCRI), Economic Development and Supportive Services Division

(ED&SS) and the Office of Native American Programs have provided

in this Notice an attachment with FIC screening instructions to

be used by the State/Area/ONAP Offices to complete application

screening.

B. The training for the reviewers at the Processing Panel site will

be conducted by Headquarters Staff from ED&SS and ONAP.

C. Headquarter\'s ED&SS and ONAP will provide technical assistance

and guidance to the Processing Panel Grant Administrators (herein

referred to as PGA) and to the State/Area/ONAP Office Grant

Administrators (herein referred to as GA) throughout the process.

10\. Application processing and screening.

State/Area/ONAP Offices shall designate a Grant Administrator (GA) and

provide the name and phone number to Headquarters, and ensure the FIC

process is conducted in accordance with the procedures set forth in

the ORI Grants Management Handbook, the schedule outlined in paragraph

18 of this processing notice, and any additional guidance provided by

Headquarters. Application screening instructions will be provided

under separate cover.

A. Chapter 2 of the Resident Initiatives Grants Management Handbook

7490.1 describes the actions required in processing grant

applications by the receiving office. It also:

\(1\) contains instructions for the administration of grants

awarded for resident initiatives by OCRI and ONAP.

\(2\) provides specific instructions on the grant application

processing, grant agreement execution process, payment

procedures, required reporting, monitoring, grant

extensions, grant closeout procedures, etc.

B. Applications shall be received at the State/Area/ONAP Office in

accordance with Chapter 2 of the Resident Initiatives Grants

Management Handbook with the following additional guidance and

responsibilities.

\(1\) Responsible for date/time stamping each grant application

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the same day they are received and entering all submissions

in a master log, as attached, that includes: (1) code

number identification of the housing authority; (2) name

of the applicant; (3) date the application was received;

\(4\) time application was received; (5) name of staff

person logging in each application; (6) and type of grant

and amount. Grant designations are: S - Supportive

Services Only, R - Renovation/Conversion/New Construction/

Acquisition Only, or C - Combination Activities.

\(2\) Faxing the completed master log (no later than Monday, June

19, 1995) to Headquarters as follows:

o Public Housing Authority application log sheets to

Marcia Martin, ED&SS, FAX number (202) 708-0690.

oIndian Housing Authority application log sheets to

Charles V. Bell, ONAP, FAX number (202) 755-0182.

(3)If a State/Area/ONAP Office receives an application not in

their jurisdiction by the application deadline date,

ensuring the following:

a.To log the date and time of receipt in its Master Log;

b.Forward the application to the appropriate Office

within 24 hours via overnight mail with a transmittal

memo to the Director, PHD/ONAP;

c.Notify the Office by telephone that the application is

being forwarded.

oThe State/Area/ONAP Office receiving the

application shall log in the application according

to the prior State/Area/ONAP Office receipt date

and time.

(5)Responsible for reviewing the applications for completeness,

internal consistency and correct computations in accordance

with guidance provided. The applicant shall be notified in

writing of any curable technical deficiencies identified. A

follow-up telephone call must be made to the applicants who

are sent these letters to alert them on the matter.

Otherwise, the Sate/Area/ONAP

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Office shall mail to each applicant an acknowledgement of

the receipt of their application.

(a)The applicant must submit corrections to the

State/Area/ONAP Office in accordance with the

information specified in the Office\'s letter within 14

calendar days from the date of HUD\'s letter notifying

the applicant of any deficiencies. The corrections

must be date and time stamped and logged in (use the

corrected deficiencies log in order to clearly

delineate the receipt of the corrected deficiencies).

(b)If the applicant submits incomplete corrections prior

to the end of the 14 day calendar day period, the

State/Area/ONAP may contact the applicant requesting

complete and corrected materials. The material(s) must

be submitted by the end of the original 14 calendar day

period. No extension of the 14 day calendar day period

is permitted.

(6)The GA shall validate and certify the original master log

listing of all applications and provide full accountability

of all applications received, the corrected deficiencies

log, and any rejected applications. This documentation and

one (1) copy of the application with corrected deficiencies

shall be sent to Processing Panel by overnight mail.

C.In connection with the ORI Resident Initiatives Grants Management

Handbook, the SMIRPH/MIRS Grants Management Module will be used

in the FY 1995 FIC grant cycle. The receiving State/Area Office

will be responsible for assuring that initial application

information on all applications is entered into the computer

system. Do not delete any ineligible applications from the

database despite the instructions to do so in the Grants

Management Handbook at Chapter 2, 2-5.

D.The State/Area/ONAP Office GA will validate the correctness of

all information entered in each of the required screens of the

Grants Management Module. If the databases are not complete, the

GA will be asked to resubmit the databases to the Processing

Panel. The databases must include the Program Summary on Screen

7 at F3. This summary should be 4 to 5 brief sentences

describing the activities support by the grant award. The

Program Summary will be used in the Congressional

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Notification for those applications receiving grant awards. The

Program Summary information may be found in Tab 1 of the

application submission. Please make sure the summary contains

complete sentences with all spelling correct.

E.The SMIRPH/MIRS Grants Management computer module and user manual

complement the Resident Initiatives Grants Management Handbook

7490.01 and provides all automated data management requirements

for all phases of the grant process.

F.The State/Area/ONAP Offices will retain each original and one

copy of the FIC application and send 1 copy of each application

with related documents to the Processing Panel site guaranteeing

arrival by July 12, 1995. This means applications should be

shipped by overnight contractor in order that the shipment may be

tracked in case of loss or late arrival. Applications should be

organized in HA code order and grouped together in the shipping

carton.

The GA should ensure the shipment contains the following items:

(1)A transmittal letter. The transmittal letter shall include

\(1\) a list of the applications prepared for scoring, and (2)

a list of applications that will not be scored, along with

an explanation regarding why they will not be scored.

(2)A copy of the application master log.

(3)A copy of the corrected deficiency master log.

(4)A diskette with the SMIRPH/MIRS Grants Management Database

with the application information. Contact the State/Area

Office Data Base Administrator (DBA) with any questions.

In addition to the above, the following items should be attached

to each application:

(1)An application screening checklist.

(2)A copy of the curable deficiency letter (if applicable).

(3)A copy of the curable deficiency correction (If applicable).

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(G)Addresses for the Processing Panel Sites are as follows:

Public Housing Authority FIC Applications:

Texas State Office

1600 Throckmorton

Post Office Box 2905

Fort Worth, TX 76113-2905

Attn: Mr. Angeles Ramos

FIC Processing Panel Grant Administrator

Telephone: (817) 885-6282

Indian Housing Authority FIC Applications:

Eastern/Woodlands Office of Native American Programs

Ralph H. Metcalfe Federal Building

77 West Jackson Boulevard

Chicago, IL 60604-3507

Attn: Mr. Kevin Fitzgibbons

FIC Processing Panel Grant Administrator

Telephone: (312) 353-1282

11.Review and scoring of applications.

A.Two Processing Panel Grant Administrators (PGA) will be assigned

to oversee the review processes - one for public housing

applications and one for Indian housing applications. The PGA

will be assigned as the immediate contact to the Offices of

Community Relations and Involvement (OCRI) and Native American

Programs (ONAP) for the duration of the review, selection and

award process. The PGA shall:

1.Coordinate and manage the grant application review process.

2.Identify reviewers for applications. Reviewers may be

selected from HUD staff from both the local and other

State/Area/ONAP Offices.

3.Serve as liaison to Headquarters and to State/Area/ONAP

Offices.

4.Receive all applications from the State/Area/ONAP

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Offices and validate receipt based on the application

print-out from the Grants Management Module reports and the

hard copy of the application log sheet.

5.Work with the data entry person at the Processing Panel

entering data into the Grants Management Module. Validate

entry.

B.All reviewers will be trained in one training session by ED&SS

and ONAP staff at the beginning of the review process to assure

consistency.

C.Each application will be independently scored by two individuals.

Scoring will not be done by staff from the State/Area/ONAP Office

having jurisdiction over the applicant.

D.Scores will be posted on FIC scoresheets. The PGA will verify

that all factors are scored, math computations are correct, any

corrections to scores are explained in the comments for the

applicable factor, scoresheets are signed by the reviewer, and

validate all data entry with the scoresheets. Scores will be

entered into the Grants Management Module at the Processing Panel

site.

12.Ranking of applications.

A.The two highest ranked eligible applications in each funding

category per HUD Field (not State/Area) Office will be selected

for funding. In addition, grants will be awarded to the two

highest ranked, eligible IHA applications in each funding

category on a nationwide basis. The actual number of awards

granted per Field Office will be determined based on funding

available, and may be less than stated. All of the remaining

funds will be awarded based on project size and geographical

diversity. HUD reserves the right to select lower rated

applications, if necessary to achieve geographic diversity or to

meet the need for services. (For example, the Department retains

the authority to fund additional IHAs in rank order, even though

they scored less than PHAs that have not been selected for

funding.)

B.Each application that proposes acquisition, new construction, or

renovation activities shall be tagged during the screening

process. The Field Environmental Officer (FEO) will determine

the extent to which an environmental review under 24 CFR Part 50

is required for any tagged application.

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C.Whenever an environmental review is required, the Directors,

Public Housing Division/Administrators, Office of Native American

Programs assigns appropriate staff to perform the environmental

review and document its review on HUD Form 4128.1 within 10

working days (and no later than August 11, 1995) with support

from the Field Environmental Officer. Whenever the environmental

review encounters any problems that cannot be resolved within the

allowable time, staff shall notify the Director PHD/ONAP and

indicate the reasons why more time is needed for completion of

the environmental review. The environmental review schedule is

listed in section 18 of this notice.

13.Submission of selection data.

A.The Grants Management Module databases with all application and

scoring information completed must be submitted by the PGA to

Headquarters through standard procedures for transmission of

SMIRPH/MIRS databases. Ensure that data entry is complete before

the database is sent.

B.At the completion of the application review process the PGA will

ship score sheets (receipt requested) to the appropriate

State/Area/ONAP Offices.

C.Headquarters will transfer via SMIRPH/MIRS standard procedures

the Grants Management Module databases with application and

scoring information completed to the appropriate State/Area/ONAP

Offices once grant awards are made.

14.Congressional notifications.

Congressional notifications will be prepared by OCRI and ONAP based on

the information in the Grants Management Module. The memorandum will

be submitted along with a listing of grant awards to the Assistant

Secretary for Congressional and Intergovernmental Relations, who will

officially notify Congress.

15.Notifications to selectees and non-selectees.

A.Headquarters will notify all applicants, in writing, of their

funding status. Letters to applicants selected for funding will

be sent when:

(1)Headquarters has completed the HUD-185.

(2)Congressional and Intergovernmental Relations has completed

the notification of Congress.

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B.Copies of the award letters will be sent to the State/Area/ONAP

Offices. The copy shall be provided to the Field Accounting

Division to reserve grant funds.

16.Grant agreement preparation and process.

A grant agreement will be prepared in accordance with Handbook

7490.01, Chapter 4. A standardized grant agreement to accompany the

HUD-1044 will be provided to assist in this process.

17.Application debriefing.

State/Area/ONAP Offices will conduct debriefings of unfunded

applications using the score sheets in accordance with guidance

provided in Handbook 7490.01, Chapter 3, 3-7.

18.Family Investment Centers processing schedule.

STEPS DEADLINE DATE

1.Designate State/Area/ONAP Office Grant

Administrator (GA), provide name/phone

number to ED&SS/ONAP June 12, 1995

2.Application Deadline June 15, 1995

3.Fax master log to ED&SS/ONAP June 16, 1995

4.Begin data entry of applications

in Grants Management Module June 16, 1995

5.Acknowledgement letters sent to

applicants June 23, 1995

6.Screening for technical

deficiencies completed and

letters sent to PHAs/IHAs June 23, 1995

7.State/Area/ONAP Offices ship

applications to the Processing

Panel with diskette of

of application information from

the Grants Management Module

assuring receipt by July 12, 1995

8.Environmental Reviews begin July 13, 1995

9.Processing Panel Grant

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administrator begins

organization of applications

for review process July 14, 1995

10.Processing Panel Grant

Administrator completes

organization of applications

for review process July 17, 1995

11.Reviewers trained July 18, 1995

12.Review begins July 19, 1995

13.Review of applications

complete August 9, 1995

14.Data entry completed in Grants

Management Module by data entry

person and validated by the

PGA August 9, 1995

15.Grants Management Module databases

transmitted to Headquarters August 11, 1995

16.Environmental Reviews completed August 11, 1995

17.ED&SS/ONAP ranks all applications August 18, 1995

18.Assistant Secretary approves

grant selections August 21, 1995

19.Congressional Notifications August 21, 1995

20.List of geographical regional

and national grant awards to

State/Area Offices August 24, 1995

21.Environmental Review Information on

Selected Applicants forwarded to

Headquarters from State/Area/ONAP

Offices August 24, 1995

22.Award and disapproval letters

completed by Headquarters. Copy of

award letter to FAD August 24, 1995

23.Headquarters sends HUD-185 August 24, 1995

24.FAD completes reservation of

FIC grant funds August 28, 1995

25.Grant Agreements completed and

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sent to grantees September 15, 1995

26.Grant Agreements signed by

PHA/IHA and returned to the

State/Area/ONAP Office October 5, 1995

27.Grant Agreements signed by Public

Housing Administrators and

ONAP Administrators October 10, 1995

28.Budget line items entered into

LOCCS October 12, 1995

29.Funds available for grantees to

drawdown October 18, 1995

For further information, contact Marcia Y. Martin, Office of Community

Relations and Involvement (OCRI), Room 4106, at (202) 708-4214, or
Charles

V. Bell, Office of Native American Programs (ONAP), Room P8204 at (202)

755-0088, U.S. Department of Housing and Urban Development, 451 Seventh

Street, S.W., Washington, D.C. 20410. \[These are not toll-free
telephone

numbers.\]

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Joseph Shuldiner

Assistant Secretary for

Public and Indian Housing

Attachments

FIC Application Log

FIC Deficiency Log

Screening Checklist

Comment Form/Certification

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FY 1995 FAMILY INVESTMENT CENTERS PROGRAM

MASTER LOG

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FY 1995 FAMILY INVESTMENT CENTERS CORRECTED DEFICIENCIES LOG

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FY 1995 FAMILY INVESTMENT CENTERS CORRECTED DEFICIENCIES LOG

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FY 1995 FAMILY INVESTMENT CENTERS PROGRAM

MASTER LOG

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FY 1995 FAMILY INVESTMENT CENTERS GRANT

SCREENING CHECKLIST

Supportive Services Only

(TABS 1,2,3,4 & 7)

Directions: Use this checklist in conjunction with the screening

instructions for Supportive Services (Only) activities to screen the
entire

application to determine whether it is complete, is internally
consistent,

and contains correct computations. The instructions provide guidance for

curable and non-curable deficiencies. The applicant will have an

opportunity to correct any curable deficiencies identified.

APPLICANT
NAME\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TYPE OF FUNDING SUPPORTIVE SERVICES (ONLY)

HA CODE
NUMBER\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TAB/DESCRIPTION LIST DEFICIENCY(IES)

CURABLE (Y/N) COMPLETE OR N/A (/)

===========================================================================

1FACT SHEET, SUMMARY SHEET

NARRATIVE, CERTIFICATIONS

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2STANDARD FORMS 424/424A

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3a CERTIFICATION ASSURANCES

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3b DRUG-FREE WORKPLACE

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3c FORM 2880

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3d FORM LLL

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4A DESCRIPTION OF ASSISTANCE

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4B NEED FOR SUPPORTIVE SERVICES

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1

TAB/DESCRIPTION LIST DEFICIENCY(IES)

CURABLE (Y/N) COMPLETE OR N/A (/)

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4CDESCRIPTION OF SUPPORTIVE

SERVICES

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4DCOMMITMENT TO PROVIDE

SERVICES

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4EDESCRIPTION OF PUBLIC/

PRIVATE ASSISTANCE

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4FDESCRIPTION OF THE PLAN

FOR CONTINUING SERVICES

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4GSERVICE AGENCY

CERTIFICATION

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4H FACILITY LOCATION

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4I FACILITY CONTROL

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4J FSS CERTIFICATION

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4KSERVICE COORDINATOR

CERTIFICATION

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4L RESIDENT INVOLVEMENT

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4M RESIDENT EMPLOYMENT

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4NOTHER RESOURCE

COMMITMENTS

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4OCGP/CIAP

CERTIFICATION

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4PPROGRAM BUDGET/

MILESTONES

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2

TAB/DESCRIPTION LIST DEFICIENCY(IES)

CURABLE (Y/N) COMPLETE OR N/A (/)

===========================================================================

4Q CERTIFICATION FORM

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TAB 7

BUDGET OUTLINE

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

===========================================================================

SUMMARY: Place check mark on applicable line

\_\_\_\_\_\_ Application has no deficiencies.

\_\_\_\_\_\_ Application has no curable technical deficiencies.

\_\_\_\_\_\_ Application has \_\_\_\_\_ (number) of curable technical
deficiencies.

===========================================================================

REVIEWER(S):\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE\_\_\_\_\_\_\_\_\_\_\_\_\_

3

FY 1995 FAMILY INVESTMENT CENTERS GRANT

SCREENING CHECKLIST

Renovation/Conversion/Construction/Acquisition (Only)

(TABS 1,2,3,5 & 7)

Directions: Use this checklist in conjunction with the screening

instructions for Renovation/Conversion/Construction/Acquisition
activities

(only) to screen the entire application to determine whether it is

complete, is internally consistent, and contains correct computations.
The

instructions provide guidance for curable and non-curable deficiencies.

The applicant will have an opportunity to correct any curable
deficiencies

identified.

APPLICANT NAME
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TYPE OF FUNDING RENOVATION/CONVERSION/CONSTRUCTION/ACQUISITION (ONLY)

HA CODE
NUMBER\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TAB/DESCRIPTION LIST DEFICIENCY(IES)

CURABLE (Y/N) COMPLETE OR N/A (/)

===========================================================================

1FACT SHEET, SUMMARY SHEET

NARRATIVE, CERTIFICATION

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2STANDARD FORM 424/424A

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3a CERTIFICATION ASSURANCES

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3b DRUG-FREE WORKPLACE

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3c FORM 2880

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3d FORM LLL

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5A FACILITY LOCATION

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5B FACILITY CONTROL

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5C RESIDENT EMPLOYMENT

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

1

TAB/DESCRIPTION LIST DEFICIENCY(IES)

CURABLE (Y/N) COMPLETE OR N/A (/)

===========================================================================

5DCGP/CIAP

CERTIFICATION

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5EPROGRAM BUDGET/

MILESTONES

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5FCERTIFICATION

FORM

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5GCOMMITMENT TO PROVIDE

SERVICES

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5HDESCRIPTION OF THE NEED

FOR SUPPORTIVE SERVICES

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5IDESCRIPTION OF

SUPPORTIVE SERVICES

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5JDESCRIPTION OF PUBLIC/

PRIVATE ASSISTANCE

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5K SERVICE AGENCY CERTIFICATION

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5LDESCRIPTION OF PLAN FOR

CONTINUING SERVICES

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TAB 7

BUDGET OUTLINE

===========================================================================

SUMMARY: Place check mark on applicable line

\_\_\_\_\_\_ Application has no deficiencies.

\_\_\_\_\_\_ Application has no curable technical deficiencies.

\_\_\_\_\_\_ Application has \_\_\_\_\_ (number) of curable technical
deficiencies.

===========================================================================

REVIEWER(S):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE\_\_\_\_\_\_\_\_\_\_\_\_\_

2

FY 1995 FAMILY INVESTMENT CENTERS GRANT

SCREENING CHECKLIST

Combination Services

(TABS 1,2,3,6 & 7)

Directions: Use this checklist in conjunction with the screening

instructions for Combination
Renovation/Conversion/Construction/Acquisition

and Supportive Services activities to screen the entire application to

determine whether it is complete, is internally consistent, and contains

correct computations. The instructions provide guidance for curable and

non-curable deficiencies. The applicant will have an opportunity to

correct any curable deficiencies identified.

APPLICANT
NAME\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TYPE OF FUNDING COMBINATION SERVICES

HA CODE
NUMBER\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TAB/DESCRIPTION LIST DEFICIENCY(IES)

CURABLE (Y/N) COMPLETE OR N/A (/)

===========================================================================

1FACT SHEET, SUMMARY SHEET

NARRATIVE, CERTIFICATION

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2STANDARD FORM 424/424A

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3a CERTIFICATION ASSURANCES

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3b DRUG-FREE WORKPLACE

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3c FORM 2880

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3d FORM LLL

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6ADESCRIPTION OF

ASSISTANCE

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6BNEED FOR SUPPORTIVE

SERVICES

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6CDESCRIPTION OF SUPPORTIVE

SERVICES

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

1

TAB/DESCRIPTION LIST DEFICIENCY(IES)

CURABLE (Y/N) COMPLETE OR N/A (/)

===========================================================================

6DSERVICE AGENCY

CERTIFICATION

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6EEVIDENCE OF FIRM

COMMITMENT

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6FDESCRIPTION OF PLAN FOR

CONTINUING SERVICES

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6GDESCRIPTION OF SERVICES

HA RESIDENTS

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6H RESIDENT EMPLOYMENT

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6I FSS CERTIFICATION

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6JSERVICE COORDINATOR

CERTIFICATION

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6K RESIDENT INVOLVEMENT

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6L CIAP/CGP CERTIFICATION

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6M PROGRAM BUDGET MILESTONES

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6N OTHER RESOURCE COMMITMENTS

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6O FACILITY LOCATION

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6P FACILITY CONTROL

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6Q CERTIFICATION FORM

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TAB 7

BUDGET OUTLINE

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

===========================================================================

2

SUMMARY: Place check mark on applicable line

\_\_\_\_\_\_ Application has no deficiencies.

\_\_\_\_\_\_ Application has no curable technical deficiencies.

\_\_\_\_\_\_ Application has \_\_\_\_\_ (number) of curable technical
deficiencies.

===========================================================================

REVIEWER(S):\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE\_\_\_\_\_\_\_\_\_\_\_\_\_

3

FY 1995 FAMILY INVESTMENT CENTERS GRANT

COMMENT FORM

APPLICANT
NAME:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TYPE OF FUNDING/CHECK ONE:

\_\_\_\_ Supportive Services (Only)

\_\_\_\_ Renovation/Conversion/Construction/Acquisition (Only)

\_\_\_\_ Combination Services

HA CODE:\_\_\_\_\_\_\_\_\_\_\_\_

REGARDING TAB(S):

\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

COMMENTS:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Commenter

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature of Commenter Date

FY 1995 FAMILY INVESTMENT CENTERS GRANT

RESCREENING CHECKLIST

Supportive Services (Only)

(TAB 4)

Directions: Use this checklist in conjunction with the screening

instructions to screen responses to curable deficiencies to determine

whether they are complete, internally consistent, and contain correct

computations.

APPLICANT
NAME\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TYPE OF FUNDING SUPPORTIVE SERVICES (ONLY)

HA CODE NUMBER
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

===========================================================================

ITEM RESCREENED IS IT CURED?

\_\_\_\_ TAB 1 FACT SHEET/NARR/CERT. Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 2 STANDARD FORMS 424/424A Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 3a CERT. ASSURANCES Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 3b DRUG-FREE WORKPLACE Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 3c FORM 2880 Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 3d FORM LLL Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 4A DESCRIPTION OF ASSISTANCE Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 4B NEED FOR SUPP. SERVICES Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 4C DESC. OF SUPP. SERVICES Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 4D COMMIT. TO PROVIDE SERVICES Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 4E DESC. OF PUB/PRIV ASSISTANCE Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 4F DESC. PLAN FOR CONT. SERVICES Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 4G SERVICE AGENCY CERTIFICATION Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 4H FACILITY LOCATION Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 4I FACILITY CONTROL Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 4J FSS CERTIFICATION Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 4K SERVICE COORD. CERTIFICATION Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 4L RESIDENT INVOLVEMENT Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 4M RESIDENT EMPLOYMENT Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 4N OTHER PROGRAM COMMITMENTS Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 4O CGP/CIAP CERTIFICATION Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 4P PROGRAM BUDGET MILESTONES Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 4Q CERTIFICATION FORM Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 7 BUDGET OUTLINE Y\_\_\_ N\_\_\_

SUMMARY: Place check mark on applicable line

\_\_\_\_\_\_After rescreening, the application has no deficiencies \--
all

deficiencies are cured \-- forward for rating.

\_\_\_\_\_\_\_ After rescreening, the application continues to have
deficiencies

\-- not all deficiencies cured \-- application not to be considered

for rating.

===========================================================================

REVIEWER(S)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE\_\_\_\_\_\_\_\_\_\_\_\_\_

FY 1995 FAMILY INVESTMENT CENTERS GRANT

RESCREENING CHECKLIST

Renovation/Conversion/Construction/Acquisition (Only)

(TAB 5)

Directions: Use this checklist in conjunction with the screening

instructions to screen responses to curable deficiencies to determine

whether they are complete, internally consistent, and contain correct

computations.

APPLICANT
NAME\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TYPE OF FUNDING RENOVATION/CONVERSION/CONSTRUCTION/ACQUISITION (ONLY)

HA CODE NUMBER
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

===========================================================================

ITEM RESCREENED IS IT CURED?

\_\_\_\_ TAB 1 FACT SHEET/NARR/CERT. Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 2 STANDARD FORMS 424/424A Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 3a CERT. ASSURANCES Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 3b DRUG-FREE WORKPLACE Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 3c FORM 2880 Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 3d FORM LLL Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 5A FACILITY LOCATION Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 5B FACILITY CONTROL Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 5C RESIDENT EMPLOYMENT Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 5D CGP/CIAP CERTIFICATION Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 5E PROGRAM/BUDGET MILESTONES Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 5F CERTIFICATION FORM Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 5G COMM. TO PROVIDE SERVICES Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 5H DESC. OF NEED FOR SUPP. SERV. Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 5I DESC. OF SUPPORTIVE SERVICES Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 5J DESC. OF PUB/PRIV ASSISTANCE Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 5K SERVICE AGENCY CERTIFICATION Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 5L DESC. PLAN FOR CONT. SERVICES Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 7 BUDGET OUTLINE Y\_\_\_ N\_\_\_

SUMMARY: Place check mark on applicable line

\_\_\_\_\_\_After rescreening, the application has no deficiencies \--
all

deficiencies are cured \-- forward for rating.

\_\_\_\_\_\_After rescreening, the application continues to have
deficiencies

\-- not all deficiencies cured \-- application not to be considered

for rating.

===========================================================================

REVIEWER(S)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE\_\_\_\_\_\_\_\_\_\_\_\_\_

FY 1995 FAMILY INVESTMENT CENTERS GRANT

RESCREENING CHECKLIST

Combination Services

(TAB 6)

Directions: Use this checklist in conjunction with the screening

instructions for screen responses to curable deficiencies to determine

whether they are complete, internally consistent, and contain correct

computations.

APPLICANT NAME
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TYPE OF FUNDING COMBINATION SERVICES

HA CODE NUMBER
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

===========================================================================

ITEM RESCREENED IS IT CURED?

\_\_\_\_ TAB 1 FACT SHEET/NARR/CERT. Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 2 STANDARD FORMS 424/424A Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 3a CERT. ASSURANCES Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 3b DRUG-FREE WORKPLACE Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 3c FORM 2880 Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 3d FORM LLL Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 6A DESCRIPTION OF ASSISTANCE Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 6B NEED FOR SUPP. SERVICES Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 6C DESC. OF SUPPORTIVE SERVICES Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 6D SERVICE AGENCY CERTIFICATION Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 6E EVIDENCE OF FIRM COMMITMENT Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 6F DESC. OF PLAN FOR CONT. SERV. Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 6G DESC. OF SERV. BY HA RES. Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 6H RESIDENT EMPLOYMENT Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 6I FSS CERTIFICATION Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 6J SERVICE COORDINATOR CERT. Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 6K RESIDENT INVOLVEMENT Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 6L CIAP/CGP CERTIFICATION Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 6M PROGRAM BUDGET/MILESTONES Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 6N OTHER RESOURCE COMMITMENTS Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 6O FACILITY LOCATION Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 6P FACILITY CONTROL Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 6Q CERTIFICATION FORM Y\_\_\_ N\_\_\_

\_\_\_\_ TAB 7 BUDGET OUTLINE Y\_\_\_ N\_\_\_

SUMMARY: Place check mark on applicable line

\_\_\_\_\_\_After rescreening, the application has no deficiencies \--
all

deficiencies are cured \-- forward for rating.

\_\_\_\_\_\_\_ After rescreening, the application continues to have
deficiencies

\-- not all deficiencies cured \-- application not to be considered

for rating.

===========================================================================

REVIEWER(S)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE\_\_\_\_\_\_\_\_\_\_\_\_\_

\*U.S. Government Printing Office: 1995 - 387-734/20072