Supplemental Instructions for the

Immediate Services Program Standard Application Format

Crisis Counseling Assistance and Training Program

**Immediate Services Program**

These supplemental instructions describe the purpose of each section of
*the Immediate Services Program (ISP) Standard Application Format* and
provides instruction on completing the application and required forms
and worksheets. The instructions are most useful when reviewed
simultaneously with the *ISP Standard Application Format.* The
application format and supplemental instructions are cross-referenced
with corresponding page numbers.

The *ISP Standard Application Format* consists of a signature sheet, the
Standard Form 424 Request for Federal Assistance, and the following five
parts:

-   **Part I: Geographic Areas and Initial Needs Assessment** includes
    the areas within the designated disaster area for which services
    will be provided, an estimate of the number of disaster victims
    requiring assistance, and an explanation of special circumstances
    related to the disaster that may increase the need for crisis
    counseling services;

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-   **Part II: State and Local Resources and Capabilities** describes
    the State and local resources and capabilities, and an explanation
    of why these resources cannot meet the estimated disaster crisis
    counseling needs;

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-   **Part III: Response Activities from Date of Incident** describes
    response activities from the date of the disaster incident to the
    date of the application submission;

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-   **Part IV: Plan of Services** includes a list of service providers
    and a plan of services to meet the identified needs, including plans
    for staffing, training, and staff support; and

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-   **Part V: Budget** includes a format for a budget that is integrated
    with the needs assessment and program plan.

Part II and specific sections of Part IV may be drafted prior to a
disaster and submitted to FEMA and CMHS for review. These materials
should be submitted to the FEMA regional office, which will forward to
CMHS for recommendations. CMHS will review and submit to the FEMA
Regional Director. The FEMA Regional Director may pre-approve the
submission to expedite processing of future Immediate Services
applications.

**Signature Sheet**

**Purpose:** The Governor's Authorized Representative (GAR) is required
to sign the Immediate Services Program application. The GAR must also
certify that crisis counseling needs exceed the capacity of available
State and local resources to respond. The signature sheet is used as a
transmittal letter and fulfills the requirement to have the GAR's
signature and certification on the application. Most States find it
easier to use this form than to draft a separate transmittal letter.

**Where to Find the Coversheet in the Immediate Services Application:**
The signature sheet is page one of the application.

**Instruction:** The GAR is the only State official authorized to
represent the Governor and apply for Immediate Services funding. An
Immediate Services application will not be accepted by the Federal
Emergency Management Agency (FEMA) without the GAR's signature. The
Director of the State Mental Health Authority (SMHA) does not have
authority to apply for Immediate Services Program funds without the
GAR's signature. Page three of this document provides a signature sheet
that may be used to obtain the GAR's signature.

Note: While the GAR's signature and certification are required for
submission of an Immediate Services Program application, the signature
sheet provided in this package is an [optional]{.underline} form**.** If
the State prefers, a transmittal letter to the FEMA Disaster Recovery
Manager (DRM) from the GAR may be used. Be sure that the transmittal
letter states the amount of funding requested and the Governor agrees to
and certifies the four points listed on the signature sheet.

**Standard Form 424 (SF-424) Request for Federal Assistance**

**Purpose:** The SF 424 is the Federal form required by the Office of
Management and Budget (OBM) on grant applications. All States applying
for Immediate Services funds must submit a completed SF 424 signed by
the Governor's Authorized Representative (GAR).

**Where to Find the SF-424:** A copy of the SF 424 form is included with
this application package. Additional copies of the SF 424 may be
obtained from FEMA or CMHS. Electronic versions of the SF-424 may be
obtained through the CMHS website at
[www.mentalhealth.org/cmhs/EmergencyServices](http://www.mentalhealth.org/cmhs/EmergencyServices).

**Instruction:** The SF 424 is an attachment to the application. The
SF-424 is separated into numbered blocks requesting information that is
critical in assuring an accurate funding award. Instructions are
provided with the SF 424. The following information may be helpful in
completing the information blocks of the SF 424 for an Immediate
Services Program.

-   **Block 1 (Type of Submission)**: ISP applicants should check the
    box labeled "non-construction."

-   **Block 2 (Date Submitted)**: Enter actual date of submission. This
    must be no later than 14 days following the Presidential disaster
    declaration. The date of the declaration is day zero (0). The day
    after the declaration date is day one (1) for determining the
    application due date.

-   **Block 3 (Date Received by State)**: Leave blank or enter date
    application submitted to the GAR. This block is not used by the
    Federal government in the ISP application process.

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-   **Block 4 (Date Received by Federal Agency):** Leave blank.

-   **Block 5 (Applicant's Information)**: This section should be
    completed with information for the Governor's Authorized
    Representative, who is the legal applicant. Additional contact
    information should be provided in the application for the project
    director at the State Mental Health Authority.

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-   **Block 6 (Employer Identification Number):** The Employer
    Identification Number is an IRS number and should be obtained from
    the State's fiscal management office.

-   **Block 7 (Type of Applicant):** The type of applicant is "State."
    Therefore, applicants should enter the letter "A" in the box
    provided.

-   **Block 8 (Type of Application)**: Applicants should check the box
    labeled "new."

-   **Block 9 (Name of Federal Agency):** The Federal agency is the
    "Federal Emergency Management Agency."

-   **Block 10 (The Code of Federal Domestic Assistance Number)**: The
    Code of Federal Domestic Assistance (CFDA) number for the Immediate
    Services Application is the following: 83.539.

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-   **Block 11 (Descriptive Title of Applicant's Project)** This may be
    listed as "Immediate Services Program - Crisis Counseling Project"
    or if the State has already titled the project (e.g. "Project
    Recovery"), the title may be used.

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-   **Block 12 (Areas Affected by the Project)** Applicants should list
    declared areas to be served, based on the President's disaster
    declaration. Even if the Immediate Services application is based on
    a different breakdown for areas, the SF 424 submitted to FEMA must
    correspond with areas listed in the Presidential declaration
    (generally declarations specify counties as geographic units
    included in the declaration, but may specify parishes,
    municipalities or other large geographic area designations). Even if
    only part of an geographic unit (such as a county) listed in the
    Presidential declaration will be served, list the entire geographic
    unit.

-   

-   **Block 13 (Proposed Project Start and End Dates)**: technically,
    this box is asking for the "[proposed project]{.underline}" start
    and end dates. Since the application is due on the fourteenth day
    following the declaration, the date of the ["proposed
    project"]{.underline} must be that day following the date of the ISP
    submission. You may not post date the SF-424. The end date of the
    "[proposed project"]{.underline} which should be indicated on the
    SF-424 is the sixtieth (60^th^) day after the date of declaration.

-   

-   The CCP is a sixty-day program which begins on the date of the
    disaster declaration. Day one is the day after the date of
    declaration. Costs incurred to carry out services funded by the CCP
    may be reimbursed from the Date of Incident (DOI) through the date
    the ISP is applied for (typically day fourteen). Please note in the
    budget section that separate budgets are required for the projected
    program period and the reimbursable period leading up to the
    submission of the ISP grant application. As an example, if the
    President declares a disaster on March 1, the 60 day ISP program
    period will begin that day which is day zero. The sixty day period
    will end April 30. The ["proposed project"]{.underline} dates on the
    SF-424 would be March 15 as a start date, and April 30 as an end
    date. The reimbursable budget would represent those costs incurred
    from the date of declaration or the DOI if prior to the declaration,
    through March 15.

-   

-   **Block 14 (Congressional Districts)**: List all Congressional
    Districts served by the project.

-   **Block 15 (Estimated Funding)**: The amount of Federal assistance
    requested should be provided in block a. In-kind contributions
    should be listed in c or d. There should be no program income.
    Estimates may be rounded to the nearest dollar only.

-   **Block 16 (Is the application subject to review by State Executive
    Order 12372 Process?)**: Before completing this block, applicants
    should check with the State's Single Point of Contact for Executive
    Order 12372.

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-   **Block 17 (Is the applicant delinquent on any Federal debt?)**: The
    State must answer this question in consultation with its fiscal
    management offices.

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-   **Block 18, (Signature Block).** The signature block must be
    completed by the Governor's Authorized Representative (GAR) No one
    else may sign for the Governor. A SF 424 signed by the State Mental
    Health Agency Director or another employee of the State Mental
    Health Authority will be returned by FEMA and may delay processing
    of the application.

**Part I: Geographic Areas and Initial Needs Assessment**

**Purpose:** The CCP regulations lists six required elements of the
Immediate Services application. The first two elements are:

1.  The geographical areas within the designated disaster area for which
    services will be provided; and

2.  An estimate of the number of disaster victims requiring assistance.

To simplify the application process, these elements have been combined
into Part One of the application. Consequently, the application includes
a total of five parts in contrast to the six required elements of the
regulations.

The first element of the regulations requires the State to disclose
which areas will be served by the Immediate Services project. The second
element requires that the State assess the needs and determine how many
disaster victims will be assisted. This information has been streamlined
for the revised pilot application and can be provided primarily in a
summary table developed using a Needs Assessment Formula developed by
CMHS in consultation with experienced State Disaster Mental Health
Coordinators. In addition, because special circumstances and crisis
counseling needs may not be captured through the needs assessment
formula, the application format provides space for an anecdotal
description of crisis counseling needs and special circumstances
surrounding the disaster. Applicants are strongly encouraged to provide
some narrative description of needs.

The needs assessment provides the foundation for all grant program
activities under the Crisis Counseling Assistance and Training Program.
Because the timeframe for developing an Immediate Services Program
application is very limited, applicants must rely on the best available
information available during the initial aftermath of the disaster.[^1]
The most reliable data on disaster damage generally will come from the
FEMA Preliminary Damage Assessment, which can be provided by the FEMA
Human Services Officer responsible for the disaster response. Other
important sources of information on crisis counseling needs may include
the State Emergency Management Agency, voluntary agencies such as the
American Red Cross, and media sources. In addition, any crisis
counselors and other human service workers deployed by the State Mental
Health Authority or other public agencies in the immediate aftermath of
a disaster may provide information on crisis counseling needs not
revealed through the damage assessment formula.

**Where to find Part I in the Immediate Services application**: Part I
begins on page 2 of the application

#### Instruction: Part I of the application format is divided into three sections: A) Geographic Areas to be Served and Estimated Need, B) Needs Assessment Formula, and C) Description of Crisis Counseling Needs and Special Circumstances. Instructions for completing each section are provided separately below.

**A. Geographic Areas to be Served and Estimated Need**

All applicants are required under Federal regulation to identify the
areas within the Presidentially declared disaster areas for which
services will be provided. State Disaster Mental Health Coordinators
should use data from all available sources to identify areas most in
need of crisis counseling services. They must also ensure that available
services within the existing mental health system are not sufficient to
meet those needs.

The Presidential declaration is generally for counties, parishes,
municipalities, tribal lands or other large geographic area
designations. Counties are the most commonly designated geographic areas
in Presidential disaster declarations. In the past, States were required
to submit applications based on the geographic designation used in the
Presidential declaration of the disaster. In the current application
format, the State may use any geographic or organizational identifier to
designate the areas to be served, as long as all areas to be served fall
within the area declared by the President to be eligible for individual
assistance.

How the State elects to designate disaster areas to be served by the
Immediate Services project is generally dependent on how mental health
services are organized in the State and the location of local providers.
The mental health service areas in the State may not organized by
county, parish, municipality, or tribal lands. In developing an
Immediate Services project, the State does not have to define the areas
in the same manner as the Presidential declaration (i.e., by county).
However, the service areas defined by the State but must stay within the
boundaries established by the Presidential declaration and the areas
must be clearly defined in the application. It is recommended a map of
the service areas be attached to the application, particularly if the
State is designating the disaster area differently than the Presidential
declaration. The FEMA reviewers are required to verify that the
Immediate Services project is only providing services in areas declared
by the President. If a map is provided, they will be able to compare it
to their map of Presidentially declared areas.

Once the State has determined how best to designate the disaster areas,
the areas need to be listed on the left hand column of the table
provided under the text box entitled "A. Geographic Areas and Estimated
Need.**"** This table is provided on page 2 of the Standard Application
Format. The right hand column of the table requires that the applicant
enter an estimate of the number of disaster victims requiring
assistance. These estimates are developed using the CMHS Needs
Assessment formula, which is described on the following page.

**B. Needs Assessment Formula**

The CMHS Needs Assessment Formula Sheet was developed through extensive
consultation with State Mental Health Authorities experienced with the
Crisis Counseling Program. It provides a simple methodology for
estimating potential crisis counseling needs based on the number of
deaths, injuries, damaged or destroyed homes, and other disaster losses
documented in the community. This formula serves as the foundation of
the Immediate Services Application and can help in identifying
geographic service areas for the program and staffing needs.

[How to complete the CMHS Damage Assessment Formula]{.underline}:

FEMA and the State Emergency Management Agency (SEMA) conduct a
Preliminary Damage Assessment (PDA) following the disaster. The
information is updated as new information is collected. The State
Disaster Mental Health Coordinator should contact FEMA and/or SEMA and
ask for copies of damage assessment information. Make sure to use the
most current data available the day the formula is completed. Damage
assessment can change rapidly. If possible, the State should obtain PDA
data that correspond to the service areas. In some cases, it may be
necessary to combine PDA data from one or more counties to obtain
complete PDA data for the service region identified by the State for the
Immediate Services Program.

The CMHS Needs Assessment Formula is provided in a chart format on page
3 of the Standard Application format and can be modified electronically.
The left hand column of the chart entitled "Loss Categories" identifies
major types of loss that may result in crisis counseling needs. These
needs are listed in the chart as follows:

+-----------------------------------------------------------------------+
| **Loss**                                                              |
|                                                                       |
| **Categories**                                                        |
+-----------------------------------------------------------------------+
| Type of Loss                                                          |
+-----------------------------------------------------------------------+
| [Dead]{.mark}                                                         |
+-----------------------------------------------------------------------+
| [Hospitalized]{.mark}                                                 |
+-----------------------------------------------------------------------+
| [Non-Hospitalized injured]{.mark}                                     |
+-----------------------------------------------------------------------+
| [Homes destroyed]{.mark}                                              |
+-----------------------------------------------------------------------+
| [Homes "major damage"]{.mark}                                         |
+-----------------------------------------------------------------------+
| [Homes "minor damage"]{.mark}                                         |
+-----------------------------------------------------------------------+
| [Disaster unemployed]{.mark}                                          |
|                                                                       |
| [(Others---Specify)]{.mark}                                           |
+-----------------------------------------------------------------------+

These loss categories generally correspond to categories of data
collected by FEMA and the State Emergency Management Agency (SEMA)
during the Preliminary Damage Assessment. Data on the last category
(Disaster Unemployed) may be available from FEMA and may change
significantly during the ISP period.

The second column of the chart, entitled "Number of Persons" should be
completed using data from the Preliminary Damage Assessment. If FEMA
Preliminary Damage Assessment data have not been collected in this
disaster, the State should identify alternate sources of data that may
be used. These may include data from the American Red Cross or data from
the State Emergency Management Agency. If the State is using data that
is not provided by FEMA, this should be identified clearly in the
application.

The second column of the chart below has been completed with sample
data:

+------------------------------------+---------------------------------+
| **Loss**                           | **Number of Persons**           |
|                                    |                                 |
| **Categories**                     |                                 |
+------------------------------------+---------------------------------+
| Type of Loss                       | Number                          |
+------------------------------------+---------------------------------+
| Dead                               | [25]{.mark}                     |
+------------------------------------+---------------------------------+
| Hospitalized                       | [250]{.mark}                    |
+------------------------------------+---------------------------------+
| Non-Hospitalized injured           | [15]{.mark}                     |
+------------------------------------+---------------------------------+
| Homes destroyed                    | [1000]{.mark}                   |
+------------------------------------+---------------------------------+
| Homes "major damage"               | [3000]{.mark}                   |
+------------------------------------+---------------------------------+
| Homes "minor damage"               | [5000]{.mark}                   |
+------------------------------------+---------------------------------+
| Disaster unemployed                | [200]{.mark}                    |
|                                    |                                 |
| (Others---Specify)                 |                                 |
+------------------------------------+---------------------------------+

Once Preliminary Damage Assessment Data have been entered into the
chart, final numbers are determined by a formula, multiplying the
numbers from the preliminary damage assessment by the average number of
persons per household in the impacted area and then multiplying this
number by the percentage estimated to need and access crisis counseling
services. The Average Number of persons per household (ANH) is a number
available from the Census Bureau. If the State is unable to determine
the ANH for the identified service area, then use the national average
figure of 2.5. Using this average figure, the sample data in the example
have been multiplied in the following chart. This number has been
multiplied by the "At-Risk Multiplier" which is provided in the chart.

Example:

+-----------------+-----------+----------+----------+-----------------+
| **Loss          | **Number  | **ANH**  | **Range  | **Total**       |
| Categories**    | of**      |          | Est      |                 |
|                 |           |          | imated** |                 |
|                 | **        |          |          |                 |
|                 | Persons** |          |          |                 |
+-----------------+-----------+----------+----------+-----------------+
| Type of Loss    | Number    | Multiply | At-Risk  | Number of       |
|                 |           |          |          | persons         |
|                 |           | by       | Mu       | targeted per    |
|                 |           |          | ltiplier | loss category   |
|                 |           | ANH      |          |                 |
|                 |           | \[2.5\]  |          |                 |
+-----------------+-----------+----------+----------+-----------------+
| Dead            | 25        | 62       | 100%     | [62]{.mark}     |
+-----------------+-----------+----------+----------+-----------------+
| Hospitalized    | 250       | 625      | 35%      | [219]{.mark}    |
+-----------------+-----------+----------+----------+-----------------+
| N               | 10        | 25       | 15%      | [4]{.mark}      |
| on-hospitalized |           |          |          |                 |
| Injured         |           |          |          |                 |
+-----------------+-----------+----------+----------+-----------------+
| Homes destroyed | 1000      | 2500     | 100%     | [2500]{.mark}   |
+-----------------+-----------+----------+----------+-----------------+
| Homes           | 3000      | 7500     | 35%      | [2625]{.mark}   |
|                 |           |          |          |                 |
| "Major Damage"  |           |          |          |                 |
+-----------------+-----------+----------+----------+-----------------+
| Homes "Minor    | 5000      | 12500    | 15%      | [1875]{.mark}   |
| Damage"         |           |          |          |                 |
+-----------------+-----------+----------+----------+-----------------+
| Disaster        | 200       | 500      | 15%      | [75]{.mark}     |
| Unemployed      |           |          |          |                 |
| (Ot             |           |          |          |                 |
| hers\--Specify) |           |          |          |                 |
+-----------------+-----------+----------+----------+-----------------+
| **Total         |           |          |          | **              |
| estimated       |           |          |          | [7360]{.mark}** |
| persons in need |           |          |          |                 |
| of crisis**     |           |          |          |                 |
|                 |           |          |          |                 |
| **Counseling    |           |          |          |                 |
| services (add   |           |          |          |                 |
| total column)** |           |          |          |                 |
+-----------------+-----------+----------+----------+-----------------+

In this example, according to the damage assessment formula, the total
number of people estimated to need crisis counseling services within the
identified service area would be 7360. This number in the far right hand
column is a simple estimate that can be used in developing an initial
program plan. If you have questions about completing this formula,
contact your CMHS project officer.

**C. Description of Crisis Counseling Needs and Special Circumstances**

Section C of Part I provides an opportunity for the State to document
any crisis counseling needs or special circumstances not identified
though the Damage Assessment Formula. For many disasters the CMHS
formula provides a reasonably accurate estimate of the need and
sufficient information for planning an Immediate Services project.
However, if the State determines that the worksheets underestimate the
need, additional methods of needs assessment may be applied to document
a more accurate needs assessment.

In addition, disaster damage information is not always available within
14 days following a declaration. If an area has been evacuated and is
inaccessible, the Federal, State, and local emergency managers may not
be able to do a damage assessment until after the application due date.
If no disaster damage data is available, the State will have to provide
a narrative description of the disaster crisis counseling needs. In such
cases, it is recommended that the State Disaster Mental Health
Coordinator contact the FEMA Individual Assistance Officer and the CMHS
Project Officer before the application deadline to discuss alternate
methods of documenting needs. The crisis counseling needs of people
evacuated and sheltered, as well as all disaster other disaster victims,
should be described in narrative form.

[Examples of Special Circumstances]{.underline}

Some examples of special circumstances that might be described in this
section include the following:

-   Large numbers of community residents undergoing a dangerous or
    traumatic evacuation (e.g. older adults evacuated from a senior
    nursing home); and

-   Large numbers of residents directly exposed to a traumatic event
    (e.g. school children in a building directly impacted by a tornado).

[Special Population Needs]{.underline}

To complete a Regular Services Grant application, States are required to
conduct a comprehensive assessment of need, including a detailed
assessment of the needs of special populations groups that may be
especially vulnerable to disaster effects, or who may have unique needs,
such as children, older adults, ethnic and cultural groups, rural
populations. During the initial needs assessment process conducted in
the immediate aftermath of the disaster, it may not be possible to
obtain detailed information on all populations impacted. Therefore,
applicants for Immediate Services Program grants are not expected to
submit detailed demographic information on the impacted population.
However, applicants should provide any available information regarding
special population needs that may impact the design and implementation
of the immediate services program. Information on special population
needs may be obtained from key informant interviews with community
leaders, administrators, and service providers who have been active in
the disaster response.

[Examples of Special Population Needs]{.underline}

Some examples of special population needs that should be described in
Section C would include the following:

-   A brief description of generally-available information about unique
    cultural issues in the impacted community that may present special
    needs (e.g. language issues that may present a need for bilingual
    outreach workers and bilingual eduational materials); and

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-   A brief description of unique characteristics of the impacted area
    that may impact the delivery of services (e.g. largely rural and
    isolated populations impacted by the disaster requiring more
    difficult outreach).

#### Part II: State and Local Resources and Capabilities

**Purpose:** The CCP regulations require that the Immediate Services
application provide "a description of the State and local resources and
capabilities, and an explanation of why these resources cannot meet the
need." The Federal government is required to verify that the needs are
beyond State and local resources and capabilities, before Federal funds
may be awarded.

**Where to find Part II in the application:** Part II is located on page
5 of the Standard Application provided in this package.

**Instruction:** State Disaster Mental Health Coordinators should very
briefly describe the State and local mental health system. For example,
applicants should describe whether the State Mental Health Authority
operates based on a county or regional system, or whether services are
directly delivered by the State Mental Health Authority. Other issues
that may be addressed include the following:

-   What role does managed care play?

-   Who are the clients served by the SMHA and local providers?

Keep your description brief. Explain why these resources cannot meet the
needs of disaster victims. Does the SMHA set aside funds for disaster
programs? Are crisis counseling services beyond the SMHA's and local
providers normal scope of services?

Part II is one of the sections of the application that may be completed
prior to a disaster occurrence. If a Regional Director elects to
pre-approve this portion of the application, he or she may request
annual or more frequent updates on the State and local resources and
capabilities and why they are insufficient to respond to meet disaster
crisis counseling needs.

**Part III: Response Activities from Date of Disaster Incident**

**Purpose:** The fourth required element of the Immediate Services
application in the regulations is "description of response activities
from the date of the disater incident to the date of the application."
The response information reported in Part III of the application is used
by FEMA and CMHS to verify that the reimbursement costs from the date of
incident to the date of the application are reasonable and appropriate.

**Where to find Part III in the Immediate Services Application:** Part
III is on page 6 of the application and is color coded yellow.

**Instruction:** In order to be reimbursed for costs from the date of
incident to the date of the application, the State must document what
crisis counseling services have been provided and justify the costs. In
this section of the application, the State must describe the services
that have been provided. Expenses incurred in providing these services
must be documented at the end of the application in the budget section.
CMHS recommends that the local service providers play an active role in
completing Part III. This is an opportunity to demonstrate to FEMA and
CMHS that the local service providers are offering crisis counseling
services that are in compliance with the scope and limits of the
immediate services grant.

In the best case scenario, the crisis counseling staff have been
documenting services offered from the date of incident. If this is the
case, Part III will be easy to complete. Describe the types of services
provided and the number of recipients. Displaying numbers in a table is
helpful. If there were delays in providing services following the
disaster incident and few or no crisis counseling services can be
reported, explain what caused the delay and measures taken to assure
immediate services will be implemented.

Unless there are unusual situations related to crisis counseling
services the State wants to convey to FEMA and CMHS in detail, this
section should be no more than one page. The description in the section
should be limited to [crisis counseling services]{.underline} provided
to date by service providers in the application.

**Part IV: Plan of Services to Meet the Identified Needs**

**Purpose:** The fifth required element of the Immediate Services
application in the CCP regulations is "a plan of services be provided to
meet the identified needs." The pilot application divides the plan of
services into service providers, staffing plan, organizational
structures, job descriptions and types of services.

**Where to find Part IV in the Immediate Services Application:** Part IV
is on pages 7 - 11 of the Immediate Services Standard Application
format. Part IV is the longest section and is broken down as follows:

A. Service Providers (page 7)

B. Staffing Plan (page 8)

C. Organizational Structure (page 9)

D. Job Descriptions (page 10)

E. Brief Plan of Services (page 10)

F. Training (page 11)

**Instruction for Service Plan:**

#### A. Service Providers

This section describes service providers and is located on page 7 of the
application. The State must provide the Federal government with
information on the agencies or organizations that will be providing
crisis counseling services. The State will also identify which
designated area(s) each service provider has been assigned. The
designated areas should be based on the information on service areas
provided in Part I of the Immediate Services application.

Most commonly, service providers in the Crisis Counseling Assistance and
Training Program are community mental health agencies with which the
State Mental Health Authority has a pre-existing organizational
relationship. However, because the fiscal, administrative, and program
procedures of the Crisis Counseling Program are substantially different
from other State mental health programs, specialized training and
planning is crucial to ensure an effective immediate services response,
it is strongly recommended that potential service providers in each
community should be identified prior to a disaster and provided with
training in the requirements and procedures of the Immediate Services
Program. If qualified potential service providers have not been selected
and trained prior to a disaster, the State Disaster Mental Health
Coordinator will have to work closely with each service provider to
familiarize them with the procedures and requirements of the program.
The FEMA Individual Assistance Officer and a CMHS Project Officer are
available to provide on-site technical assistance to the State Disaster
Mental Health Coordinator.

In the ISP Standard Application Format, service provider information
should be entered in the chart provided. Applicants may add or delete
rows from the table, depending on the number of service providers
included in the project. The names, addresses, and contact information
for each service provider should be provided in the left hand column.
The service area for each service provider should be provided in the
center column. These service areas should correspond with the service
areas identified in Part I of the application. In some instances, more
than one service provider may be identified for a service area. For
example, one service provider may have credibility with a particular
cutural group or community and may provide targeted outreach. In
instances where more than one service provider is identified for a
service area, the roles, target populations, and coordination mechanisms
for each service provider should be clearly identified and described in
"Section E. Brief Plan of Services," which is provided later in the
application.

For each service provider, if a project manager has been identified, his
or her name should be provided in the right hand along with contact
information. If the project manager has not been identified, applicants
should provide the name of the agency director and indicate that the
project manager has not yet been identified.

#### B. Staffing Plan

The number of staff required for the Immediate Services project is
reported as follows for each service provider:

1\. the number of supervisors/team leaders;

2\. the number of outreach workers/crisis counselors; and

3\. the number of fiscal and administrative staff.

This number is further broken down to show the number of in-kind
positions that will be supported by the State or local agencies. A table
has been provided on page 7 of the ISP Standard Application format to
list this information. The State may elect to use this format or may
modify based on personnel titles or categories used in the State. The
staffing plan must correspond with personnel expenses identified later
in the application in the program budget.

In this section of the Immediate Services Program application,
applicants may report numbers in terms of full-time staff equivalents
(F.T.E). For example, if one full-time and one half-time staff will be
hired, report 1.5 will be hired.

**C. Organizational Structure**

As noted on page 9 of the ISP Standard Application Format, a simple
organizational chart for the project is required for the Immediate
Services application. If an organizational chart can not be developed on
computer software in time for the Immediate Services Application,
applicants should provide a simple hand-drawn chart and attach to the
end of the application document. In addtion, applicants with complex
organzational structures should provide a very brief description of
organizational and supervisory structure for the project.

**D. Job Descriptions**

Job titles and descriptions are provided here as guidance for the State
and may be revised or replaced. The State may elect any of three
following options:

1.  Accept the descriptions provided in this section and "cut and paste"
    this information into the application and customize to meet State
    needs;

2.  Submit different job descriptions for approval by FEMA as part of
    the application; or

3.  If the State is not currently responding to a Presidentially
    declared disaster, revisions may be submitted through the State
    Emergency Management Director for the Regional Director's
    pre-approval.

If a State elects to "cut, paste, and modify" job descriptions from this
format, a statement must be included in the application indicating that
these descriptions are applicable within the State system and
appropriate personnel categories have been identified for each service
provider. Because job descriptions are important for effective program
management, FEMA and CMHS strongly recommend that these job descriptions
should be customized to address the service system within the State.
More detailed descriptions of roles and responsibilities in the Crisis
Counseling Program are available in the CMHS Program Guidance entitled
[Staff Roles and Services within Crisis Counseling
Programs]{.underline}, available online at
[www.mentalhealth.org/cmhs/EmergencyServices](http://www.mentalhealth.org/cmhs/EmergencyServices).
In addition, a CMHS Project Officer can consult with the State Disaster
Mental Health Coordinator in reviewing job descriptions.

[Optional Job Descriptions]{.underline}

The following job descriptions are optional and may be inserted into
page 9 of the application and modified to address specific State
concerns. States may elect to add or delete responsibilities as
appropriate or replace these job descriptions with their own.

***"Cut, Paste, and Modify"***

> **Crisis Counseling Project (CCP) Manager**
>
> *Duties*: Lead coordinator for the crisis counseling response at the
> State/local level. Ensures adequate and appropriate staffing &
> training, complies with Federal/State/local reporting requirements,
> responsible for fiscal tracking/monitoring, liaison to other disaster
> services agencies to ensure non-duplication of services. Regularly
> conducts site visits to providers, accompanies crisis counselors as an
> observer to ensure that appropriate services are delivered.
>
> **CCP Assistant Manager**
>
> *Duties*: Depending on the size and scope of the disaster and
> subsequent staffing requirements, an assistant may be needed to
> complete the duties as outlined above.
>
> **CCP Fiscal/Contracts Coordinator**
>
> *Duties*: It is very important to ensure that funds are monitored and
> tracked so that funds are used efficiently and effectively. This
> person reviews program budget modifications.
>
> **CCP Team Leader**
>
> *Duties*: At the local level, this person leads the crisis counseling
> response in the field for whatever size team is assigned. Usually,
> this person is a mental health professional. Depending on the size and
> scope of the disaster, providers may have more than one team leader on
> staff.
>
> **Crisis Counselors/Outreach Workers**
>
> *Duties*: People who work as crisis counselors may have a bachelor's
> degree or less in a specialty that may or may not be related to
> counseling or they may be mental health professionals. Whatever their
> education background, good crisis counselors/outreach workers have
> strong intuitive skills about people and how to relate well to others.
> They possess good judgment, common sense, and are good listeners.
> Crisis counselors/outreach workers will conduct outreach, counseling,
> education, provide information and referral services, and work with
> individuals, families and groups.

**E. Brief Plan of Services**

The basic services provided through the Crisis Counseling Assistance and
Training Program include outreach, crisis counseling, assessment, and
services to groups. During the first 14 days after a Presidential
disaster declaration, the overall plan of services is likely to focus
primarily on outreach basic counseling services. Therefore service plans
may be relatively general during the Immediate Services Phase. However,
the plan of services should address issues identified in the needs
assessment, such as any special population needs in the impacted
community. If the State has identified service needs that are likely to
result in a Regular Services Program application, the plan of services
here will form the foundation for a longer term response.

Examples of the types of services that may be provided in the Crisis
Counseling Program are provided below. In developing an Immediate
Services Program application, a State may "cut and paste" all or
portions of these descriptions and modify to show how these types of
services will be implemented within the disaster. It is strongly
recommended that a State Disaster Mental Health Coordinator review all
materials with local service providers and modify descriptions of
services to specifically address the types of services that will be
implemented in the disaster. If the State is not currently developing an
Immediate Services application, additional services may be submitted to
FEMA and CMHS for review. The FEMA Regional office will forward
submissions to CMHS for review and a recommendation. The FEMA Regional
Director may pre-approve specific types of services for future disaster
responses.

[Examples of Types of Services in a Crisis Counseling
Program]{.underline}

The following descriptions characterize services most frequently funded
by the CCP. Portions of these descriptions may be "cut, pasted, and
modified" to address specific disaster plans in the State.

***"Cut, Paste, and Modify"*\
**

**Individual Crisis Counseling Services** assist disaster survivors in
understanding their current situation and reactions, reviewing their
options, addressing their emotional support and linking with other
individuals and agencies who may assist them. During individual
services, crisis counseling are active listeners who provide emotional
support.

**Group Crisis Counseling Services** involve providing/facilitating
support groups, meeting with citizens, working in classrooms with
affected students, working with affected teachers and administrators
after school, discussing disaster-related issues with families,
assisting people in understanding their current situation and reactions,
reviewing their options, addressing their emotional support and linking
with other individuals and agencies who may provide assistance. Groups
may be facilitated by a mental health professional, a paraprofessional
or the group members themselves.

**Education Services** include the distribution or presentation of
information on the project or crisis counseling-related topics.
Educational information may be provided through brochures, flyers posted
in public areas, mailings and training to human service personnel such
as the clergy or teachers. The media is often a partner in providing
information through Public Service Announcements, newspaper articles and
advertisements. Educational information may also be provided to groups
of people. The key difference between group education services and group
crisis counseling services is that project staff present information to
groups rather than facilitate the sharing of experiences between members
of the group.

**Referrals** are a key component of the CCP. In most disasters, the
majority of survivors have needs that can be met by short-term,
relatively informal interventions. However, in some circumstances, some
disaster survivors may need long-term, more formal mental health
services that are beyond the scope of the Crisis Counseling Program.
Survivors requiring longer-term, more formal mental health treatment
should be referred to an appropriate agency or licensed mental health
professional. Some disaster recovery needs may be more physical,
structural or economical in nature and addressing these issues is
outside the scope of the CCP (Refer to CCP-PG-04 for additional
information). In these instances, CCP staff play a key role in referring
survivors to specific disaster services available through FEMA
Teleregistration, the State, and voluntary agencies such as the American
Red Cross, the Salvation Army, Interfaith Disaster Recovery Services and
Unmet Need Committees.

As indicated above, the State may include modified descriptions of these
types of services in the brief immediate services program plan. If the
State will be offering services other than described above, it will be
important to provide a description of the services with an explanation.

In addition, the Brief Plan of Services should briefly describe how
staff will be deployed to provide the types of services described above.
The plan should describe strategies for targeting those identified as in
need of services, including special population groups identified in the
needs assessment. The plan should also briefly outline any quality
control methods in place to assure that appropriate services to disaster
survivors and staff support mechanisms are available. While a plan of
basic plan of immediate services can be created by the State prior to a
disaster, it is important that It be adapted to ensure that services are
organized and delivered appropriately for each disaster.

**F. Training**

A description of training plans is requested on on page 11 of the
application. It is divided into the following two sections: 1) Selection
of Trainers; 2)Training Content; and 3) Dates of Training. Applicants
may respond using "check boxes" indicating whether qualified trainers
are available in the State. FEMA training policy places a priority on
use of trainers from within the State who have experience with the
Crisis Counseling Program. Training needs vary by disaster, therefore
this section cannot be pre-approved by the FEMA Regional Director.

[Selection of Trainers]{.underline}

The first section on trainers asks the State to determine if there are
professionals within the State who can provide the training free of cost
or if a referral for a CCP trainer is needed. If the State has a trainer
or trainers identified the names should be listed. It is also
recommended that a resume be included as an attachment.

[Training Content]{.underline}

> The second section on training content asks the State determine if the
> training outline provided in the CMHS guidance will be used or if the
> State will develop an outline for the training. If the State develops
> an outline, it should be attached. CMHS has developed a training
> manual and program guidances that can be used in with Immediate and
> Regular Service program staff. Program guidances and the training
> manual, entitled [Training Manual for Mental Health and Human Services
> Workers in Major Disasters, 2^nd^ Edition]{.underline}*,* can be
> obtained from the CMHS clearinghouse and is available online at the
> following website:
>
> [www.mentalhealth.org/cmhs/EmergencyServices](http://www.mentalhealth.org/cmhs/EmergencyServices).

Dates of Training

The third section requests dates of training. If possible, applicants
should identify the specific dates during which Immediate Services
Program training will take place. If training dates have not been
finalized, projected dates of training should be identified.

**Part V: Budget**

**Purpose:** The sixth and final element of the Immediate Services
application required by the CCP regulation is the budget. CCP
regulations require "a detailed budget, showing the cost of proposed
services separately from the cost of reimbursement for any eligible
services provided prior to application." It is important to note the
regulation states that the budget for proposed services must be
separated from reimbursement costs and that the budget must be detailed.

**Where to find Part V in the Immediate Services Application:** Part V
is on page 12 of the ISP Standard Application Format.

**Instruction:** The regulatory requirement for the budget is met by
completing three types of budget worksheets:

1.  Individual budgets for each service provider and the SMHA that
    separates reimbursement from projected costs;

2.  An overall summary of costs; and

3.  A justification of costs.

CMHS has developed a sample spreadsheet that is available for use in
completing the budget. This pre-formatted spreadsheet, referred to as
the Budget Estimating and Reporting Tool (BERT) includes tips on FEMA
budget policies. It can be downloaded on-line from the CMHS website. For
more information contact your CMHS project officer.

#### 

#### 

#### Immediate Services Overall Summary of Costs

Worksheet 2 (page 13 of the application format) is a summary of all of
the Worksheet's submitted by the SMHA and the local providers. The
interim and project costs are combined in one document. In the actual
application submission, it is recommended that this overall summary of
costs be provided before the individual agency budgets.

#### Instructions for Budget Narrative

The budget narrative (pages 16-17 of the application format) provides
the required narrative that details and justifies the types of
expenditures. The budget narrative is used by CMHS and FEMA to assure
all costs are allowable and appropriate. In developing a budget
narrative, States should provide basic information to convey the
rationale for budget figures. As a supplemental program, FEMA does not
fund a line item category for indirect costs. All projected costs for
the project must be carefully documented and explained. Indirect costs
are commonly an in-kind contribution to the program.

Question 1. How were salary levels and fringe benefits determined? Were
they based on comparable positions in the local area? (If not, explain
why.)

The State is required to confirm that the salaries and fringes are based
on comparable positions in the local area. If the costs are based on
comparable positions, the State should answer yes and in one or two
sentences describe the comparable positions. If the answer is no, the
State needs to describe why salaries/fringe benefits differ from
comparable positions. For example, some States do not provide fringe
benefits to temporary hires. Thus, Immediate Services staff may be hired
at a slightly higher rate to compensate for not receiving fringe
benefits.

**Question 2: Complete the table on consultants.**

The compensation must be in compliance with FEMA policy as described in
the *Immediate Services* *Allowable and Appropriate Costs* matrix.
Trainers traveling from out-of-state should be included in the
consultant category.

**Question 3. List types of items included in supplies (i.e., cell
phones, computers, beepers, etc.).**

Office supplies do not have to be listed as specific item types (i.e.,
pens, pencils, paper). Any supply item that is not normally stocked in a
typical business office should be listed. Each piece of equipment to be
purchased must be listed. Also list equipment that will be offered by
the agency for use in-kind (*computers, mobile phones, pagers,
fax,copier*) and whether some equipment may be available from State
warehouses or donated by a local corporation.

**Question 4: List the types of travel expenses (i.e., mileage, rental
cars) and confirm the costs are based on established State rates.**

The general calculations behind travel figures should be provided. For
example, if local travel is based on reimbursement for mileage, the rate
of reimbursement and estimated number of miles should be listed. If
rental cars will be used, justify the need in 1-2 sentences.

**Question 5. Complete the table on Trainers.**

The compensation must be in compliance with FEMA policy as described in
the *Immediate Services* *Allowable and Appropriate Costs* matrix in the
CCP Fiscal Guidance. Trainers traveling from out-of-state should be
included in the consultant category.

Question 6. List and describe the types of expenditures included in the
media/public information category.

Expenses for pamphlets, flyers, and handouts should be documented. Media
expenses for recruitment should be listed. For print ads and broadcast
time regarding the availability of Crisis Counseling Services, FEMA
advises that programs seek donations as a public service for space and
airtime announcements. If this is not possible, provide a detailed
explanation for additional media needs related to the program plan.

[^1]: If the State intends to apply for a Regular Services Grant
    application, it is important to note the Regular Services Grant
    application will require a much more detailed needs assessment. It
    is recommended the State Disaster Mental Health Coordinator review
    the needs assessment information in the Regular Services Grant
    application as soon as possible.