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# Senior Corps **GRANT APPLICATION Volume**  **I RSVP (Retired and Senior Volunteer Program)**  for **Competitiv e**  **Applications Non**  **- Competitiv** **e Ad**  **ministrativ e Renew**  **als Continuation A**  **pplications**

**DRA FT FA** **C SIMIL**  **E OF ELECTRONIC FORMS** Form is Authori zed for Local Reproduction **CNCS Form 424 -**  **NSSC** 

### OMB Control No. 3045 **- 0035**  **- Expiration:**  **06/30/2014**2 

## T**AB LE OF**  

## C **ONTENTS INSTRUCTIONS**  I. Purpose
................................ ................................ ................................ ................................ ..................... 3 I I
. Required Sections
................................ ................................ ................................ ................................ ..... 4 Part I: Facesheet Instructions (eGrants “Applicant” , “Application” , and “Funding Demographics” Sections )
.... 5 Part II: Project Narratives Instructions (eGrants “Narratives ” Sections )
................................ ......................... 9 Part II Section A: Executive Summary
................................ ................................ ........................... 9 Part II Section B : Strengthening Communities
. ................................ ................................ .............. 1 1 Part II Section C : Recruitment and Development
................................ ................................ ........... 1 2 Part II Section D : Program Management
................................ ................................ ...................... 1 2 Part II Section E : Organizational Cap ability
................................ ................................ ................... 1 3 Part II Section F : Other NOFA Requirements
................................ ................................ ................ 1 3 Part I II : Performance Measures and W ork Plans (eGrants “Wo rkPlan ” Sections )
... ....... .................. ...... 1 4 Part I II Section A: About Performance Measures Requirements
................................ ..................... 1 4 Part I II Section B: About W ork P lans
................................ ................................ ............................. 1 5 Part IV: Required Documents
................................ ................................ ................................ .................. 18 Part V : Budget Instructions (eGrants “Budget” Sections)
................................ ................................ ........... 20 Part V Section A: Voluntee r Support Expenses
................................ ................................ ............. 21 Part V Section B: Volunteer Expenses
................................ ................................ ......................... 22 Part VI: Funding/Demographics (eGrants “Estimated Funding” Sections)
................................ ................... 22 Continuation Application Instructions
.. ............................................................................. .................................. ..2 3 **FORMS:** Part I
– Facesheet
................................ ................................ ................................ ................................ . .... 2 4 Roster of Active Volunteer Stations (Form and Instructions)
................................ ................................ ..... .... 2 5
**AP PENDICES:**  eGrants Step - by- Step Instructions
................................ ................................ ................................ ............. 28 eGrants Performance Measures Module (PMM) Step - by- Step Inst ructions
................................ .................. 60 Wo rk Plan Development W orksheets
................................ ................................ ................................ .......... ? List of Service Activities and Instruments/Tools
................................ ................................ ............................ ?3

**SENIOR CORPS GRA NT**  **AP PLICA**  **TION: GENERA**  **L SUBMISSION INSTRUCTIONS 1**  **(I) Purpose:**  The Senior Corps Grant Application of the Corporation for National a nd Community Service (CNCS) is for use by prospective and existing sponsors of Senior Corps projects under the RSVP Program (RSVP) , Foster Grandparent Program (FGP), Senior Companion Program (SCP), and Senior Demonstration Programs (SDP). The fo rms in thi s package conform to CNCS’s web - based electronic grants management system, eGrants
. If needed, please refer to **eGrants step -**  **by -** **step instructions** as you complete the grant application, located here: LINK
. TIP for new applicants in particular: You are en couraged to review and reference these instructions as you read these Grant Application Instructions and use eGrants. The Senior Corps Grant Application Consists of two volumes : 1) Volume I
– Used by applicants for RSVP grants. Instructions within the grant application indicate which sections are required for: (A)
– Competitive Grant Application Submissions (B)
– Non - Competitive Administrative Renewals (only as applicable). (C)
– Continuation Grant Application Submissions (current grantees in the second or third years of a three - year grant ). 2) Volume II
– Used by applicants for FGP and SCP grants, including competitive grants, renewal (non competitive grants), and continuation grants (current grantees in the second or third year of a three year grant). Instructions in t his package apply to all applicants. The instructions address the types of information that must be included to fulfill application and grant requirements. New applicants must establish an eGrants account by accessing this link: https://egrants.cns.gov/espan/main/login.jsp and selecting: “Don’t have an eGrants account? Create an account.” **For A pplicants submitting Competitive Grant**  **Ap plications**  **:** Please use these Grant Application Instructions in conjunction with the Notice of Federal Funding Opportunity (Notice) and RSVP Program Regulations [45 CFR Part 2553]. The Notice includes deadlines, eligibility requirements, submission requirements, review criteria and other information applicable to RS VP grant competitions. The Notice is located here: INSERT **For Ap**  **plicant s submitting**  **N on**  **- C**  **ompetitive G**  **rant Ap**  **plications** : T he CNCS offi ce in each state will provide notification instructions, including when to begin your next grant application in eGrants
.

1 OMB No. 3045 - 0035. T he collection of this information is authorized by the provisions of the Dom estic Volunteer Service Act of 1973, as a mended, and the Natio nal and Community Service Trust Act of 1993. This agency informs the potential persons who may respond to the collection of information that such persons are not required to respond to this collection of information unless it displays a currently valid OM B control number. Estimated time to complete this application, including time for reviewing instructions, searching existing data sources, gathering and maintain ing data needed, and completing and reviewing the collection of information averages 13.2 hours per response (16.5 for new applicants, 15 for previous sponsors, and 5 for revisions). I f you have any comments regarding this collection of information, send them to: Corporation for National and Co mmunity Service, Senior Corps, Attn: Angela Roberts, 1 201 New York Avenue, W, Wa shington, D.C. 20525. As required by Section 504 of the Rehabilitation Act of 1973, as amended, this application may be available in alternative formats. M ake **TTD/TTY** inquiries to: (202) 565 - 2799. D irect written inquiries to: Senior Corps, 1201 New York Ave. N W, 9 th Floor, W ashington, DC 20525. Direct telephone inquiries to: (202) 606 - 5000, Ext. 554.4

**Prohibited A ctivities**  For competitive applications, please refer to the Notice
. For continuation grants, please refer to the RSVP Regulations link. **(II) Required**  **Sections of the Grant A pplication**  **(a) First**  **- time A** **pplicants for a n RSVP,**  **FGP , or**  **SCP Grant that are a**  **pplying for a competitive grant**  **or current**  **FGP or**  **SCP grantees apply**  **ing for a new** **mult i**  **- year renewal g**  **rant must complete all**  **sections of the Grant Application :** 


###  Part I: Facesheet (Modified Standard Form 424 NSSC)
– Page 5 

###  Part II: Project Narratives
– Page s 9 - 13 

###  Part III: Wo rk Plans
– Pages 14 - 15 

###  Part IV: Attachments: Required attachments are indicated on Page 18 

###  Part V : Budget (NSSC Form 424A)
– Page s 20 - 22 

###  Part VI: Funding/Demographics
– Page 22 

###  Assurances (Standard Form 424B)
– Page 2 4 

###  Certifications (NSSC Form 424C)
– ??? **(b) Non**  **- Competitive**  **Continuation Ap**  **plications :**  **Years 2 and 3 of t he Multi**  **- Year Grant**  **must complete the following sections**  **:** 

###  Part I: Facesheet (Modified Standard Form 424 NSSC)
– Page 5 

###  Part II : Section ___: Executive Summary
– Page and amend any existing information if not relevant or current for the upcoming grant per fo rmance period. 

###  Part III: Wo rk Plans
– Update work plans that have changed from initial submission to remain consistent with the proposed acti vities and performance measures Page s 14 - 15 

###  Part IV: Attachments: As specified for continuation projects on Page 18 

###  Part V : Budget (NSSC Form 424A)
– Page s 20 - 22 

###  Part VI: Funding/Demographics
– Page 22 

###  Other: Updates of any other sections of the application or the required attachments if significant changes have occurred or are anticipated during Year 2 or Year 3. **Note:** Submission of a grant application does not assure receipt of a grant award.5 **PA RT I: FA** **CESHEET INSTRUCTION S**  **: eGrants “A pplicant**  **Info ”**  **, “A** **pplication Info**  **” , and** 

**“ Funding**  **/ Demographics**  **” Sections**  

### Information entered in the Applicant Info, Application Info, and Funding/Dem ographics sections will populate the SF 424 Facesheet in the eGrants system
. The item s below coincide to sections of the SF 424 Facesheet. Please enter or update the requested inform ation in the fields that appear. The co ntact person needs to be the individual who can best answer questions about the application. **Item #** 1. Filled in for your convenience. 2. Self- explanatory. 3. 3.a. and 3.b. are for State use only ( for AmeriCorps use only
– not applicable for Senior Corps) 4. Item 4.a: Leave blank Item 4.b: If you are a current grantee applying for year 2 or 3 of an already- awarded grant, your grant number will automatically populate
. 5. This section contains the Applicant Information. Please e nter the following information: a. The co mplete name of the organization that will be legally responsible for the grant. This is **not** the name of the organizational unit within the legally responsible organization. For example, indicate “National University” instead of “Liberal Arts Department.” b. The name of the primary organizational unit that will undertake the assistance activity, if different from 5.a. Using the example above, here is the place to use “Liberal Arts Department.” c. Your organization’s complete address with the 5 - digit ZIP code and the 4 - digit extension. The 4 - digit ZIP code extension is required. d. The name and contact information of the project director or other person to contact on matters related to this application. 6. Enter your Employer Identification Number (EIN) as assigned by the Internal Revenue Service. 6a. Enter your Organization’s Dun and Bradstreet Data Universal Numbering System (DUNS) number. If needed, the applicant organization may obtain a DUNS number by calling the request line at (866) 705 - 5711 or online at **http://www.dnb.com .**  7. Item 7.a.: Enter the appropriate letter in the box. Item 7.b: Consult the following list of characteristics of applicants and enter (all that apply) the corresponding numbers, each in a separate blank
.6 8. Check the appropriate box for type of application and enter the appropriate letter(s) in the lower boxes: a. Check “New” if you are applying for a new competitive RSVP grant
. b. Check “Continuation” if you are a current grantee applying for your second or third year of funding. c. Check “Amendme nt” if you are a grantee proposing any change in your budget , requesting a no cost extension , or revising your W ork P lans
. If you are proposing an Amendment to your grant, check the type of revision you are submitting. Contact your CNCS State Office prio r to creating an amendment. a. Select “Augmentation” if you are taking an action that changes the programming of the awarded grant. b. Select “ Budget Revision ” if you are a Senior Corps RSVP grantee submitting a revised budget to incorporate a CNCS - authorized i ncrease or CNCS - authorized decrease. c. Select “ No Cost Extension ” to request an extension of the grant period, then enter the extension date requested in the blank following the checkbox. No - cost extensions must be requested before the project period ends. d. Select “Other,” as applicable, and specify in the blank provided. 9. Filled in for your convenience. 10. Use the following list of CFDA (Catalog of Federal Domestic Assistance) number fo r RSVP : 94.01 Retired and Senior Volunteer Program (RSVP) 11. Select the appropri ate link or dropdown project to: a. Enter the title of the project. (For example, RSVP of Cabot County)
. b. Enter the name of the CNCS program initiative, if any, as provided in the instructions corresponding to the Notice fo r which you are applying; otherwise, lea ve blank. 1. 2 - year college 17. Local Government 2. 4 - year college 18. National Non - profit (Multistate) 3. Area Agency on Aging 19. Other Native American Organization 4. Chamber of Commerce/Business Association 20. Other State Government 5. Community Action Agency/ Commu nity Action Program 21.School (K- 12) 6. Community College 22. Self- Incorporated Senior Corps Project 7. Community- Based Organization 23. Service/Civic Organization 8. Faith - based organization 24. State Commission/Alternative Administrative Entity 9. Governor’s Office 25. State Education Agency 10. Grant- making Entity Operating in Two or More States 26. Statewide Association 11. Health Department 27. Tribal Government Entity 12. Hispanic Serving College or University 28. Tribal Organization (non government) 13. Historically Black College or University (HBCU) 29. U.S. Territory 14. Law Enforcement Agency 30. Vocational/Technical College 15. Local Affiliate of National Organization 31. Volunteer Management Organization 16. Local Education Agency7 12. List all of the geographic locations where the service will occur or is occurring. Please designate by the county or counties. Please include all counties applicable. For **competitive grants** , please also include the appropriate state and n umber of the grant opportunity from the Notice (for example: North Carolina #3). 13. Please reference Item 8 (Above) 

###  “New: Enter the proposed project Start and End Dates. This is a 3 - year period , also known as the “project period.” 

###  “Continuation” or “Amen dment” application: Enter the dates of the approved project period. 14. Fill in the performance period. The “performance period” is the time period covered by the budget, and is usually defined as 12 - months. If other than 12 - months, the Notice or supplementa l guidance will indicate the performance period. 15. Estimated Funding: Enter the estimated amount requested or to be contributed during this performance period on the appropriate line, as shown below. The value of in - kind contributions should be includ ed in these amounts, as applicable. (a) Federal - The total amount of Federal funds being requested in the budget. This amount is automatically populated based on budget sections I and II. (b) Applicant - The total amount of the applicant share as entered in the budget. This amount is automatically populated based on budget sections I and II. (c) Local - The amount of the applicant share that is coming from local sources. (d) State - The amount of the applicant share that is coming from state sources. (e ) Other - The amount of the applicant share that is coming from other sources. (f) Income - The amount of the applicant share that is coming from income generated by programmatic activities. (g) Total - The applicant's estimate of the total funding amount for the agreement. This amount is automatically populated based on budget sections I and II. 16. Indicate if this application is subject to review by the state "Executive Order 12372 Process" by checking the box. Executive Order 12372, "Intergovernmental Rev iew of Federal Programs," was issued with the desire to foster the intergovernmental partnership and strengthen federalism by relying on state and local processes for the coordination and review of proposed federal financial assistance and direct Federal d evelopment. The Order allows each state to designate an entity to perform this function. A list of these "Single Point of Contact" entities can be found at: http://www.whitehouse.gov/omb/grants_spo c . Contact the Single Point of Contact to determine whether your application is subject to the state intergovernmental review process. a. If Yes, indicate the date a copy of your application was submitted to the state for review under the Executive Order 12 372 Process b. If No, check the appropriate box. 17. Check the appropriate box. This question applies to the applicant organization, not the person who signs as the authorized representative. Categories of debt include delinquent audit allowances, loans, and taxes. If Yes, attach an explanation. 18. Signature. Please note that this is an electronic signature that results from submitting the grant application in the electronic grants management system, eGrants. The person who signs this form must be the applicant’s authorized representative. A copy of the governing body’s authorization for this official representative to sign must be on file in the applicant’s office.8

**Note:** Falsification or concealment of a material fact or submission of false, fictitious or frau dulent statements or representations to any department or agency of the United States Government may result in a fine of not more than $10,000 or imprisonment for not more than five (5) years, or both. (18 U.S. Code Section 1001)9 **PA RT II: PROJECT NARR** **ATI VES INSTRUCTIONS (eGrants “Narratives”**  **Section s)**  The purpose of the project narratives and the accompanying Wo rk Plan s (see Part IV) is for you to provide a project plan with a clear and compelling justification for achieving results with the requested funds. You **may**

**not exceed 2 5**  **double -** **spaced pages for the Narratives, including the Executive Summar y**  **and Facesheet** as th e pages print out from eGrants. In the case of **competitive grants** , **reviewers will not consider** material submitted over the page lim it, even if eGrants allows you to enter and submit text over the limit. From the Review and Submit page, print out your application prior to final submission to ensure it is not over the 2 5 page limit. This limit does not include the budget and performance measures. **PA RT II**  **– SECTION A** **. EXECUTIVE SUMMA RY**  Please provide a summary of your proposed project. The Executive Summary must be no longer than one page. The Executive S ummary should include:
 The number of unduplicated RSVP volunteers serv ing or th at will serve.
 The types of populations they serve or will serve , such as children , frail seniors, veterans, etc.
 The primary focus area that the project will address.
 The volunteer service activities or what they will actually do.
 The locations of these service activities
.  The expected results or outcomes of the volunteers’ services
.  The number of stations
.  The federal funding level
.  The non -federal funding level
. You may adopt and fill in the blanks on the following template to complete your Executive S ummary: “An estimated [**fill in the number** ] RSVP volunteers will serve. They will [**fill in service activities** ] through a network of [**fill in the number of volunteer stations/placement sites**  ] such as [**fill in ty pes of**  **organizations where the volunteers serve or will serve**  ]. The primary focus area of this project is [**fill in CNCS Focus A** **rea** ]. At the end of the 12 - month performance period, [**fill in the anticipated outcome(s** )]. The CNCS federal investment of $ [**fill in the annual federal grant amount or the requ ested amount** ] will be supplemented by $ [**fill in the anticipated level of non -** **federal resources** ]. **NOTE:** CNCS will post these summaries on www.nationalservice.gov in the interest of transparency and o pen g ove rnment.10 **PA RT II**  **– SECTION B**  **. STR ENGTHENING COMMUNITIES**  The recommended number of pages for this section is: ______ Competitive grants must align with the **RSVP Performance Measures Requirements** . These requirements are listed below, and are repeated in Part I II
– Wo rk Plans. **1) Performance Measures Requirements for RSVP**  Your grant application must reflect the Performance Measures Requirements established for the RSVP program by CNCS, as listed in items A) through D) below . The performance measures are a re quired part of the work plans submitted as part of your grant application. The unit of measure for RSVP performance measures requirements is “unduplicated RSVP volunteers.” “ Unduplicated RSVP volunteers ” means that each RSVP volunteer is only counted once, even if the volunteer is engaged in more than one activity. As noted previously, please refer to the Appendices for the list of performance measures, work plan development worksheets, and list of service activities.11

A) **Requirement 1:** A minimum of 1 0 percent of the unduplicated RSVP volunteers must be in work plans that result in outcomes. As you formulate the community needs that your volunteers will meet , and develop appropriate service activities to meet those needs , please ensure that this 10 percent total is included. The 10 percent of volunteers can be consolidated in one work plan, or can be reflected in as many work plans as you need to accurately describe their placements and outcomes. The 10 percent is the minimum threshold. You may increase the required percentage. B) **Requirement 2:** At least 25 percent of the unduplicated RSVP volunteers must be placed in assignments that address **one** of the CNCS Focus Areas , which would be the **Primary Focus Ar** **ea** fo r this grant application
. You may exceed the required percentage. The Focus Areas are: • Education • Healthy Futures • Veterans and Military Families • Environmental Stewardship • Economic Opportunity • Disaster Services C) **Requirement 3:** No more than 30 percent of the unduplicated RSVP volunteers can be placed in the community priorities work plan. D) **Requirement 4:** The remainder of the unduplicated RSVP volunteers are placed in volunteer activities aligned with either :  CNCS Agency-Wi de outputs and/or Complementary Program Outputs ; OR  CNCS Agency-Wi de outputs and/or Complementary Program Capacity Building outputs. After planning for 25 percent of the unduplicated RSVP volunteers to be placed in CNCS primary focus a reas (requirement B) and for a maximum of 30 percent of unduplicated RSVP volunteers to be placed in local community priorities (requirement C), the remainder must be placed in activities aligned with the CNCS Agency-Wi de OR Complementary Program outputs.
**2 –**  **Writing Your Strengthening Communities**  **Narrative** As you write your grant app lication narratives, which are found in **Part II –**  **Sections B through E** of this application, unless otherwise noted, please limit your descriptions to at least 25 percent of volunteers that must be placed to meet needs in **one P**  **rimary F**  **ocus A** **rea** . As you write your narrative, please respond to the follow ing :

 Describe t he community you serve. Provide persuasive evidence that community needs identified **in the P**  **rimary F**  **ocus A** **rea** exist in the geographic service area and is currently unmet
. Use demographic information, census data, or other sources as needed to present your case.  Describe the ways in which RSVP volunteers and their stations are managed as a highly effective means to address the identified community need(s) **in the P**  **rimary F**  **ocus A** **rea .**   Describe the service activities **in the P**  **rimary F**  **ocus A** **rea** that lead to National Performance M easure outputs or outcomes.  Connect the following three major elements in **the P**  **rimary F**  **ocus A** **rea** , so that the service activities address the need, and result in the anticipated outputs and/or outcomes :12

1. the community needs identified, 2. the service activities that will be carried out by RSVP volunteers 3. the anticipated output(s) or outcome(s)  Include current or planned significant activities in service to veterans and m i litary families. o Serving veterans and military families should be discussed as part of the Primary Focus Area, Other Focus Areas, or in Capacity Building. Serving veterans and military families does not need to be included in the Community Priorities. **PA RT II**  **– SECTION C. RECRUITMENT A** **ND DEVELOPMENT** The recommended number of pages for this section is:

______ In this section of the narrative, please describe:

 Your plan and infrastructure to create high quality volunteer assignments with opportunities such as building skills, develop ing leadership potential , reflect ing on the meaning of service, and enhanc ing the quality of the volunteers’ own lives.  Your plan and infrastructure to ensure RSVP volunteers receive the training needed to be effective in t heir assignments.  Your p lan and infrastructure to recruit a volunteer pool reflective of the demographics of the geographic communities served . As applicable, include plans to recruit and place individuals of all races, ethnicities, and degrees of English language proficiency
.  Your p lan and infrastructure to recruit veterans and military family members as RSVP volunteers
.  Your plan and infrastructure to recruit RSVP volunteers with disabilities , including individuals with age related disabilities  Your p la n and infrastructure to retain and recognize the RSVP volunteers
. **PA RT II**  **– SECTION D**  **. PROGRA M MA**  **NA GEMENT**  The recommended number of pages for this section is:

_______ In this section, describe specific plans and strategies for overall management of th e RSVP project that you p ropose. Please focus your narrative on the following:

 Your plan and infrastructure to ensure management of volunteer stations in compliance with RSVP program regulations and applicable laws.  Your plan and infrastructu re to devel op capacity to recruit and manage volunteer stations that address specified unmet community needs **outside** the P rimary F ocu s A rea .  Your plan and infrastructure to responsibly graduate volunteer stations to meet changing community needs a nd minimize disrupti ons to current volunteers where possible. The plan may include reassigning volunteers at the station to capacity building assignments.  Your plan and infrastructure to assure N ational P erformance M easure outcomes and outputs are measured and collected.  You r plan and infrastructure to manag e project resources, both financial and in - kind, to ensure accountability and efficient and effective use of available resources.13 **PA RT II**  **– SECTION E**  **. ORGA NIZA**  **TIONA L**  **CA PA**  **BILITY** Briefly d escribe your organization’s cap a bility to operate the RSVP project that you propose with respect to:

 Your plans and infrastructure to provide sound programmatic and fiscal oversight, day- to - day operational support and data collection, to include clearly defined internal policies
.  D escriptions of clearly defined staff positions , including how these positions will be sustained and (as applicable) identification of current staff assigned to the project.  Your organization’s track record in the P rimary F ocus A rea, senior service, manag ing volunteers, and in measuring performance
.  Demonstrati ng strong organizational infrastructure, including: (1) Tangible assets such as facilities , equipment, and supplies; (2) Governance structure and operations, such as internal policies, purchasing pro ced ures, and personnel management ; (3) Role of a community participation group, such as an RSVP Advisory C ouncil, to ensure input from the community; and (4) The existence of robust management systems and past experience managing federal grant funds.  Demo nstrate h ow your organization will adequately sustain the proposed required non -federal share. **PA RT II**  **– SECTION F. OTHER**  **Notice REQUIREMENTS**  **– REFERENCE ONLY**  This section is used, as needed, to address any additional program requirements that appear in the published Notice or supplemental instructions . Refer to the Notice for specifics.14 **PA RT I**  **II –**  **Performance Measures and Work Plans :**  **eGrants “ Work Plan**  **” Section** 
**PA RT I**  **II –**  **SECTION A .**  **AB OUT PERFORMA**  **NCE MEA SURES REQ**  **UIREMENTS 1)**  **Ab out**  **RSVP Performance Measures** Performance Measures are the means by which RSVP grantees demonstrate tangible outcomes and results of the volunteers’ services in the community. Performance Measures include the “what” ( indicators ); the “how” ( tools ) ; and the “proof” (targets )
. **A) Requirement 1:**  A minimum of 10 percent of the unduplicated RSVP volunteers must be identified in work plans that result in outcomes. As you formulate the community needs that your volunteers will address , along with their service activities, please ensure that this 10 percent total is included. The 10 percent of volunteers can be consolidated in one work plan, or can be reflected in as many work plans as you need to accurately describe their placements and outcomes. The 10 percent requirement is the minimum threshold. You may increase the required percentage. **B) Requirement 2:**  At least 25 percent of the unduplicated RSVP volunteers must be placed in assignments that address **one** of the CNCS Focus Areas , which would be the **Prim ary Focus**  **Ar ea**  fo r this grant application
. You may increase the required percentage. The Focus Areas are: • Education • Healthy Futures • Veterans and Military Families • Environmental Stewardship • Economic Opportunity • Disaster Services **C) Requirem**  **ent 3:** No more than 30 percent of the unduplicated RSVP volunteers can be placed in the community priorities work plan. **D) Requirement 4:**  The remainder of the unduplicated RSVP volunteers are placed in volunteer activities aligned with either : a. CNCS Agency-Wi de outputs and/or Complementary Program Outputs OR b. CNCS Agency-Wi de outputs and/or Complementary Program Capacity Building outputs. After planning for 25 percent of the unduplicated RSVP volunteers to be placed in CNCS primary focus areas (requirement B) and for a maximum of 30 percent of unduplicated RSVP volunteers to be placed in local community priorities (requirement C), the remainder must be placed in activities aligned with the CNCS Agency-Wi de OR Complementary Program outputs.15 **PA RT III**  **– SECTI**  **ON B .**  **AB OUT WORK PLA**  **NS 2)**  **Ab out Work Plans** 
 A Wo rk Plan is **a task plan with action steps** to address a specified community need. In the grant application, these W ork Plans form the basis for a proposed project plan: the need the volunteers will address, what they will do, what their service should accomplish for each 12 - month performance period of the grant.
 Wo rk Plans follow a standard format in eGrants Performance Measures Module.
 Wo rk Plans capture the focus of the volunteers’ services in standard categorie s. These include **Focus A reas and Service**  **Ac tivities**  **. 3)**  **H ow** **many Work Plan**  **s are needed?** The number of work plans needed is determined by how you place your volunteers, and by the types of service activities they will undertake. **4) How** **are Work Plans complete d?**  Data that you enter into the **eGrants Performance Measures Module** (PMM) are the basis for your work plans. As you enter data on the community need and select your outcomes, out puts, service activities and other information, the eGrants PMM will bui ld you r work plans for you. Attachment ____ consists of worksheets designed to help you plan your performance measures. These worksheets can help to organize how you will fit your performance measures together with the volunteer activities. W e recommend that yo u use the worksheets and instructions to map out your work plans, and then use the completed worksheets to transfer the information into the eGrants PMM. Please click here fo r step - by- step instructions on how to use the eGrants PMM. **5) Which sections of the**  **Work Plan s must be completed**  **and what is the purpose of each section ?**  The following sections must be completed for **all** Wo rk Plan s with **one exception** . This exception is the one work plan that will capture all of the volunteers placed to meet “Community Pri orities.” **(a) Description of**  **C ommunity Need**  **:** The description of the community need must be completed for each output you select. This needs statement should explain the compelling need that will be addressed by the volunteers. Wh en you develop your community need, be sure to:  Describe the need in enough detail to convey its importance in the community. Use of local statistics can be helpful to make your case.  Describe the consequences of the need going unmet in the community.  Describe why RSVP volunteers can be effective resources to meet the need.  Describe the need in a way that is clear to people unfamiliar with your community. Do not assume that other readers have an existing understanding. **(b) Primary** 

**Focus Ar** **ea and Objective:** These items must be completed by selecting the correct options on the pull down menus in the eGrants PMM.16

**The set of Focus A reas and Related Objectives are:**  **Focus A rea**  **Related Objectives** Healthy Futures Aging in Place Access to Care Obesity and Food Aging in Place - Respite Education K- 12 Success School Readiness Economic Opportunity Housing Financial Literacy Employment Disaster Services Assistance Provided Veterans and Military Families Veterans and Military Families Served Environmental Stewardship At Risk Ecosys tems **(c) O**  **utput:** Outputs are the immediate results of the volunteers’ services. These are usually counts
– numbers of people served, etc. The output is selected using the pull down menu in the eGrants PMM. **(d) Service A** **ctivity :**  The service activity is the actu al task (such as mentoring, providing transportation) that the volunteers will perform. For each output, you may select more th an one service activity. The service activities are selected by checking the appropriate boxes in the eGrants PMM. **For each servi ce activity**  **selected, the eGrants PMM will create a separate work plan**
. **(e) Number of Unduplicated Volunteers:**  This is the proposed number of volunteers who will be performing each service activity. Each volunteer can only be counted once when assigned to a s ervice activity. The volunteer should be counted in the area where he/she will make the most impact
– in terms of the type of service or in terms of the scope of service, such as the most number of hours served.17

**(f) Total Number of Volunteers:**  The total numbe r of volunteers engaged in the activities, if you were to assign all of them according to each activity , will be entered in this section . In this way, volunteers **can** be counted more than once
– fo r example, if the same volunteer does two different types of activities such as meal delivery AND companionship, you can account for all assignments in this field. **(g) Targets:**  The target is the number that you anticipate achieving in the performance period (usually 12 months). For example, if you think your volunteers will serve 200 frail seniors over the course of the performance period, you would enter 200 as your target. **(h) Instrument used for Tracking Output:**  This is the tool that will be used for data collection. The Instrument is selected using the pull down menu i n the eGrants PMM. **The follo wing is only** 

**completed for Work Plans that y ou select as containing outcomes.**  **(i) Outcome:**  Outcomes are the longer term or permanent change or improvement expected in the community due to the volunteers and their services. The outcome is selected using the pull down menu in the eGrants PMM. As noted in the requirement sections, a minimum of 10 percent of your total unduplicated volunteers must be in assignments with outcomes
. **(j) Instrument used for Tracking Ou**  **tcome :**  This is the tool th at will be used for data collection. The Instrument is selected using the pull down menu in the eGrants PMM. **Example of ho w the eGrants Performance Measures Module will build work plans based**  **on the information y ou enter**  **:** In this example, your community need is lack of enough resources to help frail seniors, many of whom live on fixed incomes, particularly to help alleviate loneliness and to find affordable transportation to medical and other necessary appointments. RSVP volunteers can provide such assis tance. You would describe this in the “community need” section. You select the “Healthy Futures” Focus Area, with the Objective of “Aging in Place”, because the stated need aligns with these components. You then select one output and one instrument for th e overall community need from the options list in the PMM. If you decide to select outcomes, you designate this, and select an outcome instrument as well. Then, you start selecting service activities from the options list in the PMM. These are the duties/a ctivities that the RSVP volunteers will perform
– “transportation” as one service activity, “food delivery” as another, and “companionship” as another. Once you finish selecting your service activities and click to add the performance measure, the eGrants system will automatically generate three work plans
– one for each service activity you selected. You will then enter your targets for each work plan that you will enter in the PMM that you will report against in a Progress Report. These work plans will a ll share the same community need, Focus Area and Objective, output and instrument, outcome and instrument (if selected). **6.1 Which sections of the Work Plan must be completed for the no more than 30**  **percent of volunteers placed in the category**  **“Community Priorities”?**  The requirement that no more than 30 percent of volunteers may be placed to meet “Community Priorities” will be consolidated into one (1) comprehensive work plan. This work plan has fewer required sections. The following sections must be co mpleted in the “Community Priorities” work plan. No other sections are required.18

(a) **Description of Community Need:**  The description should briefly state the needs that the volunteers will meet. If more than one need will be addressed as a community priority, each need should be listed. (For example: “ Local community organizations need assistance to better serve their clients. Nursing homes need items for residents; museums needs docents to guide tours, senior centers need helpers for congregate meals, and libraries need help with filing and general clerical support. RSVP volunteers will knit lap robes for nursing home residents; serve as docents in our local history museum; assist congregate meal sites; and help community libraries with filing and mailing their newsletters .”) (b) **Output:** There is one pre - determined output for the “Community Priorities” work plan
– “Grantee met its target for community priority activity Yes/No.” This will be the only option available when entering the Community Priority work plan. (c) **Number of Unduplicated Volunteers:** This is the proposed number of volunteers who will be performing each service activity. (d) **Number of Volunteers:** The total number of volunteers proposed, when counting the volunteers by assignment. Volunteers can be counte d more than once (such as one volunteer serving in nursing homes and also at the library). (e) **Total Number of Volunteer Stations:** The total number of placement sites or volunteer stations.
**PA RT**  **I V. INSTRUCTIONS FOR**  **REQUIRED SUPPLEMENTA L DOCUMENTS**  **(eGran ts “Documents”**  **Section)** Documents cannot be attached in eGrants. U se eGrants to indicate the status of t he document: Already on File at CNCS, Not Applicable, Sent , or Not Sent
. F or competitive applications, all items marked as Sent in eGrants should b e sent to the address listed in the NOF O . For continuation applications, all items marked as Sent in eGrants should be sent to your CNCS State Office. A ll financial documents (items 4, 5, 6, 10, 11, 12, and 13) for competitive applications and continuati on applications should be sent to the FFMC at: Field Financial Management Center The Curtis Center 601 W alnut Street 8 th Floor
– Room 876
– E Philadelphia, PA 19106 Include your eGrants application ID number and organization name with all documents.19 **REQUIRED SUPPLEMENTA L DOCUMENTS**  **Description of A**

**ttachment Ap**  **plicants who must submit the attachment as part of the**  **application New**  **New /**  **Previous CNCS**  **Grantee Continuation** 
1. Copy of the **annual assessment** to assess the accomplishments and impact of the project. No No Once during year 2 or year 3 2. List of the sponsor’s current **Board of Directors** , including name, address, and organizational or community affiliation. Yes Only if changed Only if

changed 3. Names and addresses of **community advisory**  **gro up**  or proposed advisory group members. Yes Only if changed Only if

changed 4. **Direct Deposit Forms** including SF - 1199A, Recipient Contact Form, and FFR User Form. Yes No No **5. Financial Management Survey**  **.** Yes No No 6. Copy of **Negotiated Indirect Cost Rate A greeme**  **nt** , if indirect costs are requested. Yes Yes Yes 7. Applicant’s **organizational chart** showing the major components and the number, positions and reporting relationships of the proposed project staff within the sponsoring organization. Yes Only if changed Only if

changed 8. **Project Director job description**
. Yes Only if changed Only if

changed 9. **Roster of Volunteer Stations** in standard, required format (see p. 19)
. Yes Yes Yes 10. **Statement of audit status** that indicates whether the applicant is subject to A- 133 Audit requirements. If yes, provide the date of the last audit and the date forwarded to the Audit Clearinghouse. Yes Yes Yes **AD DITIONA**  **L AT** **TA CHMENTS REQUIRED OF PRIVA**  **TE NON -**  **PROFIT A PPLICA**  **NTS** In addition to the Attachments listed above under Section V. private non - profit applicants must also include the following: **Description of A**

**ttachment Ap**  **plicants who must submit the attachment as part of the application**  **New New** **/**

**Previous CNCS**  **Grantee Continuation** 
11. **Ag gregate annual dollar amounts of funding**  broken out by name and type. Include the name and dollar amount for any organizations/sources that provide at least 10 percent of total funding in the past budget year. Use standard, required format ( see p. ). Yes Yes Yes

**12.** IRS **certification of non -**  **profit status.** Yes O nly if changed Only if changed 13. Most recent **financial statement audit or 990.** Yes Yes Yes Note: By signing the application, an official of the grantee organization certifies that any attachment not included has not changed from the prior submission that i s on file with CNCS.20 **PA RT**  **V –**  **BUDGET INSTRUCTIONS: eGrants Budget Sections Refer to the eGrants Step**  **- by** **- Step Instructions for entering y** **our budget.** Below are the following instructions for each line item of the B udget form. For competitive applicati ons, please refer to the NOFA which includes the elements of cost effectiveness and budget adequacy that will be highlighted during the competition. **(a) Multi -** **year applications** - Complete the SF 424A Budget form requesting funds for the first annual budget period following the instructions below. Multi - year project approval does not guarantee that the application will be approved for additional funding. If we approve an application and enter into a multi year award agreement, we will issue a Notice of Grant Award (NGA) that will provide funding only for the first year. You must submit a continuation application, via eGrants, for each year of the award to request additional funding. W e will use the distribution of line item amounts proposed for the first year in budgeting for subsequent years , unless you submit an application for revising the budget. **(b) Single -** **year applications** - Complete the SF 424A Budget form for the 12 - month period, following the instructions below. Unless otherwise instructed by an agent of the C NCS , or referenced in the NOFA or supplemental guidance, all grants are multi - year. **General Instructions for SF 424A Budget form Columns 1, 2, 3, and 4:**  In Column 1, enter the total project cost for that line item from all sources. (a) In Column 2, enter the amount of CNCS funding requested for each line item and the total. (b) In Column 3, enter the amount of funds for the item that is expected to be covered by grantee funds or funds the grantee expects to receive from other sources, includi ng cash and in - kind support. (c) Required Non - Federal Share: Please see table below. In cases of demonstrated need, as specified in the respective program regulations, exceptions to these cost- sharing requirements may be allowed. **Program Required Non**  **- Federal**  **Share** RSVP New Applicants that do not currently sponsor an RSVP project:

10% of the total project cost in Year 1, 20% in Year 2, and 30% in subsequent years Current RSVP sponsors applying for a competitive grant in their current geographic service area : 30% of the total project cost for every year (d) Enter any excess contributions in **excess of required non -** **federal share in optional Column 4** , as stipulated in Section 224 of the Domestic Volunteer Service Act, as amended. (e) For each Budget Line Item, pleas e:  Briefly describe all amounts in Columns 2, 3, and 4.21 **PA RT**  **V –**  **SECTION A . VOLUNTEER SUPPORT SERVICES**  **Source of Matching Funds:** Please fill in the sources of non -fe deral share at the beginning of eGrants Sections I and II. NOTE: For all line items, please put the total cost in Column 1 and then use Columns 2
– 4 to identify the source of funds as appropriate: **Line A . Project Personnel Expenses**  **–** List the title of each staff position charged to the project. List all positions/titles that are eithe r funded by CNCS, grantee share, or excess resources. Include: 1. The position title. 2. The full - time equivalent (FTE) annual salary. 100% FTE is normally 40 hours/week. Thus, if an employee works half time or 20 hours/wk for the project and is paid $10,00 0 from project funds, the FTE annual salary would be $20,000. 3. The percentage of time the person will work for the project over a 12 month year (for example, if the employee works 10 hours per week for the project over 12 months, you would enter 25%.). **Line B. Personnel Fringe Benefits –**  Enter in the appropriate column the cost of fringe benefits to wh ich employees are entitled, calculated on the same percentage time indicated under line A for each individual. In your Budget Narrative , provide detai ls concerning the benefits provided. ( e.g ., Retirement contributions for all staff working over 60% time, calculated at 5% of total annual salaries of $80,000 = $4,000). **L ine C.**  **Local Travel –**  Enter travel costs on the local lines, as appropriate, on th e B udget form. Include only travel costs for staff listed under budget line A and who directly support the grant activities described in your application. Local travel is travel within the project service area as shown in item 12 of the Face Sheet. Briefly list the purpose of anticipated local travel and the basis for cost calculations. **Line D. Long Distance Travel –**  Enter travel costs on the long distance lines, as appropriate, on the Budget form. Include only travel costs for staff listed under budg et line A and who directly support the grant activities described in your application. All travel outside the service area is long distance travel. For long distance travel, show the purpose for each trip and break out for each the cost of transportation, meals and lodging, and other travel costs. **Line E . Equipment**  **-** Enter on the B udget form the cost of equipment. Items costing less than $5,000 should be listed in supplies. **L ine F**  **. Supplies**  **-** List the types of supplies and their respective costs. Pl ease itemize large items. **Line G . Contractual and Consultant Services**  **-** Enter t he cost of contracts and consultants as appropriate. In your Narrative itemize each contract or consultant and provide a brief justification of the need for each. Include h ere all services documented in a contract, such as clerical support, training consultants, equipment repair and maintenance, or bookkeeping services.22

**Line H .**  **Other Volunteer Support Costs –**  Briefly d escribe all other allowable Volunteer Support Expenses n ot included in categories A through F, such as criminal history background checks, training, evaluation services, recruitment expenses, and other items. Crimi nal history background checks are required for all e mployees or other individuals who receive a sa lary or similar payment from the grant (federal or non -federal share). **Line I . Indirect Costs**  **-** Enter indirect charges applicable to volunteer support expenses. In your Narrative, describe the type of rate (provisional, predetermined, final or fixed) i n effect during the budget period, estimated amount of the base to which the indirect rate was applie d, and total indirect expense. A copy of the current negotiated indirect cost agreement must be in place with the cognizant federal agency. **SUB TOTA**  **L BUDGET**  **SECTION I**
– The subtotal will automatically be populated based on Budget section A. **PA RT**  **V –**  **SECTION B .**  **VOLUNTEER EXPENSES Source of Matching Funds:**  Please fill in the sources of non -fe deral share at the beginning of eGrants Sections I and II. **Line A** **. Other Volunteer Costs**
– Enter line items in the respective categories the applicable costs and reimbursable expenses in columns 1, 2, 3, and 4, as appropriate.

 RSVP allowable costs and reimbursable expenses include: Volunteer Travel, Meals, Volunteer Recognition, and Insurance. Insurance for volunteers when on assignment is required. Volunteers may also be reimbursed for costs incurred while performing assignments
– including transportation, equipment, supplies, etc.
– provided such costs are describ ed in the Memorandum of Understanding negotiated with the volunteer station where the volunteer is assigned and there are sufficient funds available to cover these expenses and meet all other requirements of the NGA. **SUB TOTA**  **L BUDGET**  **SECTION II**
– T he subtotal will automatically be populated based on Budget section B. **PA RT V**  **I –**  **FUNDING/DEMOGRA PHICS INSTRUCTIONS:**  **Estimated Funding Line A** **. Total**
– The sum of the totals for Sections I and II will auto - calculate from sections A and B of your Budget. **Line B . Federal Share** 
– The sum of the totals for Federal funding will auto - calculate from section A and B of your Budget. **Line C. A pplicant Share**  - The sum of the totals for Grantee funding will auto - calculate from section A and B of your Budget. **Line D. A ppl**  **icant Share Breakdown**
– Enter the breakdown of the applicant share into the following sources. The sum of the source amounts must add up to Line C. **Line E . Demographics**  - Enter the total number of unduplicated volunteers
.23 **CONTINUA**

**TION A PPLICA** 

**T ION INSTRUCTIONS**  **Must be completed by current grantees submitting a non**  **- competitive continuation request for year 2** 

**or 3 of the multi**  **- year grant.**  Contact your CNCS State Office for specific timeframes for continuation application submission. **How to Subm**  **it Your Continuation Request:**  From your eGrants home page, click **Continuation/Renewal.** A list of applications for your organization will be displayed.  Click **Continue** next to the application that you plan to update and submit for your continuation. Be s ure to select the correct application.  Next you will see a list of Notice options. Your CNCS State Office will provide you with the appropriate NOFA to select.  After the NOFA is selected, eGrants creates the continuation application which will include a copy of all information from your previously awarded application. Edit your continuation application as directed in the continuation request instructions below.  Wh en you have completed your edits, your Authorized Representative should login with their eG rants account and click the **SUBMIT** button. If you have questions about the content of your continuation, please contact your CNCS State Office. **If y ou**  **experience problems using eGrants, contact the eGrants Help Desk at (800) 942**  **- 2677.**  **What to Include in Your Continuation Request:**  **I. A pplicant Info**  **, Ap**  **plication Info and Funding/Demographics**  Update only if there have been significant changes at your project or organization
. **II. Narratives** The Executive Summary should be reviewed and updated to ensure th at the outcomes reflect any changes made in the Wo rk Plans. All other narratives should only be updated if the information is no longer accurate due to project or sponsor organization changes. If the narrative information is accurate, leave it unchanged in the continuation application. **III. Work Plan**  Information will copy from your previous ly awarded application into your continuation application
. Wo rk Plans are designed to align with the 12 - month performance period. Update the W ork Plans as needed to reflect the upcoming performance period for the continuation. **IV. Documents** Refer to the Continuation column on pages ___ and send the required documents to your CNCS State Office. **V . Budget**  Update the budget for the upcoming year. Incorporate any change s such as a new source of non -federal funds, adjustments to recognition, or personnel changes. T he non -federal share must increase to 20% in year 2 and 30% in year 3 and subsequent years.24 **PA RT I**  **– FA** **CESHEET OMB No.**  **3045 -**  **0035 Expiration Date** 

**______ AP**  **PLICA**

**TION FOR FEDERA L A** **SSISTA NCE**  1. TYPE OF SUBMISSION: Application Non - Construction 2. DATE SUBMITTED TO CORPORATION FOR NATIONAL AND COMMUNITY SERVICE (CNCS): 3. a. DATE RECEIVED BY STATE: 3.b. STATE APPLICATION IDENTIFIER: 4. a. DATE RECEIVED BY CNCS: 4.b. CNCS GRANT NUMBER: 5. APPLICANT INFORMATION LEGAL NAME: ORGANIZATIONAL U NIT: NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR OTHER PERSON TO BE CONTACTED ON MATTERS INVOLVING THIS APPLICATION (give area codes): ADDRESS (give street address, city, county, state and zip code): NAME: TELEPHONE NUMBER: ( ) - FAX NUMBER: ( ) - INTERNET E - MAIL ADDRESS: WEBSITE: 6. EMPLOYER IDENTIFICATION NUMBER (EIN): 6A. DUNS Number: 7.a. TYPE OF APPLICANT: (enter appropriate letter in box) A. State H. Independent School District B. County I. State Institution of High er Learning C. Municipal J. Private University D. Township K. Indian Tribe E. Interstate L. Individual F. Intermunicipal M. Profit Organization G. Special District N. Private Non - Profit Organization O. Other (specify) 7.b. CNCS A PPLICANT CHARACTERISTICS 8. TYPE OF APPLICATION (Check appropriate box): NEW CONTINUATION REVISION I f Revision, enter appropriate letter(s) in box(es): A. Increase Award: B. Decrease Award: C. Increase Duration: to (en ter date) D. Decrease Duration: to (enter date) E. OTHER (specify): 9. NAME OF FEDERAL AGENCY: Corporation for National and Community Service 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: Name of Program ___________-

__________________________________________ 11. a. TITLE OF APPLICANT’S PROJECT:

12. AREAS AFFECTED BY PROJECT (List Cities, Counties, States, et c.): 14. PERFORMANCE PERIOD: Start Date End Date:
13. PROPOSED PROJECT: START DATE: END DATE: 15. ESTIMATED FUNDING: Check applicable box: Yr 1: Yr.2: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE a . FEDERAL $ ORDER 12372 PROCESS? a. Y ES. T HIS PREAPPLICATION/APPLICATION WAS MADE b. APPLICANT $ TO THE STATE EXECUTIVE ORDER 12372 PROCESSS FOR REVIEWON: c. STATE $ DATE ___________________________________ b. NO. PROGRAM IS NOT COVERED BY E.O. 12372 d. LOCAL $ OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW e. OTHER $ 1 7 . IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? f. TOTAL $ YES If “Yes,” attach an explanation. NO 18. TO THE BEST OF MY K NOW LEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT, THE DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED. a. TYPED NAME OF AUTHORIZED REPRESENTATIVE: b. TITLE: c. TELEPHONE NUMBER: d. SIGNATURE OF AUTHORIZED REPRESENTATIVE: e. DATE SIGNED: Modified Standard Form 424 - NSSC (Rev. 3/03 to conform to the CNCS eGrants system) 

### -25 **ROSTER OF A CTIVE VOLUNTEER**  **STA TIONS**  **INSTRUCTIONS** The accompanying template in Excel corresponds to these instructions. The Volunteer Station Roster must be completed using the MS Excel workbook template
. The workbook template contains the following parts: Tab 1: Instructions T ab 2: Volunteer Station Roster template Tab 3: Volunteer Station Types The purpose of this form is to provide information about each active volunteer station. For **New A** **pplicants** : The definition of “active volunteer station” is any volunteer station where you intend to place RSVP volunteers if the grant application is funded. If the grant application is funded, the Volunteer Station Roster will be updated at a later time to reflect actual volunteer placement. The definition of “active volunteer station” i s any volunteer station with which you have a MO U
. Please make every effort to provide complete and accurate data. For each header item with a small red triangle in the upper right corner of the cell: if you place your cursor over the cell and wait a few s econds (“hover”), a “pop - up” comment box, with further description, will appear. Note that the spreadsheet will “scroll” up and down, leaving the column names and station names visible at all times. Please do not change the location of each data item (e.g ., moving or adding cells or columns), as this is a standardized form.

### 26 PUBLIC BURDEN STATEMENT: Public reporting burden for this collection of inform ation is estimated to average 5 hours per submission, including reviewing instructions, gathering and maintaining the data needed, and completing the form. Comments on the burden or content of this instrument may be sent to the Corporation for National and Community Service , Attn: Am y B orgstrom, 1201 New York Avenue, NW , Wa shington, D.C. 20525. The Corporation informs people who may respond to this collection of information that they are not required to respond to the collection of information unless the OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) PRIVACY ACT NOTICE: The Privacy Act of 1974 (5 U.S.C § 552a) requires that the following notice be provided to you: The information requested on the Senior Corps Grant Appli cation is collected pursuant to 42 U.S.C 12592 and 12615 of the National and Community Service Act of 1990 as amended, and 42 U.S.C. 4953 of the Domestic Volunteer Service Act of 1973 as amended. Purposes and Uses - The information requested is collected for the purposes of reviewing grant applications and granting funding requests. Routine Uses - Routine uses may include disclosure of the information to federal, state, or local agencies pursuant to lawfully authorized requests. In some programs, the inform ation may also be provided to federal, state, and local law enforcement agencies to determine the existence of any prior criminal convictions. The information may also be provided to appropriate federal agencies and Department contractors that have a need to know the information for the purpose of assisting the Department’s efforts to respond to a suspected or confirmed breach of the security or confidentiality or information maintained in this system of records, and the information disclosed is relevant an d unnecessary for the assistance. The information will not otherwise be disclosed to entities outside of the Corporation for National and Community Service without prior written permission. Effects of Nondisclosure - The information requested is mandatory in order to receive benefits. OMB Control Number 3045 - 0035 Expiration Date 6/30/2014