Illinois Administrative Code › Title 77 - PUBLIC HEALTH › Part 577 - PSYCHIATRY INCENTIVE PROGRAM CODE › Subpart B - GRANTS TO PSYCHIATRIC PRACTICE RESIDENCY PROGRAMS › Section 577.150 - Application for Grants

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Department shall prepare and make available grant application forms. These
				forms will be distributed to eligible applicants that have submitted a valid
				Notice of Application (see Section
				577.130
				).
b) Applications shall describe
				the applicant's proposed methods to achieve the goals specified in the
				Department's notice of grant opportunity and project requirements (see Sections
				577.120
				and
				577.140
				).
c) Applications shall be in two
				formats, one for new projects and one for the subsequent years of a continuing
				project.
1) New project applications shall
				include the following:
A) Legal name of the
				applicant;
B) Names and titles of
				all of the applicant's officers and managers;
C) Applicant's legal address;
D) General description of the applicant,
				including its business and business experience;
E) Applicant's telephone number, fax number,
				federal employer identification number (FEIN), Illinois Department of Human
				Rights number, and DUNS (Data Universal Numbering System) number;
F) Project director's name, phone number and
				e-mail address;
G) Detailed
				description of the project, including a summary of the applicant's plan to
				address the goals described in the Department's notice of grant
				opportunity;
H) Detailed
				description of the geographic area or special population group to be served by
				the project, a statement of the special needs of the service area or special
				population group and a thorough explanation of the manner in which the proposed
				project would meet those needs;
I)
				Detailed list of objectives that the applicant proposes and a time table for
				their achievement. These objectives shall be specific, measurable and relevant
				to the Department's notice of grant opportunity;
J) A process and measurement criterion that
				will allow for an objective evaluation of the project's progress in meeting the
				needs of the service area or special population group described in subsection
				(c)(1)(H), including appropriate measuring metrics;
K) A budget listing the total dollar amount
				needed for the project, including the amount to be provided by the applicant
				and other funding sources and the amount of funding requested through the
				grant. The applicant shall identify all revenue sources and amounts and provide
				budget estimates, including expenditures for the duration of the project. The
				project's budget could include the following costs (if applicable):
i) Personal services;
ii) Benefits;
iii) Travel;
iv) Commodities/supplies;
v) Equipment;
vi) Contractual, consulting and outside
				services;
vii) Printing;
viii) Telecommunications;
ix) Patient/client care; and
x) Administrative costs;
L) A plan and time table for the development
				of the project's self-sufficiency;
M) A description of the psychiatric medical
				student or resident involvement in the project, including numbers
				participating, level of training, amount of academic time involved, and whether
				involvement will be a required or an optional experience for the student or
				resident;
N) A description of the
				educational benefits the project would offer students or residents, which would
				not be available to them without the project;
O) A description of the project's
				relationship to other activities and goals of the school or residency
				program;
P) For residency program
				applicants, a summary report for the most recent five-year period of the
				percentage of graduates who have established psychiatric practices in
				designated shortage areas in Illinois and, if available, a count of those who
				have established psychiatric practices in underserved areas of Illinois;
				and
Q) The ratio of State support
				to local support for the project. Documentation of local support shall be in
				the form of funds, services, or other resources. (Section 20 of the
				Act)