Illinois Administrative Code
Title 77 - PUBLIC HEALTH
Part 960 - PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK GRANTS PHHS RULES
Section 960.50 - Application Procedures
Universal Citation: 77 IL Admin Code ยง 960.50
Current through Register Vol. 48, No. 12, March 22, 2024
The Department shall provide written application instructions to local agencies.
a) All applications shall include the following:
1) applicant's
name, address and telephone number;
2) documentation of applicant's
not-for-profit status (such as Certificate of Good Standing from the Secretary
of State) for non-governmental units;
3) Taxpayer Identification Number (TIN) or
for governmental agencies, the Governmental Unit Code assigned by the State of
Illinois Office of the Comptroller;
4) date of submission;
5) signature of agency official authorized to
certify the application;
6) project
period;
7) a detailed budget
providing sufficient resources to carry out the project. The budget shall be by
line item category and provide sufficient detail to justify the use of grant
funds to support project activities. The budget shall indicate the total cost
of conducting the projects, the source of other funds supporting the projects,
as well as the amount of support requested from the Department; and
8) a signed Statement of Assurances
indicating compliance with applicable State and federal requirements, such as
the Fiscal Control and Internal Auditing Act, Office of Management and Budget
(OMB) Circular A-128 (local governments), OMB Circular A-133 (not-for-profit
organizations), bribery certification, contract debarment, unlawful
discrimination, Illinois Human Rights Act, Federal Civil Rights Act, Drug Free
Workplace Act, Davis-Bacon Act, conflict of interest as specified in the
Illinois Purchasing Act, and protection of the confidentiality of recipients of
services.
b) In addition to the items listed in subsection (a) of this Section, all initial applications shall include the following:
1) Healthy People
2000 Priorities selected by the applicant;
2) geographic areas and target populations to
be served, including estimated numbers by age range and sex, and estimates of
any special population targets (consistent with Healthy People 2000) within the
general target population;
3)
target area data summary relevant to the selected priorities as documented by a
Local Needs Assessment (beginning with State Fiscal Year 1995
application);
4) documentation of
the existence of a Year 2000 Plan for the selected priorities or a description
of how one will be organized;
5)
description of the methods to be used to identify and select interventions or
model programs or a description of interventions or model programs on which
project implementation will be based;
6) a prioritized listing of project
objectives for the funding period;
7) for each objective, a sequential listing
of activities to achieve the objective and the timeline for completing each
activity; and
8) evaluation methods
to be used to measure progress in achieving objectives and a plan for
monitoring the overall project including, for the selected priorities, any data
items identified by the Centers for Disease Control and Prevention for use in
uniform tracking through Preventive Health and Health Services Block Grant
funded agencies.
c) In addition to the items listed in subsection (a) of this Section, continuation applications shall include the following:
1) a
progress report that contains a description of the findings to date as
specified in subsection (b)(8) of this Section;
2) progress in meeting each project
objective;
3) project objectives
for the new grant year, along with activities and timelines for completion of
each activity; and
4) any revisions
in the evaluation methods or the monitoring plan along with the rationale for
such revisions.
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