Agree 2 Contribute Match

							                      Commitment to Contribute Match
                                    to
             the California Department of Rehabilitation (DOR)
                                  for the
                 Older Individuals who are Blind Program
                                    by
                              Agency Name

Purpose

The intent of this commitment agreement is to document your agreement to
provide match fund support for the Older Individuals who are Blind (OIB)
Program that provide services to individuals who are aged 55 or older, blind
or visually impaired. The primary goal of this program is to enable the older
blind population to remain as independent as possible by providing
Independent Living Services (ILS), information, and resources in their local
communities. These services are provided through annual sub grants from
the DOR to local agencies. The OIB Program is funded with federal funds
provided under Title VII, Chapter 2 of the Rehabilitation Act as amended.

A requirement of receiving these federal funds is that the DOR secure state
and local match funds of at least 10% to match the 90% provided by the
OIB federal grant. The DOR looks to agencies, programs, service
providers, and other interested stakeholders to provide voluntary
contributions of match. Contribution of match does not entitle the
contributing agency, program, service provider, or other interested
stakeholder to be a beneficiary of any federal OIB funds or receive any
other benefit from the DOR as a result of the contribution. Per 34 CFR
80.24, this match can be either cash (which includes cash or actual
expenditures paid by the agency), or in-kind (which no actual expenditures
have occurred, but for which value exists such as volunteer time, donated
supplies/equipment, office space, and other activities that provide a cost
savings to the agency). All activities must be in support of services to older
blind individuals.
Commitment of Match

Agency Name will provide match in support of the Department of
Rehabilitation (DOR) OIB program. This match will consist of $XX,XXX.XX
in Actual Expenditures and/or In-Kind Match. Actual cash match can be
paid to DOR annually/quarterly/monthly. Certified Expenditure Match will
be submitted to DOR on a monthly basis.

Attachments

   Attachment A – Annual Program Expenditure Match Budget –
    Budget with categories of items to be expensed or in-kind values.
    Categories may include, but are not limited to: personnel job titles
    with percentage of Full Time Equivalents (FTE) budgeted; employee
    benefits associated to personnel; office supplies;
    copying/printing/postage; communications (telephone, cell phone,
    internet service); travel/mileage; out of state travel; professional
    services; volunteer time; indirect costs.

   Attachment B – Annual Program Expenditure Match Budget
    Narrative – narrative provides detailed descriptions of each budget
    line item as listed in the budget.


Accounting Requirements

Submission of Match will be in accordance with principles described in the
CFR or OMB Circular referenced below and will be completed and
submitted monthly. Additional support documentation may be requested
such as Personal Activity Reports (PARS) of match staff.

References:
   34 CFR 80.24 UNIFORM ADMINISTRATIVE REQUIREMENTS FOR
     GRANTS AND COOPERATIVE AGREEMENTS TO STATE AND
     LOCAL GOVERNMENTS - Matching or cost sharing

   OMB Circular A-122 or 2 CFR Part 230 COST PRINCIPLES FOR
    NON-PROFIT ORGANIZATIONS
   OMB Circular A-133 AUDITS OF STATES, LOCAL
    GOVERNMENTS, AND NON-PROFIT ORGANIZATIONS

This Letter of Commitment and attached budget shall remain in effect until
9/30/2013 unless either party terminates the commitment. This Letter of
Commitment and attached budget may be revised by mutual consent of
both DOR and the partner entity.



                             Signed:__________________________

                                  NAME
                                  Director
                                  AGENCY NAME
                                  DATE 2012




_______________________________
DOR – Approval (Signature)

________________
Date