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       Community Services Block Grant Program

            Instructions for Completing the
          FY 2010-11 Application for Funding
             (July 1, 2010 – June 30, 2011)

                 Office of Economic Opportunity
           N. C. Department of Health and Human Services
                       2013 Mail Service Center
                 Raleigh, North Carolina 27699-2013

                      Voice (919) 715-5850
                      Fax (919) 715-5855
OEO 01/10
                              N.C. Department of Health and Human Services
                                     Office of Economic Opportunity
                                Community Services Block Grant Program
                                                FY 2010-11


The purpose of the Community Services Block Grant is to provide a range of services and activities
having a measurable and potentially major impact on the causes of poverty in the community or those
areas of the community where poverty is a particularly acute problem.

Completing this application for funding requires the implementation by the Board of Directors of a
strategic planning process as follows:

             - Determination of planning period
             - Development of a process which allows for meaningful citizen participation
             - Completion of needs assessment
             - Prioritization of identified needs
             - Analysis of available and needed resources
             - Establishment of long-range goals
             - Development of alternative strategies
             - Development of work plan with annual objectives, activities and budget
             - Development of monitoring, assessment and evaluation criteria

In compliance with 10A NCAC 97B .0401 General Provisions, OEO rules require that citizens are
provided adequate opportunities for meaningful involvement on a continuing basis for participation in the
planning, implementation, evaluation and assessment of the program. Specifically, each applicant shall
provide adequate information to citizens, hold a public hearing at the initial stage of the planning process,
publish a notice of intent to file an application prior to the governing board’s approval and subsequent
submission to the application to the Office, allow citizen participation on substantive amendments in the
program and provide an opportunity to comment on the applicant’s performance.

As specified in 10A NCAC 97B .0402, OEO rules further require that at least one public hearing be held
at the initial stage of the planning process to allow citizens the opportunity to express views and
proposals. The Board of Directors shall ensure that the public hearing is scheduled at a time and location
that permits broad participation, especially by the low-income, and is accessible and understandable to all

Citizen participation is an integral part of the application process. As required in 10A NCAC 97C .0111
Citizen Participation, each grant recipient is required to establish citizen participation policy and
procedures. These procedures must detail plans to hold a public hearing during the initial planning when
a new multi-year plan is developed. The public hearing (which can be held at the time of the Board
meeting) must take place prior to Board approval of the application. When applicable, these procedures
may include but are not limited to holding community meetings to ascertain the views, comments,
questions and citizen proposals on how the funds will be utilized.

FY2010-11 CSBG Application Instructions                 rev. 01/10                                    1
                                      APPLICATION INSTRUCTIONS

Following is information on completing specific components of the grant application, which should be
helpful. Please read carefully and follow instructions.

The FY 2010-11 CSBG Application contains the revisions listed below:

1. Question #16, linked to ROMA Goals 3, 4, and 5 has been added to this year’s application process to
   explore your agency’s efforts to identify and contract services with minority-owned banks and
   business owned by minorities, women and the disabled as encouraged in section 10A NCAC
   97C.0404. Minority-Owned Banks and Executive Order 13 support for Historically Underutilized
   Businesses ( A
   listing of HUB’S in your service area can be obtained from
2. Additional continuation pages have been added to the Grantee One-Year Work Program.
3. Submit Tripartite Board of Directors Member Profile for all members with application.
4. Agency Cognizant-Approved Cost Agreement should be current (recommended) within a two year
5. The Budget (Form 225) should include ALL ARRA funded programs.
6. Applications should be submitted with job description(s) and resume(s) for all staff paid using any
   percentage of CSBG funds.


Several revisions were made during the FY 2009-10.

    1. Questions #14 and #15, linked to ROMA Goals 1 and 5, were added to the application
       process to explore your agency’s efforts to acquire and sustain an unrestricted funds base
       and to analyze your agency’s contracting processes.
    2. The OEO Form 225 (Agency Budget Information) changed. A new set of instructions
       inclusive of samples was added to serve as guidance for completing the new form.
    3. A Key Outcome Measures chart was added to Monitoring, Assessment and Evaluation Plan
       to capture each agency’s “expected” (target) results.
    4. The Appendices page was revised to include additional guidance for each applicable
    5. The Board Member Profile sheet was revised.

Additional Reminders

    1. For Self-Sufficiency Projects, item 7 of the One-Year Work plan should indicate the total
       number of participants (all) the agency expects to serve with CSBG funding. The number
       should include those participants expected to enroll as well as those expected to continue
       from the previous year.
    2. The submission of an Emergency Succession Plan was added to the FY2007-08
       application process. Emergency Succession Plans should be current/working documents. If
       your agency’s plan has been revised since the initial submission, submit the revised plan
       with the FY2010-11 application. A plan template has been added to the Appendices section
       for guidance. (See additional information in the Appendices)
    4. Applications should be submitted with copies of current agency contracts that obligate
       CSBG funds.

FY2010-11 CSBG Application Instructions               rev. 01/10                                    2
The OEO grant application is due by close-of-business on March 1, 2010; only one original copy is
required; however, electronic submission to (excluding the Appendices) is also
required. Only information requested should be submitted (no attachments such as annual reports, letters
of support, etc.) and the application should not be submitted in a binder of any kind; tabbed pages are not
required. One copy of the grant application must be submitted in the following order, with each page
numbered consecutively:

            Certifications and Assurances
            Board Composition
            Board Officers and Committees

        ONE- YEAR WORK PROGRAM - OEO Form 212

               Cognizant-Approved Indirect Cost Agreement
               Cost Allocation Plan
               Copies of all current contracts that obligate CSBG funds
               Tripartite Board of Directors Member Profile
               Organizational Chart and CSBG staff resumes
               Conflict of Interest Policy for Private Not-for-Profit Agencies
               Emergency Succession Plan
               Minutes of public hearing at which this application was reviewed and approved

FY2010-11 CSBG Application Instructions                rev. 01/10                                   3
                       Instructions for Completing the Planning Process Narrative

The Planning Process Narrative consists of 16 topic areas about which each grantee is required to provide
a narrative description. This section is an integral and long-standing component of the annual CSBG
application for funding. In the current revision of this application, each topic area follows an appropriate
Results-Oriented Management and Accountability (ROMA) Goal, which was inserted to demonstrate the
correlation between this narrative and the ROMA initiative.

National ROMA Goals

    1.   Low-income people become more self-sufficient
    2.   The conditions in which low-income people live are improved
    3.   Low-income people own a stake in their community
    4.   Partnerships among supporters and providers of services to low-income people are achieved
    5.   Agencies increase their capacity to achieve results
    6.   Low-income people, especially vulnerable populations, achieve their potential by strengthening
         family and other support systems

FY2010-11 CSBG Application Instructions                 rev. 01/10                                   4
               Instructions for Completing the Agency Strategy for Eliminating Poverty
                                           OEO Form 210

The Planning Period must indicate either a one-year or multi-year period. If a multi-year period is
indicated, then the Agency Strategy need not be revised each year, only at the end of the planning period.
It may, however, be amended if necessary prior to the end of the multi-year period.

The Poverty Cause Description is one of the most important elements of the application. It must give a
detailed description of the poverty cause and must clearly identify the problem; why the problem exists;
the segment of the population experiencing the problem; how many are experiencing the problem
(percentages must be supported by actual numbers); and how they are adversely affected.

The Priority Number should denote the importance of the problem in comparison to other problems
identified in the planning process as determined by the Board of Directors.

The Resource Analysis must describe efforts being utilized to solve the problem in your community and
the resources that are needed to effectively eliminate or have a major impact on the problem. Your
analysis of needed resources should not be limited to the resources of your agency. The Resource
Analysis will help to determine whether or not utilization of your agency's resources will have an impact
on solving the problem.

The Long-Range Goal must be a measurable and attainable statement of what will be achieved within a
specified time frame by addressing the problem. Also see the Plan for Monitoring, Assessment and
Evaluation, which requires an analysis of your progress in meeting the Long-Range Goal.

Strategies for Achieving the Long-Range Goal are the various approaches or ways of achieving the goal
that can be implemented by your agency or others within your service area. An asterisk should be placed
beside the strategy(ies) selected for implementation by your agency.

FY2010-11 CSBG Application Instructions                rev. 01/10                                  5
                        Instructions for Completing the One-Year Work Program
                                            OEO Form 212

Item 1 Project Name should show a brief descriptive title of the project.

Items 2, 3, and 4 (Poverty Cause Name, Long-Range Goal and Selected Strategy) should be stated exactly
as they appear on the corresponding OEO Form 210 (Agency Strategy for Eliminating Poverty).

Item 5 Project Period should state the one-year period in which the project will be carried out and the Plan
Year should show the current year of your multi-year period.

Item 6 OEO Funds Requested should indicate the amount of CSBG or Other OEO funds to be used in
carrying out the project; the amount must correspond with the total project amount on line 10 of the first
page of the Grantee Budget Information (OEO Form 225).

Item 7 Number Expected to be Served should indicate the total number of participants (all) the agency
plans to serve during the program year. The number should include those participants expected to enroll
as well as those continuing from the previous year.

Item 8 Number expected to move above the Federal Poverty Income Guideline should be completed for
Self-Sufficiency Projects only.

Item 9 Percent of Long-Range Goal Met should be completed by agencies providing projects other
than Self-Sufficiency. Complete by indicating the percent of the long-range goal expected to be achieved
during the project year.

The Project One-Year Objective should be a measurable statement or summary of what will be achieved
during the project year and must be related to the long-range goal. However, the objective may not be a
re-statement of the long-range goal.

Detailed Project Activities must be listed which clearly describe how the project will be carried out and
which will ensure that the objective will be accomplished.

The Position Title column must show the title of the position(s) responsible for carrying out each project
activity. Position titles listed as "all staff" or "CSBG Staff" are not acceptable.

The Implementation Schedule must indicate the number of participants to be served each quarter or dates
when certain activities will be completed. In projects such as self-sufficiency, in which the same
participants will be served more than one quarter, the number of new participants served must be listed for
each quarter in parenthesis as well as the cumulative number of participants served. If activities listed in
the Implementation Schedule do not directly involve participants, dates the activities (will be completed)
(or occurs) must be listed.
                        First Quarter       Second      Third Quarter       Fourth
                                            Quarter                         Quarter
                            100               190           275               345
                                              (90)          (85)              (70)
                        07/10-06/11       07/10-06/11   07/10-06/11       07/10-06/11
                           09/10             12/10         03/11             06/11

FY2010-11 CSBG Application Instructions                      rev. 01/10                              6
              Instructions for Completing the CSBG Administrative Support Worksheet
                                          OEO Form 212-A

NOTE: A separate OEO Form 212-A must be completed for each grant for which administrative support
is requested.

Item 1 must show the name of the grant for which CSBG administrative support is being requested such
as S.O.S., Weatherization, etc.

Item 2 should briefly describe the purpose of the grant named in Item 1, the name of that grant’s funding
source and the total amount of the grant.

Item 3 must state the reason that CSBG administrative support is needed. The reason must be con-firmed
by supporting documentation such as a copy of the grant, and regulations or correspondence from the
funding source.

Item 4 is self-explanatory.

In Item 5, all statements refer to the grant listed in Item 1 above. Indirect Cost Base should indicate total
direct costs, salaries/wages or other.

Item 6 is self-explanatory.

Item 7 is self-explanatory.

FY2010-11 CSBG Application Instructions                 rev. 01/10                                    7
                         Instructions for Completing Grantee Budget Information
                                             OEO Form 225

Note: The OEO Form 225 is available to you at the OEO Website:
( as an Excel spreadsheet. Complete only the highlighted sections. This
will keep you from destroying formulas. Each tab is for one sheet of the budget.

Sections I - III are self-explanatory.

Section IV. Salaries and Wages:

Position Titles must be stated exactly as they appear on the OEO Form 212 and only those positions may
be listed which have been assigned to project activities on the corresponding OEO Forms 212 and which
are charged directly to the grant.

The actual Annual Salary for each position must be listed; combined salaries of positions with the same
title are not acceptable in this column.

Budget Support Data:

Section IVa
Appropriate Fringe Benefits line items must be completed unless a cognizant-approved fringe benefit
rate has been received.

Justification for total costs must be provided in the appropriate spaces for Communications, Space Costs,
Travel, Supplies/Materials, Contractual, Client Services, and Other.

Section IVb
A detailed description of Equipment to be purchased is required along with the number of items to be
purchased, the actual cost per item and the total cost of the item(s). (Note: items with a purchase cost of
less than $500 are not considered equipment.)

Section IVc
The Travel category should include local mileage, per diem, lodging, transportation and related items
while in travel status on official business of the agency.

The Supplies/Materials category should include such items as office supplies, brochures, or training

Section IVd
The Contractual category should include, in addition to audit costs, a detailed description of any goods or
services to be provided through a professional or personal consultant services contract. Agencies utilizing
the Accountable Results for Community Action (AR4CA) database system should include related
expenses under contractual. Note: copies of any contracts described in this section must accompany
the application.

The Client Services category should include a detailed description of services to be provided to clients in
each project.

The Other category should include any items not covered in previous cost categories.

FY2010-11 CSBG Application Instructions                rev. 01/10                                   8
Total Agency Budget

The Total Agency Budget is included for informational purposes and is not a formal part of the OEO
Form 225. The TAB should include all ARRA funded programs. See additional instructions included
with the form itself.

FY2010-11 CSBG Application Instructions              rev. 01/10                                 9
           Instructions for Completing the Plan for Monitoring, Assessment and Evaluation

The Monitoring, Assessment and Evaluation Plan consists of six self-explanatory topic areas for which
each grantee is required to provide a narrative description. In addition, each grantee must complete
Column A of the Key Outcome Measures chart of item 6.

FY2010-11 CSBG Application Instructions             rev. 01/10                                 10

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