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Solutions Grant Application 45
Exhibit 10
Certification of Local Government Approval
For Nonprofit Organizations – Emergency Shelter Only
Required by 25 C.F.R. § 576.202
I, duly authorized to act on behalf of the
(Name and Title)
hereby approve the submission of the following
(Name of City or County Government)
ESG Application proposed by
Name of Agency
which will serve persons
living in
(Name of City or County)
This certification solely warrants that the jurisdiction has agreed to allow the nonprofit
organization to seek the grant to be able to serve citizens in need who reside in this
jurisdiction. This certification places no responsibility or liability upon the local
government jurisdiction related to the nonprofit’s performance of grant-funded activities in
our jurisdiction.
By:
(Name) (Title)
(Signature)
(Date)
This form MUST BE signed, dated and returned with the grant application in order for
the application to be considered for funding.
2016-17 Emergency Solutions Grant Application 46
Exhibit 11
CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans and
Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or an
employee of any agency, a member of congress, an officer or employee of congress, or an
employee of a member of congress in connection with the awarding of any federal contract,
the making of any federal grant, the making of any federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to influence an officer or employee of any agency, a member
of congress, an officer or employee of congress, or an employee of a member of congress in
connection with this federal contract, grant, loan, or cooperative agreement, the undersigned
shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in
accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award
documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts
under grants, loans and cooperative agreements) and that all sub-recipients shall certify and
disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for
making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any
person who fails to file the required certification shall be subject to a civil penalty of not less
than $10,000 and not more than $100,000 for each such failure.
Signature Date
Name of Authorized Individual Application Number
Address of Organization
2016-17 Emergency Solutions Grant Application 47
Exhibit 12
Written Standards
At a minimum, the written standards must include the information below:
Street Outreach
- Standard policies and procedures for evaluating individuals’ and families’ eligibility for
assistance under ESG;
- Standards for targeting and providing essential services;
- Where and how clients will be served;
- What constitutes a client;
- Documentation needed for clients, if any;
- HMIS participation; and
- Coordination of mainstream benefits/coordinated assessment.
Emergency Shelter
- Standard policies and procedures for evaluating individuals’ and families’ eligibility for
assistance under ESG;
- Policies and procedures for admission, re-admission, referral, and discharge (clients
served, amount of time allowed at shelter, can client return, etc.) ;
- Standards regarding length of stay, safeguards to meet the safety and shelter needs of
special populations (domestic violence, dating violence, etc.), and individuals and families
who have the highest barriers to housing and are likely to be homeless the longest;
- Facility fee, if applicable;
- Policies and procedures for coordination among other homeless assistance providers
(housing needs providers, etc.);
- Grievance procedures (who/how to make complaint);
- Coordination of mainstream benefits/coordinated assessment; and
- HMIS participation.
Prevention and Rapid Re-housing
- Standard policies and procedures for evaluating individuals’ and families’ eligibility for
assistance under ESG;
- Policies and procedures for determining and prioritizing which eligible families and
individuals will receive homelessness prevention assistance and which eligible families
and individuals will receive rapid re-housing assistance;
- Standards for determining what percentage or amount of rent and utilities costs each
program participant must pay while receiving homelessness prevention or rapid re-housing
assistance;
- Standards for determining how long a particular program participant will be provided with
rental assistance and whether and how the amount of that assistance will be adjusted over
time;
- Standards for determining the type, amount, and duration of housing stabilization and/or
relocation services to provide to a program participant, including the limits, if any, on the
homelessness prevention or rapid re-housing assistance that each program participant may
receive, such as the maximum amount of assistance, maximum number of months the
program participant receive assistance; or the maximum number of times the program
participant may receive assistance.
- HMIS participation; and
- Coordination of mainstream benefits/coordinated assessment.
Exhibit 13
2016-17 Emergency Solutions Grant Application 48
HOMELESS DEFINITION
Individuals defined as Homeless under the following categories are eligible for assistance in
SO:
Street Outreach
x Category 1 – Literally Homeless
x Category 4 – Fleeing/Attempting to Flee DV (where the individual or family also
meets the criteria for Category 1)
SO projects have the following additional limitations on eligibility within Category 1:
x
(Emergency Solutions Grants Program)
Individuals and families must be living on the streets (or other p[laces not meant for
human habitation) and be unwilling or unable to access services in emergency
ELIGIBILITY BY COMPONENT
shelter
Individuals and Families defined as Homeless under the following categories are eligible for
Emergency Shelter
assistance in ES projects:
x Category 1 – Literally Homeless
x Category 2 – Imminent Risk of Homeless
x Category 3 – Homeless Under Other Federal Statutes
x Category 4 – Fleeing/Attempting to Flee DV
Individuals defined as Homeless under the following categories are eligible for assistance in
Rapid Re- RRH projects:
x Category 1 – Literally Homeless
Housing x Category 4 – Fleeing/Attempting to Flee DV (where the individual or family also
meets the criteria for Category 1)
Individuals and Families defined as Homeless under the following categories are eligible for
assistance in HP promects:
Homelessness Prevention
x Category 2 – Imminent Risk of Homeless
x Category 3 – Homeless Under Other Federal Statutes
x Category 4 – Fleeing/Attempting to Flee DV
Individuals and Families who are defined as At Risk of Homelessness are eligible for
assistance in HP projects.
HP projects have the following additional limitations on eligibility with homeless
