TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER u: MISCELLANEOUS PROGRAMS AND SERVICES
PART 960 PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK GRANTS PHHS RULES
SECTION 960.50 APPLICATION PROCEDURES
Section 960.50 Application Procedures
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.