Application: MMHU-3

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Online Application

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About the Application

This page lists all the questions you will be asked to respond to in the SurveyMonkey Apply platform. The application is organized into 9 sections. The information in Sections 1–4 is about the organization overall. The information in sections 5-9 is specific to this funding notice and scored as part of the merit-based review. In sections 5-9, please carefully note the associated criteria for each question. These criteria are used to score each question.

Section 1. Organization Information (0 points)

In Section 1, enter general information and relevant contact information related to your organization and the program.

#	Data Item	Field Information	Instructions
1.1	Legal organization name		““Add the organization name as registered with the Illinois Secretary of State.”
1.2	Common name (doing business as [DBA])
1.3	Address line 1
1.4	Address line 2
1.5	City
1.6	State
1.7	ZIP code
1.8	County of primary office location
1.9	Organization phone		““Please input the phone number in this format: ###-###-####-Ext””
1.10	Organization website address (optional)
1.11	Type of organization	Nonprofit For profit Tax exempt	Select your organization type.
1.12	Organization description		Provide a 2-3 sentence description of your organization’s mission, vision, and services.
1.13	Year founded/incorporated
1.14	IDHS /DBHR licenses, if any
1.15	Indirect cost election	Federally negotiated rate De minimis No indirect costs election	Select your indirect cost election.
1.15a	Indirect cost rate		Enter your indirect cost rate.
1.16	Program manager or director name	The primary contact should be the program manager/director who receives all program communications and ensures that materials are shared appropriately.
1.17	Program manager or director title
1.18	Program manager or director email address
1.19	Program manager or director phone
1.20	Program alternative contact name
1.21	Program alternative contact title	The secondary contact may be administrative or fiscal support and will also receive program communications.
1.22	Program alternative contact email address
1.23	Program alternative contact phone
1.24	Organizational leadership contact name	A member of the organization’s executive leadership team who will serve as the program sponsor.
1.25	Organizational leadership contact email address
1.26	Organizational leadership contact phone

Section 2. Pre-Qualification (0 Points)

In Section 2, enter information that demonstrates your organization’s eligibility for receiving grant funds.

#	Data Item	Field Information	Instructions
2.1	Federal or State Employer Identification		Indicate your FEIN/EIN.
2.2	Expiration date of sam.gov account		Enter date
2.3	Unique Entity Identifier		Indicate your UEI.
2.4	Illinois Secretary of State File ID		Indicate your File ID.
2.5	Do you attest that your organization is not on the Federal Excluded Parties List?	Yes No
2.6	Do you attest that your organization is not on the Illinois Stop Payment list?	Yes No
2.7	Do you attest that your organization is not on the Department of Healthcare and Family Services Provider Sanctions list?	Yes No
2.8	Do you attest that your organization is in good standing with the Illinois Secretary of State?	Yes No

Section 3. Internal Controls (0 Points)

In Section 3, enter information about the administrative and management controls within your organization to inform assessment of organizational risk. These questions align with the Illinois ICQ.

#	Data Item	Field Information	Instructions
3.1	What type of accounting system does the organization use? (2.01)	Manual and/or spreadsheet-driven Automated, off the shelf Automated, written in-house or by consulting firm	Select the response that best describes your accounting system.
3.2	Does the accounting system require users to have separate sign in/log on credentials for access and approval? (2.02)	Yes No
3.3	Have any new accounting systems been implemented during the last fiscal year? (2.03)	Yes No
3.3a	If yes, please describe the new accounting system.
3.4	Does the accounting system or do related written policies and procedures separate the receipt and expenditure of grant funds at the grant level? (2.04)	Tracked outside of the accounting system with spreadsheets Tracked in the accounting system	Select the response that best describes how receipt and expenditure of grant funds are tracked.
3.5	Does the accounting system or do written policies and procedures include a formal chart of accounts that allows users to record transactions by the categories of the approved budget? (2.05)	Yes No
3.6	How often are the general ledger accounts reconciled? (2.06)	Monthly Quarterly Semi-annually Annually Not applicable	Select the response that best describes how often the general ledger accounts are reconciled.
3.7	Does the organization require monthly bank reconciliations? (2.07)	Yes No
3.8	Does the organization have written policies and procedures regarding proper segregation of duties for fiscal activities that include, but are not limited to, a) authorization of transactions, b) recordkeeping for receipts and payments, and c) cash management? (2.08)	Yes No
3.9	Does the organization have written review and approval processes over financial and program-related reporting? (3.01)	Yes No
3.10	Are the annual financial statements prepared in accordance with Generally Accepted Accounting Principles (GAAP) or on a basis acceptable by the regulatory agency? (3.02)	Yes No
3.11	Does the organization have written policies and procedures to ensure program performance measures and deliverables align with the program spending plan? (3.03)	Yes No
3.12	Has the organization taken steps to ensure the individuals who prepare, review, and approve reports have the financial and/or program-related required knowledge, skills, and abilities? (3.04)	Always Sometimes Never Not applicable
3.13	Who prepares the organization’s financial statements? (3.05)	Trained staff who work for the organization Financial consultants who are not part of the organization’s audit firm Independent auditors who conduct the financial statement audit	Select the response that best describes who prepares the organization’s financial statements.
3.14	Who prepares the organization’s program performance reports? (3.06)	Trained staff who work in the specific program Grant managers or program directors Organizational management outside of the program	Select the response that best describes who prepares the organization’s performance reports.
3.15	Does the organization have written policies and procedures that support compliance with cost principles? (4.01)	Yes No
3.16	Does the organization have written policies and procedures for allocating costs? (4.02)	Yes No
3.17	Are costs recorded consistently with regulations and written policies and procedures to address uniformity both in grant awards and in the organization’s other activities? (4.03)	Yes No
3.18	Does the organization charge indirect costs? (4.04)	Yes No
3.19	Does the organization keep adequate documentation to support all costs charged to its grant awards? (4.06)	Yes No
3.20	Does the organization have a governing body (including but not limited to: Board of Directors, Board of Trustees, City Council, County Board, Leadership, Legislature, Governor’s Office, etc.)? (4.07)	Yes No
3.21	Is financial information, including budget to actual revenue and expenditure reports, provided to leadership or the governing body members? (4.08)	Always Sometimes Never	Select the response that best describes how often financial information is provided to leadership or governing body members
3.22	Is the governing body engaged in audit function activities, such as selection of an audit firm, the audit firm’s presentation of audit results, or follow-up on corrective action of audit findings? (4.09)	Engaged in all audit function activities Engaged in some audit function activities Not involved in audit activities	Select the response that best describes how often the governing body is engaged with audit function activities.
3.23	Does the organization make purchases of equipment of $5,000 or more with grant funding? (4.10)	Yes No
3.24	Is a control system in place with adequate safeguards to prevent loss, damage, theft, or unauthorized use of property? (4.13)	Yes No
3.25	Does the organization have written policies and procedures for proper authorization of property disposals? (4.14)	Yes No Not applicable
3.26	Does the organization have written policies and procedures for purchasing goods and services with grant funds? (4.15)	Yes No
3.27	Does the organization have written policies and procedures that forbid employees, management officers, or agents from participating in the selection, award, or administration of a contract supported by a grant award if there is a real or apparent conflict of interest? (4.16)	Yes No
3.28	Does the organization have written policies and procedures that forbid contractors who develop or draft specifications, requirements, statements of work (scope of services), or requests for proposals from competing for such procurements? (4.17)	Yes No
3.29	Does the organization have written policies and procedures that document subrecipient and contractor determinations? (4.18)	Yes No
3.30	In those determinations, has the organization identified any subrecipients? (4.19)	Yes No
3.31	Does the organization have written policies and procedures for assessing subrecipient risk and monitoring program implementation? (4.20)	Yes No
3.32	Does the accounting system or do related written policies and procedures identify expenses in excess of available budget? (4.21)	Yes No
3.33	Are adequate controls in place to ensure that necessary budget revisions receive prior approval from the grantor when applicable? (4.22)	Yes No
3.34	Does the organization have written policies and procedures for allocating personnel time and effort by funding source? (4.23)	Yes No
3.35	Does the organization have written policies and procedures to ensure that all salaries and wages charged to grants accurately reflect work performed (i.e., time and effort or after-the-fact payroll verification)? (4.24)	Yes No
3.36	Does the organization have written policies and procedures to ensure accurate tracking of grant deliverables and performance measures? (4.25)	Yes No
3.37	Does the organization have written policies and procedures to make sure program activities are allowable under the grant agreement and state and federal regulations? (4.26)	Yes No
3.38	Are the terms of the executed agreement and budget shared with the performance or program management staff? (4.27)	Yes No
3.39	Does the organization have written policies and procedures for determining participant eligibility? (4.28)	Yes No
3.40	Does the organization have written policies and procedures for maintaining support documentation of the participant eligibility determination? (4.29)	Yes No
3.41	Have there been any changes in key organizational personnel since the last audit, such as changes to Fiscal and Administrative Management, the Executive Director, and/or Program Management? (5.01)	Yes No
3.42	Has the organization had a financial statement audit conducted in the past year? (5.02)	Yes No
3.42a	What type of audit was conducted? (5.03)	Financial audit conducted in accordance with Generally Accepted Auditing Standards Financial audit conducted in accordance with Generally Accepted Government Auditing Standards Single Audit/Program Specific Audit in accordance with 2 CFR § 200.501	Select the response that best describes the type of audit conducted within the past year.
3.42b	What period did the audit cover?
3.42c	Did the audit disclose findings considered to be significant deficiencies or material weaknesses? (5.04)	Yes No
3.42d	If yes, please describe the audit findings and describe any corrective actions implemented.	[Text, 300 characters]
3.43	Has the organization submitted financial and program-related reporting in a timely manner and as required for prior grant awards?	Always Sometimes Rarely
3.43a	If “sometimes” or “rarely,” please further describe the situation and describe any corrective actions implemented.

Section 4. Organization Attestations (0 Points)

In Section 4, verify organizational capacity and truthfulness of information in the application and upload organization attachments.

#	Data Item	Field Information	Instructions
4.1	By entering my name, title, and date, I attest that I am authorized to submit the application on my organization’s behalf.	[Name] [Title] [Date]	Enter requested information in fields.
4.2	I attest that my organization is committed to processing a subaward within six (6) weeks from the NOIA.	Yes No
4.3	I attest that my organization is responsible for performance and monitoring of external partners, subcontractors, and subrecipients (as allowed by the grant agreement).	Yes No
4.4	I attest that I have reviewed the terms and conditions within this NOFO in its entirety. My organization meets the eligibility criteria and has the capacity to fulfill the scope of services described.	Yes No
4.5	I certify that the statements herein are true, complete, and accurate to the best of my knowledge. I agree to comply, on behalf of my organization, with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (https://www.ecfr.gov/current/title-2/section-200.415) 18 USC § 1001.	Yes No
4.6	I attest that my organization will adhere to applicable standards within 77 Ill. Admin. Code Part 2060, .	Yes No
4.7	Conflict of Interest Disclosure	Document upload (required)	Upload as “A. COI”
4.8	Form W-9, Request for Taxpayer Identification Number and Certification	Document upload (required)	Upload as “B. W-9”
4.9	Current fiscal year organizational budget or, if you are a new organization, your planned budget for the upcoming fiscal year	Document upload (required)	Upload as “C. Org Budget”
4.10	Current or planned organizational chart*	Document upload (required)	Upload as “D. Org Chart”
4.11	Financial Audit Report (most recent)	Document upload (if applicable)	Upload as “E. Audit”
4.11a	What period did the audit cover?		Enter the date range of the period covered by audit
4.12	NICRA	Document upload (if applicable)	Upload as “F. NICRA” (if applicable)
4.13	Financial Management and Personnel Policies and Procedures Upload documents that demonstrate that financial management systems meet the standards for fund control and accountability as established in 2 CFR § 200.302 and that internal controls meet standards established in § 200.303. Documents that can demonstrate adequate financial management and internal controls standards may include, but are not limited to, the following: Fiscal Policies and Procedures; Employee Handbook; Internal Expense Approvals Guidance; Organizational Chart; Chart of Accounts; etc.	Document upload (if applicable)	Upload as “G. Policies”

Section 5. Executive Summary (5/100 points)

In Section 5, provide a brief overview of your organization, experience, the proposed area and populations of focus, and program results.

Data Item

Field Information

Evaluation Criteria

5.1

Provide a summary of your organization and program, including the following:

Your organization’s mission and vision

Your organization’s experience with similar programs

The geographic area and populations of focus for your program

The goals and objectives of your program

The expected outcomes

Up to 1,000 words

(5 points)

The mission and vision of the organization are clearly stated in the response and are relevant to the proposed program.

The response summarizes relevant experience and success in similar programs.

The response summarizes the area and populations of focus.

The response summarizes the goals, objectives, and expected outcomes of the program.

The response addresses all elements of the question.

Section 6. Need and Opportunity (30/100 points)

In Section 6, describe the need for the program in the geographic location where services are planned and how the proposed activities will support the program goals.

#	Data Item	Field Information	Evaluation Criteria
6.1	Select the public health region (s) where you plan to provide MMHU-3 services per the map.	Cook County (Bellwood) West Chicago Champaign Marion Metro East Peoria Rockford Statewide	(3 points) Applicant service areas are located in Metro East, Peoria, or West Chicago public health regions.
6.2a	Please select the primary County where you plan to provide MMHU-3 services.	[list of counties]	(4 points) The municipalities and/or counties in questions 6.2a and 6.2b demonstrate high opioid fatality rates as described in Section C.2. The municipalities and/or counties in questions 6.2a and 6.2b demonstrate high poverty rates as described in Section C.2. The municipalities and/or counties in questions 6.2a and 6.2b demonstrate high rates of firearm violence as described in Section C.2. The municipalities and/or counties in questions 6.2a and 6.2b demonstrate other conditions that hinder overall wellbeing as described in Section C.2.
6.2b	Please list any other county(ies) and/or municipality(ies) where you plan to provide MMHU-3 services.
6.3	Objectives of MMHU-3 funding are to ensure that (1) patients within the priority populations (Section C.2. of the NOFO) receive immediate care for acute and chronic conditions, including SUD/OUD, wherever it is sought in the service area and (2) transitions to additional recovery services are managed and supported. What is the current need for MMHU services to achieve these program objectives in your proposed service area? Describe the following: The geographic area where services are to be provided, including descriptions of current MAR services and gaps in the service area. Data on opioid use disorder and trends in the proposed service area. Barriers to access, including social determinants of health, lack of coverage, etc. The population of focus for services, including demographic information and other relevant characteristics. The population of focus should be aligned with program objectives. Please cite the source of any data included.	Up to 2,500 words	(15 points) The response describes currently available MAR services and demonstrates gaps in services in the proposed service area. The response provides data on opioid use disorder and trends in the proposed service area. The response describes barriers to access to treatment of opioid use disorder in the proposed service area. The response clearly describes a population of focus, including demographic information and other characteristics, that aligns with program objectives. The response addresses all elements of the question, including data and appropriate citations, when appropriate.
6.4	How will your proposed services achieve program objectives by addressing gaps in services and the needs of priority populations in the proposed service area? Describe the services to be provided in the proposed services area Describe how gaps in services will be addressed by proposed services Describe specific outreach plans for disparately impacted populations. Please cite the source of any data included.		(8 points) The response proposes services that align with the intended objectives of the program. The response demonstrates how proposed services address the needs of priority populations within the geographic area. The response demonstrates how the organization will outreach to priority populations. The response clearly addresses all elements of the question, including data and appropriate citations, when appropriate.

Section 7. Experience and Capacity (30/100 points)

In Section 7, describe relevant experience and capacity to effectively perform program requirements.

Data Item

Field Information

Evaluation Criteria

7.1

What is your organization’s experience delivering services that meet the objectives of the MMHU-3 program?

Describe experience providing the following services:

Increasing access to MAR for individuals with OUD or other SUDs

Providing care for acute and chronic conditions

Administering FDA-approved OUD medications

Supporting individuals transitioning to additional recovery services

Provide detailed descriptions of relevant prior work.

Up to 1,500 words

(12 points)

The response demonstrates that the applicant has experience Increasing access to MAR for individuals with OUD or other SUDs

The response demonstrates that the applicant has experience providing care for acute and chronic conditions.

The response demonstrates that the applicant has experience administering FDA-approved OUD medications.

The applicant demonstrates relevant experience supporting individuals transitioning to additional recovery services.

The applicant demonstrates relevant experience with examples of prior work.

The response clearly addresses all elements of the question, including data and appropriate citations, when appropriate.

7.2

Provide up to five examples of grants or contracts that your organization has successfully managed in the past 5 years, with awarding agencies, dates, and dollar amounts.

Include any current fiscal year funding from IDHS/DBHR or IDPH and awards of similar size and services.

In description, note whether services relate to the services proposed for this award.

Select “not applicable” if you have not received previous grants or contracts.

Checkbox for not applicable

Table below

(4 points)

The applicant demonstrates experience with grants management of comparable size awards.

The applicant demonstrates experience with grants management for comparable services.

7.3

Who are the key personnel on the MMHU-3 project?

Describe key personnel who will lead the project and provide core support for MMHU operations. Additionally, upload at least two resumes, including the project director and other key leadership roles. If key personnel are to be hired, describe the roles and responsibilities and anticipated timeline for hire.

Upload resumes as “H. Resumes”

(4 points)

The applicant proposes personnel who demonstrate the experience and expertise required to implement the proposed program.

The applicant uploaded resumes for the appropriate key personnel.

7.4

What is your organization’s staffing plan to deliver mobile health unit services?

Provide detailed information, including title for each staff member, role, and number of staff FTE who will be providing services in the mobile unit.

If partnering with a healthcare organization or community program to fulfill program, describe their role and your organization’s experience with these partners.

Up to 1,000 words

(4 points)

The applicant proposes staff and/or partners who demonstrate the experience and expertise required to implement the proposed program.

7.5

How does your organization ensure services advance equity and racial and social justice?

Describe policies, procedures, and practices related to:

Diversity, equity, inclusion, and racial justice

Hiring people with lived and living experience

Equitable access to support and services

Implicit bias

Culturally responsive, culturally humble, and trauma-sensitive services, including providing interpreters and other accommodations

Up to 1,000 words

(6 points)

The response demonstrates organizational commitment, through policy and practice, to advancing equity, racial, and social justice.

The applicant is prepared to provide interpreters and other accommodation in response to cultural and linguistic needs.

The response addresses all elements of the question, including data and appropriate citations, when appropriate.

Name and Brief Description of Program	Funder Name	Funder Type	Dollar Amount	Population Served	Start Date (MM/DD)	End Date (MM/DD)
200 characters	200 characters	[Drop Down choices—federal, state, local government, other]	Currency, whole dollar only	200 characters	Date	Date
[same]
[same]
[same]
[same]

Section 8. Quality (30/100 points)

In Section 8, describe your overall approach to implementing program requirements.

#	Data Item	Field Information	Evaluation Criteria
8.1	Describe the goals, objectives, and projected outcomes based on your organization’s specific services and patient population. The following can be used as an example format: Goals, Objectives, and Projected Outcomes Outcome Statement: The primary outcome for this program is increased access to MAR through the number of patients cared for, medication dispensed/prescribed, and connection to treatment/recovery support services. Secondary outcomes include treatment retention, identification of OUD-related symptoms, decreased overdose mortality, and increase in treatment of comorbid Hepatitis C or HIV. Program outcomes will be monitored through MMHU logs and patient level data documented in electronic health records (EHR). Goal 1 (G1): Provide van-based MAR services and referral to treatment for patients on the south and west sides of Chicago. G1 Objective 1: Within the first year of MMHU operations, 500 people will have received harm reduction services and screening for MAR. G1 Objective 2: Within the first year of MMHU operations, 200 people will have received MAR or a referral to an organization for methadone. G1 Objective 3: Within the first year of MMHU operations, outcome data will be collected for at least 75% of patients to determine if patients followed up with clinic appointments after engagement in mobile unit-based inductions. Goal 2 (G2): Connect patients to additional medical services in the mobile unit including HIV and Hepatitis C testing and treatment, wound care, and basic primary care services. G2 Objective 1: Within the first year of MMHU operations, 90% of patients will be offered HIV and HCV testing. G2 Objective 2: Within the first year of MMHU operations, all patients who test positive for HIV and/or HCV will be offered connection to treatment either on the MMHU or through the West Side Field Station COIP clinic. Goal 3 (G3): Develop an education immersive training program for trainees (residents, DNP students, medical students) focused on harm reduction, substance use disorder treatment, and MOUD in a MMHU setting. G3 Objective 1: Within 3 months of operations, a MMHU substance use disorder rotation will be offered to trainees. G3 Objective 2: Within the first year of operations, at least 20 residents, DNP students, and medical students will have completed a rotation on the MMHU. Goal 4 (G4): Within the first two years develop a sustainability plan, evaluation report, and a MMHU toolkit. G4 Objective 1: Monitor insurance enrollment rates, billable services, and billable medications to develop a potential business model for continued sustainability of the MMHU as well as a model for sustainability for future programs. G4 Objective 2: Following a thorough evaluation, produce a document containing programmatic workflows, instructions, protocols, and a toolkit that can be disseminated to other programs in Illinois to initiate and support a similar model of care through shared learning.	Up to 1,000 words	(9 points)  The response lists specific goals, objectives, and outcomes that are related to the proposed program requirements. The service projections are clear and reasonable in relation to the budget request. The response clearly addresses all elements of the question, including data and appropriate citations, when appropriate.
8.2	Upload a detailed program plan for your proposed approach, including a month-by-month timeline that covers: Coordinating award administration requirements Hiring and training staff Developing required plans Delivering services and activities Collecting required data	Upload Program Plan as “I. Program Plan”	(3 points) The program plan contains sufficient detail to understand the overall approach and timeline of program activities. The program plan includes all required program elements. The timeline includes realistic milestones.
8.3	Describe logistics of the mobile health unit, including:  Where do you anticipate parking the vehicle?  What days of the week will the vehicle be in operation?  What are the proposed hours of operation per day?  What are the proposed hours of operation per week?	Up to 500 words	(2 points)  The response clearly describes how the organization will manage logistics of the mobile health unit.
8.4	Describe your plan to dispense and prescribe all three FDA-approved medications for OUD (naltrexone, methadone, and buprenorphine / naloxone).	Up to 500 words	(2 points)  The response describes how the organization will dispense and prescribe medication.
8.5	Describe the social determinants of health assessment and assistance you plan to provide to those receiving services, including assistance with enrollment in health insurance, housing, and employment services.	Up to 500 words	(2 points)  The response describes how the organization will assess social determinant of health needs.
8.6	Describe outreach strategies to gain support and/or attract potential participants to obtain services.  Explain how staff will engage in outreach and their outreach methods (e.g., one-on-one meetings, community forums) and type of representatives you plan to meet with (e.g., law enforcement officials, community partners, faith-based organizations).	Up to 500 words	(4 points)  The outreach plan details which staff will participate in different types of outreach activities.  The outreach plan involves engaging with a diverse set of stakeholders.
8.7	Describe additional services you are proposing to provide in the MMHU (optional, but preferred).  Include:  Harm reduction services  Recovery support services  Treatment services  Community education and referral services  Primary health services  Other services	Up to 500 words	(1 points)  The response describes how the organization will provide additional services.
8.8	Describe how your organization will ensure patients have access to the full spectrum of treatment and recovery support services, and how and when you will connect clients to “in office” care.  Describe processes for:  Recovery support and referrals to community partners  Higher levels of care as indicated  Referrals for other health services  Provide the names of the organizations and partners and describe the services provided by these organizations.	Up to 500 words	(3 points)  The response describes how the organization will ensure access to recovery supports and referrals.  The response describes how the organization will ensure access to higher levels of care as needed.  The response describes how the organization will ensure access to referrals for other health services
8.9	Provide three references that describe history and quality of work related to the goals of the funding opportunity.	Upload 3 letters of reference as “J. References”	(4 points) The organization uploaded at least three letters of reference. The letters of reference support the organization’s expertise and experience in work relevant to the funding opportunity.

Section 9. Budget (5/100 Points)

In Section 9, provide information about the program budget.

#	Data Item	Field Information	Evaluation Criteria
9.1	Total funding requested for the period of performance	[currency]	(0 points)
9.2	Please select your preferred payment term as described in Section G.5. of this document. PLEASE NOTE: Advance payment and reconcile is not guaranteed. If you are awarded and your preferred payment method is advanced payment and reconciliation, you will be evaluated based upon your eligibility per 44 Ill. Admin. Code 7000.120(b), 2 CFR § 200.302, and 2 CFR § 200.305. Illinois requires that the following conditions must be met to receive advanced payment. You must maintain or demonstrate the willingness to maintain both: Written procedures that minimize the time elapsing between the transfer of funds and disbursement by the awardee; and Financial management systems that meet the standards for fund control and accountability as established in 2 CFR § 200.302.)	Reimbursement Method Advance Payment and Reconcile Method Working Capital Advance Method	(0 points)
9.3	Upload the program budget and narrative. This workbook must tie fiscal activity to program objectives and deliverables. The budget must demonstrate that all proposed costs are Reasonable and necessary, Allocable, and Allowable as defined by program regulatory requirements and Uniform Guidance (2 CFR Part 200), as applicable.	Upload the Budget Workbook as “K. Budget” to submit your program budget and advance payment request (required)	(5 points) The proposed budget amount is not greater than the allowable amount identified in the NOFO. The budget is filled out completely (including staff/funds allocated for each task). Salaries, benefits, and other expenditures appear reasonable for the community in which the proposed program will take place. Personnel allocated reflect those proposed in application and are sufficient to support administrative requirements of program. All proposed items appear to be reasonable and allowable in accordance with program objectives.

Application: MMHU-3

NOFO Table of Contents

Section 1. Organization Information (0 points)

Section 2. Pre-Qualification (0 Points)

Section 3. Internal Controls (0 Points)

Section 4. Organization Attestations (0 Points)

Section 5. Executive Summary (5/100 points)

Section 6. Need and Opportunity (30/100 points)

Section 7. Experience and Capacity (30/100 points)

Section 8. Quality (30/100 points)

Section 9. Budget (5/100 Points)