EMERGENCY FOOD AND SHELTER PROGRAM PHASE 27 APPLICATION FORM INSTRUCTIONS

Application Deadline is 4 p.m. on December 5, 2008.

A signed original with attachments plus 3 copies & 1 copy of Audit, must be received at: EFSP Board

C/O Jewish Family Service Attn: Amy Halperin Wood

3201 S. Tamarac Drive Denver, Colorado 80231

ELECTRONIC COPIES ARE NOT ACCEPTED. POSTMARKS ARE NOT CONSIDERED TO DETERMINE IF DEADLINE IS MET.

1. The Eligibility Profile includes questions and requirements addressing the general criteria for EFSP

funding eligibility.

2. The Program Information portion of the application asks general questions regarding your target clientele, changes in clientele, and how you address gaps in services.

3. The Financial Information asks for financial accountability and a program budget. 4. The Certificate Forms include: This information must be included in the application for the local board to consider your request

for funding. • The Local Recipient Organization (LRO) Form, which is completed when applying for funding

and used when funding is awarded. • The Certificate of Accuracy should be signed by the executive director of the agency, the board

chairman and the fiscal agent (if applicable). 5. Appendices I to V asks questions regarding your specific request. Please submit only the appendices

that are applicable to your application. For example, if you are applying for shelter assistance only, you do not have to fill out the other appendices. Please be sure to sign the pages where indicated.

A signed original with all attachments and copies must also be received by the deadline at:

EFSP Board, C/O Jewish Family Service Attn: Amy Halperin Wood

3201 S. Tamarac Drive Denver, CO 80231

The Phase 27 EFSP Application Deadline is December 5, 2008 at 4:00pm.

A signed original with attachments, plus 3 copies & 1 copy of Audit, must be received at Jewish Family Service by 4:00pm. Electronic copies are not accepted. Postmarks are not

considered to determine if deadline is met. INCOMPLETE or LATE APPLICATIONS WILL NOT be CONSIDERED.

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EFSP Phase 27

POLICY STATEMENT REGARDING MEMBERSHIP AND CONFLICT OF INTERESTS OF METRO-DENVER EFSP BOARD The Metro-Denver Emergency Food and Shelter Program Board intends to be broadly representative of the community and to ensure that all decisions are made fairly, openly, and without discrimination on the basis of race, sex, religion, national origin, or membership or affiliation with members of the Board. I. Composition of Local Board The Metro-Denver EFSP Board shall consist of designated representatives from the following

organizations: 1. Local affiliates of the following organizations as mandated by legislation: United Way of America The Salvation Army The American Red Cross National Council of Churches Catholic Charities Council of Jewish Federations 2. County Executive/Mayor or designee of each county. 3. Representatives from homeless and hunger organizations. 4. Representation from the minority community. 5. Other persons who the board determines will assist it in meeting its responsibilities. II. Conflict of Interest The potential for conflict of interest in the allocations of EFSP funds exists despite the mandate

of the National EFSP Board to include representatives on the Local Board for agencies that provide emergency food and shelter. The Metro-Denver EFSP Board is committed to avoiding such conflicts. To this end, a Board member shall not vote on or participate in the deliberations concerning an application for funds from an agency that he or she represents, either as staff or as an agency board member. Such EFSP Board Member may respond to specific questions regarding the proposals for the purpose of clarification.

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EFSP Phase 27

Metro Denver Emergency Food and Shelter Board

Appeals Process

BASIS OF APPEALS SHALL BE LIMITED TO:

• Information relevant to application that was not previously available to applicant or the Local Board at the time of the funding decision

• Correction of erroneous material or evidence of miscommunication or misinterpretation of relevant information

• Violation of National guidelines by the Local Board • Allegations of fraud, bias, or misuse of funds by the Local Board

APPEALS WILL NOT BE ALLOWED IF:

• The appeal is made to revise proposal based on changes in program or organization after application was submitted

• The appeal is in reference to funding levels PROCESS

• All appeals of funding decisions must be filed within 20 working days of the date of mailing of the funding decision. All appeals must be in writing and must state the specific basis of the appeal and include all relevant information or materials in support of the appeal. Letter of appeal must be sent to:

Metro Denver Emergency Food and Shelter Board C/O Jewish Family Service Attn: Amy Halperin Wood 3201 Tamarac Drive Denver, CO 80231

• The Local Board or the Executive Committee will review appeals and notify the appellant agencies in writing within 20 working days of appeal deadline.

• Appellants still unsatisfied have the opportunity to communicate with the National Emergency Food and Shelter Board in accordance with National guidelines.

“Local decision making is an operating principle of this emergency effort. If the Local Board cannot handle an appeal locally, the case should be referred in writing to the National Board, including details on action that has been taken. Only when there is significant question of misapplication of guidelines, fraud or other abuse on the part of the Local Board, will the National Board consider action.” (p. 14, Emergency Food and Shelter National Board Program, Responsibilities and Requirements)

SPECIFIC PRIORITIES EFSP Phase 27 (Note: Rehabilitation and Purchase or Lease of Equipment for Feeding or Shelter Sites are not current priorities, but may be eligible for funding in future phases.) 1. SHELTER PROGRAMS Eviction Priorities:

• agencies agree to follow the approved Metro Denver EFSP Board process verifying that clients do not receive duplicate EFSP funding

• agencies that serve as a central distribution point for providing eviction assistance to broad community • assistance given in an amount that combined with clients' available resources enables them to stay in their

homes/housing • partial payment for eviction prevention with expectation that client obtain remainder from other agencies is

discouraged • it is permissible to maintain matching funds for eviction prevention from other sources • agencies that provide counseling and negotiation mediation with landlords in addition to financial assistance • foreclosure prevention assistance should be tied to a reasonable financial plan.

Mass Shelter Priorities: • agencies that expand emergency shelter or have expanded through EFSP funding to meet demonstrated gaps in

existing available shelter • agencies whose shelters are used in conjunction with support services • First Month's Rent Priority: agencies that provide counseling as part of the program • First Month's Rent Limitation: funds may not be used to cover security deposits • Shelters must demonstrate that FEMA funding will not supplant or replace other funding. Other Shelter (hotel/motel vouchers) limited to the following situations: • when existing shelters in the area are unavailable to client • when special health or other circumstances dictate placement in other than an emergency shelter • to meet short term shelter needs (up to 4 days) • when other public assistance resources are not available.

Other Residential Facilities Limitations: • EFSP funding is not available to residential child care facilities (RCCFs), nursing homes or other facilities

designed for long-term care of special populations 2. FOOD PROGRAMS Food Priorities:

• agencies that use to maximum extent: bulk purchases, gleaning programs, and other methods to stretch impact of EFSP funds

• agencies that provide emergency food services on a regular basis without discrimination • programs that meet demonstrated gaps in services and that do not duplicate other efforts • agencies that network with other agencies providing emergency services • agencies that provide emergency services rather than services for on-going food needs of clients

3. TRANSPORTATION PROGRAMS Transportation Priority: • transportation of food or commodities to programs that make food available to food banks or meal sites in a cost efficient manner (e.g., freight costs for gleaned or donated foodstuffs)

Transportation Limitation: • transportation costs for delivery of prepared meals (e.g., "meals on wheels") will not be allowed

4. UTILITIES PROGRAMS Utilities Priorities: • agencies agree to follow the approved Metro Denver EFSP Board process verifying that clients do not receive

duplicate EFSP funding • agencies that serve as a central distribution point for providing household utility assistance to a broad community • programs that provide assistance through FEMA funds after all other resources have been exhausted (LEAP, EAF) • programs that provide counseling to clients and negotiation/mediation with utility companies in addition to

financial assistance

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Page 1

AGENCY COVER PAGE

Phase 27: Metro Denver Emergency Food & Shelter Program Deadline: December 5, 2008 by 4:00pm at Jewish Family Service

Agency Information

Agency Name

Mission Statement

Contact Person Telephone

Fax Email address

Street Address City STATE ZIP

Mailing Address (if different) City STATE ZIP

Please indicate which county the application is for. IF YOU ARE APPLYING FOR MULTIPLE COUNTIES, YOU MUST SUBMIT AN APPLICATION FOR EACH COUNTY

Adams County Arapahoe County Denver County Douglas County Jefferson County Non-profit Status (check one): Government Private, nonprofit {501 (c)(3) or 501 (c)(4)}

Phase 27 Request Summary A. Served Meals $ B. Other Food $ C. Mass Shelter $ D. Other Shelter (Hotel/Motel Vouchers) $ E. Rent/Mortgage $ F. Utilities $ G. TOTAL REQUEST $ Total Program Budget (not Agency Budget) $ % of Budget Requested from EFSP %

EFSP Funding History Please indicate both amount received and category (food, meals, rent, shelter, utilities) Phase 25 ___________ Phase 26 ___________ Approximate date on which agency first began offering EFSP assistance_____________ For information regarding this program, go to the EFSP National Website: www.efsp.unitedway.org

Please Note: Incomplete, Late or Electronic Copies of Applications Will Not Be Accepted.

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Page 2 Metro Denver Emergency Food and Shelter Board

Phase 27 Application

Agency Information

Agency Name ________________________________________________________________ Employer Identification Number (EIN) ______________________________________________ Electronic Fund Transfer Account Number __________________________________________

PROPOSAL CHECKLIST

This checklist must be completed and returned with your application.

The following is a checklist of the items that must be included in your application in order to be considered for a grant. _____ A. AGENCY COVER PAGE _____ B. PROPOSAL CHECKLIST _____ C. PROGRAM INFORMATION ____ D. CURRENT VOLUNTARY BOARD ROSTER _____ E. FEDERAL TAX EXEMPT LETTER _____ F. FINANCIAL INFORMATION

• Signed Audit Requirements form • 1 copy of Audit or required documentation • Submit required financial information and documentation

_____ G. LOCAL RECIPIENT ORGANIZATION (LRO) CERTIFICATION FORM _____ H. CERTIFICATE OF ACCURACY FORM _____ I. APPENDICIES I –V

• Submit the appendices and forms that are applicable to your application. _____ J. COPY OF WRITTEN NON-DISCRIMINATION POLICY REGARDING SERVICES DELIVERED

Proposal Format Requirements

• Applications must be typed, using 12 point type. • Submit one signed original with all attachments, plus 3 additional copies and only 1 copy of the Audit. • Submit all materials printed single-sided on 8 ½ x 11 paper. • Do not use 3 ring binders or staples. Use paper clips only. • Place the completed Proposal Checklist on the top of the agency application.

The Phase 27 EFSP application deadline is December 5, 2008 at 4:00pm.

A signed original with attachments, plus 3 copies & 1 copy of Audit, must be received at Jewish Family Service by 4:00pm. Electronic copies are not accepted. Postmarks are not

considered to determine if deadline is met. INCOMPLETE or LATE APPLICATIONS WILL NOT be CONSIDERED.

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Phase 27 EFSP Funding Application Page 3

PROGRAM INFORMATION

a. Please indicate which categories you are applying for ESFP funds.

Food Distribution ___ Rent/Mortgage Assistance Served Meals ___ Energy Assistance ___ Emergency Shelter and/or Other Shelter (hotel/motel vouchers)

b. Briefly describe how your organization provides emergency food or shelter. c. Describe the size and characteristics of the target population. d. Describe any major changes you have experienced in the past year, i.e., number of requests, types of requests, etc. e. EFSP funds are intended to supplement or expand your existing services. Funds are not meant to start new

programs in new locations or to replace current funding. How will you ensure that these funds will not be used to replace your current funding?

f. What is the impact to your program and clients if you do not receive EFSP funding?

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Phase 27 EFSP Funding Application Page 4

PROGRAM INFORMATION

APPLICANT AGENCY:

SUMMARY OF TOTAL REQUESTS FOR EMERGENCY FOOD AND SHELTER FUNDS

EFSP $ Requested Funds from Other Total Funds From Sources All Sources A. Food Distribution $ $ $ (Appendix I) B. Served Meals (Appendix II) C. Mass Shelter and/or Other Shelter

(Hotel/Motel Vouchers) (Appendix III) D. Rent/Mortgage (Appendix IV) E. Energy Assistance (Appendix V) TOTAL $ $ $

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Phase 27 EFSP Funding Application

Page 5

AUDIT REQUIREMENTS – Phase 27 The National Board has notified all Local Boards of specific audit requirements for agencies receiving EFSP funding. The following mandatory information must be completed for the 2009 funding year, Phase 27. MUST COMPLETE PARTS I & II

PART I

Initial All Appropriate Categories: AGENCIES THAT RECEIVE LESS THAN $50,000 IN EFSP FUNDING: ______

• Complete and sign the bottom portion of this form and return it with the Phase 27 application. AGENCIES THAT RECEIVE $50,000 OR MORE IN EFSP FUNDING: ______

• Complete and sign the bottom portion of this form and return it with the Phase 27 application. ANY AGENCIES THAT HAVE AUDIT “FINDINGS” OR “OPINIONS”: ______

• Complete and sign the bottom portion of this form and return it with the Phase 27 application. • Send copy of most recent audit or Independent Review to the National Board. • Send copy to National Board if any of the following audit/review statements apply: qualified, no opinion,

adverse opinion. AGENCIES THAT RECEIVE $500,000 OR MORE IN FEDERAL FUNDING: ______

• Complete and sign the bottom portion of this form and return it with the Phase 27 application. • Send audit to the National Board. • Agencies that are required to have either an audit or review of their financial records need to ensure that EFSP

funds are clearly identified by the EFSP ID number and corresponding amount in the audit or review. • Any Agency receiving $500,000 or more in combined federal funds is required to comply with OMB Circular

A-133, Audits of States, Local Governments, and Nonprofit Organizations. Agencies, not programs, that receive $500,000 or more in federal funds are required to send a copy of the most recent audit to:

EFSP National Board Program 701 North Fairfax Street, Ste 310

Alexandria, VA 22314-2064

PART II

Check Appropriate Box(es): This agency receives less than $500,000 from federal funds and is not required to send an audit to the National

Board. This agency has “findings” or “opinions” in the most recent audit/review and has sent a copy of the audit to the

National Board. This agency receives $500,000 or more in federal funding and has sent a copy of the most recent audit to the

National Board. (OMB Circular A-133, Audits of States, Local Governments, and Nonprofit Organizations.) SIGNATURE: _____________________________________________ DATE: ____________________________ TITLE: _______________________________ AGENCY NAME: ______________________________________ E-MAIL ADDRESS: ________________________________________________

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Phase 27 EFSP Funding Application FINANCIAL INFORMATION Page 6

Please complete the appropriate financial information for your agency. Submit financial documentation with your application. Audit (Agencies requesting funding of $50,000 or more. Submit only 1 copy of Audit.): CPA or CPA Firm: ______________________________________________________________ Date of Most Recent Audit: Independent Review (An audit is preferred, but an independent review for agencies requesting funding of less than $50,000 may be accepted.): Firm: _________________________________________________________________________ Date of Most Recent Review: ___________________________________ Other Financial Information ___ Year End Financial Statement (For agencies without an audit or independent review, the local EFSP Board may allow a year end statement of accounting from the most recent year and current month. The board will conduct a detailed financial examination for these agencies before the application can be approved); or ___ Agency Requests Local Fiscal Agent Administer Any EFSP Dollars Fiscal Agent’s Name/Agent: Name of Responsible Party/Title: Address: Phone Number: ________________________________________ Electronic Funds Account Number: Note: The Fiscal Agent: • Must sign Local Recipient Organization (LRO) Certificate Form, and • Be responsible for paying all bills and maintaining all financial documentation for the recipient organization. For the program that will be paid for in part by EFSP dollars, please fill in the following program budget showing the projected 2009 revenues and expenditures. You may submit a program budget from your agency to substitute. Source of Income Income

$

Total $

Type of Expenses Expenditures

$

Total $ % of budget expected to be from EFSP PLEASE DO NOT SEND YOUR AGENCY BUDGET – ONLY THE BUDGET FOR THE EMERGENCY FOOD OR SHELTER PROGRAM.

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Phase 27 EFSP Funding Application Page 7

LOCAL RECIPIENT ORGANIZATION (LRO) CERTIFICATION FORM As a recipient of the Emergency Food and Shelter National Board Program funds made available through the Steward B. McKinney Homeless Assistance Act for the period of January 1, 2009, through December 31, 2009, and as the duly authorized representative of _____________________________________, I certify that my public or private organization:

• Has the capability to provide emergency food and/or shelter services, • Will use funds to supplement and extend existing resources and will not substitute or reimburse ongoing programs

and services, • Is nonprofit or an agency of government, • Has an accounting system, and will pay all vendors by LRO check, LRO vendor issued credit card or LRO debit

card, • Will conduct an independent annual review / audit if receiving $25,000 or more in EFSP funds, • Understands that cash payments (including petty cash) are not eligible under EFSP, • Has a Federal Employer Identification Number (FEIN), • Practices non-discrimination (LROs with religious affiliations will not refuse service to an applicant based on

religion, nor engage in religious proselytizing or religious counseling with Federal funds), • Has a voluntary board if private, not-for-profit, • Will comply with the Phase 27 Responsibilities & Requirements Manual, particularly the Eligible and

Ineligible Costs section, and will inform appropriate staff or volunteers of EFSP requirements, • Will provide all required reports to the Local Board in a timely manner; (e.g. Second Payment / Interim and Final

Reports), • Will expend monies only on eligible costs and keep complete documentation (copies of canceled LRO checks –

front and back, invoices, receipts, etc.) on all expenditures for a minimum of three years after end of program, • Will spend all funds and close-out the program by my jurisdiction’s selected end-of-program date and return any

unused funds to the National Board ($5.00 or more; make checks payable to United Way of America / Emergency Food and Shelter Board Program),

• Will provide completion documentation of expenses to the Local Board, if requested, no later than one month following my jurisdiction’s selected end-of-program date,

• Will comply with the Office of Management and Budget Circular A-133 if expending $500,000 or more in Federal Funds,

• Will comply with lobbying prohibition certification and disclosure of lobbying activities if receiving $100,000 or more in EFSP funds, if applicable, and

• Has no known EFSP compliance exceptions in this or any other jurisdiction. Check the Appropriate Box:

Previously Funded LROs: Have read, understand and agree to abide by the EFSP Responsibilities and Requirements Manual

Newly Funded LROs: Will read, understand and agree to abide by the EFSP Responsibilities and Requirements Manual once received

NAME: SIGNATURE: (acceptable signatories: Executive Director, Treasurer, Board Chairman) AGENCY: ADDRESS: FISCAL AGENT ORGANIZATION: NAME: SIGNATURE: TITLE: DATE: (This certification is applicable only to organizations to which an allocation of program funds is awarded, but should be signed and submitted as a part of the application.)

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Phase 27 EFSP Funding Application Page 8

CERTIFICATE OF ACCURACY FORM We certify that all information provided is accurate and that all applicable staff and board members are aware that this application has been submitted to the Metro Denver Emergency Food and Shelter Board. Executive Director Board President (Print) (Print) (Signature) (Signature) Fiscal Agent (If Applicable) (Print) (Signature)

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APPENDIX I Phase 27 EFSP Funding Application Program Appendices

FOOD DISTRIBUTION:

APPLICANT AGENCY: (A) (B) (C) (D) EFSP Funds + Current = Total Funds Est. # of Requested Program From All Persons Funds From Sources Served Other Sources Thru EFSP 1. Bulk Food Purchases $ $ $ 2. Meal Vouchers $ $ $ 3. Grocery Gift Certificates $ $ $ 4. Transportation Costs Associated with Pickup Of Donated Food $ $ $ Subtotals $ $ $ • Explain how you will obtain, distribute, and transport food. Do you distribute bags of groceries, prepared meals,

vouchers to restaurants or to grocery stores, or precisely what mix of these? How are you making the use of the food dollar the most effective?

• Do you plan to purchase gift certificates or vouchers from food retailers? If so, at what percentage discount, and why

do you propose to do this rather than maximizing the buying power of your EFSP funds through cost-effective grocery purchases?

Check the Appropriate Box:

Previously Funded LROs: Have read, understand and agree to abide by the EFSP Responsibilities and Requirements Manual

Newly Funded LROs: Will read, understand and agree to abide by the EFSP Responsibilities and Requirements Manual once received Name: Signature: (Print)

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Phase 27 EFSP Funding Application Program Appendices GUIDELINES FOR FOOD DISTRIBUTION Appendix I Intent of Program: The intent of this appropriation is for the purchase of food and shelter, to supplement and expand current available resources and not to substitute or reimburse ongoing programs and services or to start new programs. The Metro Denver Emergency Food and Shelter Board is committed to food purchases only for this funding. Food Purchases for food banks/pantries and other food providers, eligible costs include: • Groceries, food vouchers, seeds, gift certificates for food (must be marked “Food Only”). Agencies may not move funding from one category to another without prior written approval by the Metro Denver Emergency Food and Shelter Board.

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Phase 27 EFSP Funding Application Program Appendices

APPENDIX II SERVED MEALS

APPLICANT AGENCY:

(A) (B) (C) (D) (E) EFSP Funds + Current = Total Funds Est. # of Total # of Requested Program From All Persons Meals Thru Funds From Sources Served EFSP Other Sources Thru EFSP 1. Food Costs $ $ $ $ 2. Consumable Supplies $ $ $ $ 3. Related to Mass Feeding or $2.00 per meal $ $ $ $ Sub-Totals $ $ $ $ • Average cost per meal • Explain how you provide hot/cold prepared meals. How do you make maximum use of bulk purchases, donated

foods, gleaning programs and other methods that stretch the impact of the EFSP funds? Check the Appropriate Box:

Previously Funded LROs: Have read, understand and agree to abide by the EFSP Responsibilities and Requirements Manual

Newly Funded LROs: Will read, understand and agree to abide by the EFSP Responsibilities and Requirements Manual once received Name: Signature: (Print)

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Phase 27 EFSP Funding Application Program Appendices GUIDELINES FOR SERVED MEALS Appendix II Intent of Program: The intent of this appropriation is for the purchase of food and shelter, to supplement and expand current available resources and not to substitute or reimburse ongoing programs and services or to start new programs. For mass shelters (5 or more beds) or mass feeding sites, eligible expenditures include: • Purchase of consumable supplies essential to mass feeding (i.e., plastic cups, utensils, detergent, etc.). • Food (hot meals, groceries, food vouchers); limited amount of dessert items as part of a daily food plan; vegetable

seeds and vegetable plants cultivated in agency’s on-site garden and canning supplies. • Local transportation expenses for picking up/delivery of food, transporting clients to mass feeding site. Limited to

actual food costs, a mileage log at current Federal rate, contracted services or public transportation. Agencies may not move funding from one category to another without prior written approval by the Metro Denver Emergency Food and Shelter Board.

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APPENDIX III Phase 27 EFSP Funding Application Program Appendices EMERGENCY SHELTER

APPLICANT AGENCY:

(A) (B) (C) (E) EFSP Funds + Current = Total Funds Estimated Requested Program From All Total # of People Funds From Sources Served Per Year Other Sources 1. Mass Shelter (Per diem basis – $12.50 per night) $ $ $ 2. Other Shelter $ $ $ (hotel/motel vouchers)

Subtotals $ $ $ • Explain how you will provide mass shelter and specify the total range of costs and services that make up the shelter

program. How did you arrive at projected costs? • If using other shelter, give a rationale for using this alternative versus mass shelter. What type of other shelter are

you planning to use? How did you arrive at the projected costs? • If applying for “Other Shelter” what agreements or processes do you currently have in place to utilize hotel/motel

vouchers? • Who is your targeted population? Check the Appropriate Box:

Previously Funded LROs: Have read, understand and agree to abide by the EFSP Responsibilities and Requirements Manual

Newly Funded LROs: Will read, understand and agree to abide by the EFSP Responsibilities and Requirements Manual once received Name: ____ Signature: (Print)

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Phase 27 EFSP Funding Application Program Appendices GUIDELINES FOR MASS SHELTER AND/OR OTHER SHELTER (HOTEL/MOTEL VOUCHERS) Appendix III Intent of Program: The intent of this appropriation is for the purchase of food and shelter, to supplement and expand current available resources and not to substitute or reimburse ongoing programs and services or to start new programs. Please Note: No prepayment for expenses or services not yet rendered or incurred (i.e., where no goods or services have been provided prior to payment during program period). For mass shelter providers, there are two options for eligible costs. One option must be selected at beginning of program year and continued throughout the entire year. 1. Reimbursement of actual direct eligible costs in which case canceled checks and vendor invoices for

supplies/equipment essential to operation of mass shelter must be maintained (e.g., cots, mattresses, soap, linens, blankets, cleaning supplies, etc.);

OR 2. Per diem allowance of exactly $12.50 per person per night for mass shelter (5 beds or more), only if:

(a) Approved in advance by the Local Board; and, (b) LRO’s total mass shelter award is expended in this manner. May be expended for costs related to operation of

mass shelter. The per diem allowance may be used to cover such costs such as shelter rent, utilities, and staff salaries. The per diem allowance does not include the additional costs associated with food.

Agencies may not move funding from one category to another without prior written approval by the Metro Denver Emergency Food and Shelter Board.

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APPENDIX IV Phase 27 EFSP Funding Application Program Appendices

RENT/MORTGAGE ASSISTANCE

APPLICANT AGENCY: (A) (B) (C) (D) (E) EFSP Funds + Current = Total Funds Households Average Requested Program From All Served Payment Funds From Sources Through Other Sources ESFP Subtotals $ $ $ $ • Explain how you will determine the amount of rent/mortgage assistance. • How do you document/verify need? • How do you verify only one EFSP payment is received per household in the current award cycle? • Average rent assistance payment in Phase 26: • What problems (if any) have you experienced utilizing these funds? Check the Appropriate Box:

Previously Funded LROs: Have read, understand and agree to abide by the EFSP Responsibilities and Requirements Manual

Newly Funded LROs: Will read, understand and agree to abide by the EFSP Responsibilities and Requirements Manual once received Name: Signature: (Print)

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Phase 27 EFSP Funding Application Program Appendices

GUIDELINES FOR RENT/MORTGAGE ASSISTANCE Appendix IV Intent of Program: The intent of this appropriation is for the purchase of food and shelter, to supplement and expand current available resources and not to substitute or reimburse ongoing programs and services or to start new programs.

Agencies agree to follow the approved Metro Denver EFSP Board process verifying that clients do not receive duplicate EFSP funding. Eligible costs for rent/mortgage assistance include: 1. Limited emergency rent or mortgage assistance for individuals or households provided the following conditions are

met: a) Payment is in arrears or due within 5 days; and

b) All other resources have been exhausted; and

c) The clients is (1) a resident of the home or apartment and (2) responsible for the rent/mortgage on the home or

apartment where the rent/mortgage assistance is to be paid; and

d) Payment is limited to one month’s cost for each individual or household; assistance can be provided (1) for a full

month’s rent/mortgage all at one time, or (2) in separate payments over a period of 90 consecutive days so long

as the total amount paid does not exceed one month’s cost; and

e) Assistance is provided only once in each award phase for each individual or household (with exception of

item d(2) above); and

f) Payment must guarantee an additional 30 days of services.

Note: Landlord documentation must show the amount of one month’s rent. Late fee, legal fees and deposits are ineligible. Note: Payments for trailers and lots are eligible and can be paid to a mortgage company or to a private landlord. Assistance with one month’s rent or mortgage can be provided in addition to eligible utility assistance under this program. 2. First month’s rent may be paid when an individual or household:

a) Is transient and plans to stay in the area for an extended period of time; or b) Is moving from a temporary shelter to a more permanent living arrangement; or c) Is being evicted because one month payment will not forestall eviction in current housing.

First month’s rent

a) Cannot be provided in addition to emergency rent/mortgage payment under item 1 above. b) Can be provided in addition to assistance provided for off-site or mass shelter.

Assistance with first month’s rent can be provided in addition to eligible utility assistance under this program. Agencies may not move funding from one category to another without prior written approval by the Metro Denver Emergency Food and Shelter Board.

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APPENDIX V Phase 27 EFSP Funding Application Program Appendices

ENERGY ASSISTANCE

APPLICANT AGENCY: (A) (B) (C) (D) (E) EFSP Funds + Current = Total Funds Households Average Requested Program From All Served Payment Funds From Sources Through Other Sources ESFP Subtotals $ $ $ $ • How do you determine the amount of EFSP funds you will allocate to each household? • Average utility assistance payment in Phase 26: • How do you verify need? Check the Appropriate Box:

Previously Funded LROs: Have read, understand and agree to abide by the EFSP Responsibilities and Requirements Manual

Newly Funded LROs: Will read, understand and agree to abide by the EFSP Responsibilities and Requirements Manual once received Name: Signature: (Print)

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Phase 27 EFSP Funding Application Program Appendices GUIDELINES FOR ENERGY ASSISTANCE Appendix V Intent of Program: The intent of this appropriation is for the purchase of food and shelter, to supplement and expand current available resources and not to substitute or reimburse ongoing programs and services or to start new programs. Agencies agree to follow the approved Metro Denver EFSP Board process verifying that clients do not receive duplicate EFSP funding. Eligible programs costs for utility assistance include: 1. Limited metered utility assistance (includes gas, electricity, water and sewer service) for individuals or households

provided conditions a-f below are met:

a) Payment is in arrears or due within 5 days; and

b) All other resources have been exhausted (i.e., State’s Low Income Home Energy Assistance Program); and

c) Payment is limited to EITHER one month’s cost for each utility for each individual or household OR an

expenditure of up to $100 provided the individual or household owes at least that amount for the utility; and

d) If limiting payment to one month’s cost, the month paid is current amount or part of the arrearage that is either

from current award phase or for continuous service prior to award phase; and

e) Each utility can be paid only once in each award phase for any individual or household; and

f) Payment must guarantee an additional 30 days of service.

Note: Reconnect fees are eligible. Late fees and deposits are ineligible. 2. Limited non-metered utility assistance (includes oil, firewood, coal) for individuals or households provided

conditions a-c below are met:

a) All other resources have been exhausted (i.e., State’s Low Income Home Energy Assistance Program); and

b) Payment is limited to a one-time delivery (for example, one cord of wood, one fill-up of propane); and

c) Each utility can be paid only once in each award phase for any individual or household.

Utility assistance can be provided in addition to eligible rent/mortgage assistance under this program. Agencies may not move funding from one category to another without prior written approval by the Metro Denver Emergency Food and Shelter Board.