Rehabilitative Services Incentive Fund

FY 2007 Competitive Application

 

To address unmet or underserved needs of persons with physical and sensory disabilities as identified in your 2006 Needs Assessment Report

 

Signature Sheet

 

This page to be completed by the Disability Services Board

 

Official Name of Disability Services Board	Street Address and PO Box (if applicable)
Chairperson’s name	City	ZIP
Telephone Number	FAX Number	E-Mail (if applicable)

 

Fiscal Agent Information

 

The Fiscal Agent must be a local government entity who agrees to manage the financial aspects of the grant, assure accountability for funds expended, and maintain records on behalf of the DSB.

 

Contact Person ‘s Name and/or Fiscal Agents Name	Street Address and PO Box (if applicable)
Name of Government Affiliation	City                    ZIP	ZIP
Telephone Number	FAX Number	E-Mail (if applicable)

 

Certification of information

 

 

 

 

 

 

Rehabilitative Services Incentive Fund

FY 2007 Competitive Application

To address unmet or underserved needs of persons with physical and sensory disabilities as related to this DSBs 2006 Needs Assessment Report

 

 

Please type application and complete all sections. Submit original and six copies.

Application must be submitted in this format only.  Application available on diskette or via email at Sheila.Williams@drs.virginia.gov or Mary.Margaret.Cash@drs.virginia.gov

 

 

 

 

Subgrantee	Street Address and PO Box (if applicable)
Contact Person	City                     ZIP	zip
Telephone Number	FAX NUMBER	e-mail (if applicable)

 

Project description

 

The Project will support needs of persons with physical and sensory disabilities in your community by improving services in which of the following areas:

 

            Transportation

            Employment

            Housing

            Assistive Technology

        Case Management

 

        Public Awareness of Disabilities

            Assisted Communication

            Independent Living Services

        Other __________________________

 

1)      Describe in concrete terms how the requested funds will be used.

2)       Define the goals of the project. 

3)      What equipment, services, or programs will be provided?

 

 

 

 

 

 

 

 

 

 

Impact of project on people with physical and sensory disabilities

 

1)      In measurable terms, describe how people with physical and sensory disabilities will directly benefit from this proposal. 

2)      How will this proposal increase the availability, accessibility, and/or quality of services in your community? 

3)      How many people will receive services?  See Application Criteria in the RSIF Guidelines.

 

 

 

 

 

 

 

 

 

 

 

Implementation plan

 

1)       Provide a timeline for the project.  What experience does the organization have that contributes to the success of the project?

2)      What steps will be taken once the funds are received?

3)      Discuss how the proposed project will be implemented within the planned grant period.

 

 

 

 

 

 

 

 

 

 

 

needs assessment findings

 

1)      Describe how the proposed project responds to this DSB’s 2006 Needs Assessment findings.

2)        Attach a copy (the pages/pages specific to this proposal) of this DSBs 2006 Needs Assessment Report.  A guiding principle for the RSIF is to serve as a first step in the development of a community-based, consumer-focused service delivery system for people with physical and sensory disabilities.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

community  collaboration

 

The RSIF Guidelines emphasize inter-organizational coordination and resource pooling in the development of RSIF projects.  Additionally, a guiding principle of the RSIF is collaboration or delivery of services across programmatic, DSB or other jurisdictional boundaries.  Collaboration is a necessary factor in funding approval for transportation projects.

1)  Describe how the proposed project involves community organizations, consumer groups, businesses, and/or government organizations

 

 

 

RSIF FY 2007

Budget information – Competitive Process

 

June 1, 2006 to April 1, 2007 (equipment) & May 31, 2007 (all others)

 

 

 

 

Project funding Itemize each project expense	state rsif	local cash Match 10% of Total	Total
Purchase of service:   RSIF funds may be used to purchase units of a service.  For example: # transportation trips.  Give a brief description of the service, # of units to be provided and cost per unit.
Equipment:  Equipment must be purchased according to the Public Procurement Act.   List the equipment requested.
Other:  RSIF funds may be used to reimburse such costs as printing, postage, office supplies, telephone, travel reimbursement @ $.325/mile.  List below:
TOTAL

 

 

 

Note the following: 

·         This is a reimbursement grant, with payment made after the service is provided.

·         These figures will become part of a State Contract between the DSB, DRS and the Subgrantee.

·         The total for the local match column should equal only the percentage of local match required (10% of total project).  Match cannot be in-kind or from state funds.

·         The grant contract is for Fiscal Year 2007.  All equipment grants conclude April 1, 2007, and services must conclude by May 31, 2007.  All invoices for goods and/or services will need to be received by DRS by June 8, 2007.