Community Affairs Division

Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Applicant Name:

INSTRUCTIONS:

When responding to the questions in Attachment B:

a. Attachments: Applicant must complete all areas highlighted in yellow and upload attachments according to the instructions found on the Wufoo submission page. b. Responses: If the response is provided in a separate document, please ensure that the response is uploaded as the appropriate entry in the Wufoo submission. If the Department is unable to clearly determine which question the response pertains to, the applicant may not receive points for their response. c. Years of Experience: When responding to years of experience, if the experience is 6 months or greater, round your response up to one year. If it is less than six months, do not. For example: 1 year 5 months would be 1 year and 1 year 6 months would be 2 years. d. Self-score: The applicant is to include a self-score for each question.

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Part 1: Organization Capacity Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 1.1 Indicate if the applicant is a Private  Private Nonprofit: 25 Nonprofit Organization or a Public Award = 25 points Organization.  Public Organization: Award = 0 points Private Nonprofit Public Organization

1.2 Indicate if the applicant is currently The applicant is 30 administering the CSBG. experienced in and currently administering the Yes CSBG:  No Yes. Award = 30 points  No. Award = 0 points 1.3 Indicate if the applicant is currently The applicant is 15 administering the CEAP experienced in and currently administering the Yes Community Energy Assistance Program (CEAP): No  Yes, award = 15 points  No, award = 0 points

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 1.4 Applicant is to only answer either If you answered A: 25 question A. or B., NOT both.  Yes, award = 25 points The Applicant is:  No, award = 0 points A)geographically located in the unserved area for which the OR applicant is applying for and is providing a range of services If you answered B: designed to eliminate poverty  and foster self-sufficiency Yes, award = 25 points  No, award = 0 points Yes, list services currently provided in box below.

B)in an area that is contiguous to or within reasonable proximity to the unserved area for which applicant is applying for and is already providing a related service in the unserved area

Yes, list services currently provided in box below.

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 1.5 The applicant’s experience State or federally funded 30 administering other state or federally programs administered: funded programs subject to 2 CFR Part Award up to a maximum 200 or UGMS (currently administered of 30 points for years directly by applicant), including funds administering fund source. from the Texas Department of Housing Award points as follows: and Community Affairs (TDHCA), but  6+ years not including CSBG or CEAP. administering fund source: award 10 In the table below, list all current state points per fund or federally funded programs greater source than $150,000 administered directly by  2-5 years the applicant and the number of years administering fund administering the grant (indicate each source: award 5 fund source only once), including points per fund TDHCA funds. source  Less than 2 years: award 0 points Section 1.5 - Table Administered State Federal # of Years in Dimmit or Funds Funds Administer Funding Entity and Purpose of Fund Name La Salle? (Y/N) (Y/N) Program Award

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Score (TDHCA Maximum Self- use Section Question Scoring Mechanism Points Score only) 1.6 Indicate the number of years your Award up to a maximum 20 organization has administered non- of 20 points for years federal or non-state funded grant administering programs. funds to provide assistance and or Award points as follows: services to low-income individuals. Years administering non- federal or non-state funded In the table below, provide the grants or fund programs: information requested.  6+ years administering fund source: award = 5 points per fund source  2-5 years administering fund source: award = 4 point per fund source  Less than 2 years total for all fund source: award = 0 points Section 1.6 – Table # of Years Administering Funding Organization/Entity Fund Purpose of Grant

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 1.7 In the table below, list all federal and If the audit indicates that the Points to be state funded programs administered findings/deficiencies, or Determined in the past 24 months as identified in concerns are those raised in response to questions 1.5 and 1.6. the monitoring reports already addressed in Note: Provide copies of the last question 1.7 and the monitoring reports for all programs Department is easily able to listed even if the monitoring review determine that it is the same occurred during the prior 24 months. deficiency, the department If the fund source has not been will not deduct points in both monitored, provide information question 1.7 and 3.1. explaining such, preferably a letter Question 1.7 will be scored from the funding source. Only the first. most recent monitoring report will be considered for point deductions. Monitoring Findings For ease of review, please number  Monitoring report the pages of the documents, even if had some the numbering is handwritten. findings/deficiencies, but Note: If monitoring report is not none were significant attached, 15 points will be deducted findings: -0 point per grant. If applicant shows history deduction of non cooperation with monitoring  Monitoring report agency/entity, 25 points will be had significant deducted per grant. findings/deficiencies (Note that significant Significant findings are those which findings/deficiencies identity fraud, waste, abuse, financial and/or unresolved irregularity, major non-compliance monitoring with program rules, or non- findings/deficiencies can compliance with OMB Circulars or deem an application UGMS. ineligible: -25 point deduction per fund source with a significant finding/deficiency. Note: Disallowed costs will be deducted in question 3.1 if they are identified in the Single Audit.  Applicant shows history of not cooperating with or not submitting documentation upon request with oversight agencies/entities: -25 point deduction per fund source of non- cooperation.

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Section 1.7 - Table: NOTE: Monitoring reports must be provided. If a report is not submitted a 15 point deduction will be taken for each report not submitted. Submit one attachment with all the monitoring reports and number each page.

Date of Last Copy of Of the Attachment Name of State or Federal Monitoring Report findings, # of Amount of Name and Agency (agency providing Fund Review attached # of Significant Disallowed Page # where funds) Source (MM/DD/YYYY) (Y/N) Findings Findings Costs Located

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 1.8 Does the applicant have a history in Yes, If Departmental records Points to be the preceding 24 months of not show late submissions of any determined submitting requested documentation requested documentation timely (i.e. monthly reports) and/or and/or planning submissions planning submissions (Community in the preceding 24 months, Action Plan, Community Needs 15 points will be deducted Assessment, Service Delivery Plan, per late submission. Strategic Plan) to the Department No late submissions = 0 Yes, list which points documents/submissions:

No 1.9 Has the applicant been placed on a Number of years since the -75 modified cost reimbursement basis applicant has been or if of payment for TDHCA funded currently on a modified cost- programs during the past 3 years? reimbursement basis of payment for TDHCA funded Yes programs: No  Yes, during the past 3 Is the applicant currently on a years: Deduct -25 points modified cost reimbursement  Yes, currently on method of payment for TDHCA modified cost funded programs? reimbursement: Deduct Yes -75 points  No, not during the past 3 No years: Deduct 0 points 1.10 Indicate which of the Financial Financial Accounting Method -40 up to Accounting Methods listed below is used to account for funds 40 used to track grant(s). Select one. and report to funding sources. Specialized Financial Software  Specialized Financial Microsoft Excel Software: Award = 40 Manual ledger points  Microsoft Excel or Other. Explain: manual ledger: Deduct -40 points

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 1.11 Indicate the method and software Software used to track -30 up to used to track performance data for performance data to report 30 grant(s). to funding sources and board or oversight body. Identify type of software:  Specialized Software: Award = 30 points  Microsoft Excel or manual system: Deduct -30 points

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County

Part 2: Governance Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 2.1 In the table below, provide Frequency of regularly 30 information on the frequency of scheduled meetings: regularly scheduled meetings held Monthly: 30 points from January 1, 2016 thru Present Twice Per Quarter (min 8 Day. times in the 14 month period): 25 points Note: Provide the minutes for each 5 to 7 times during the 14 of the meetings held during that month period: 20 points period. Minutes must indicate if a Four times in the fourteen quorum was present. month period: 10 points Less than 4 times in the fourteen month period: 0 points

Note: If meeting minutes are not provided or if a quorum was not present, the meeting will not be counted for points. Section 2.1 – Table: Date of Meeting Minutes attached? Attendance Roster Was a quorum present? (MM/DD/YYYY) (Y/N) attached? (Y/N) (Y/N)

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Date of Meeting Minutes attached? Attendance Roster Was a quorum present? (MM/DD/YYYY) (Y/N) attached? (Y/N) (Y/N)

Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 2.2 In the table below, provide Percentage of meetings held 30 information on meeting attendance from January 1, 2016 thru requirements according to the Present Day where quorum Bylaws. was met: 100%: 30 points 75%: 20 points 60%: 10 points Fewer than 60% of meetings had a quorum present: 0 points Section 2.2 - Table: Attendance According to the Bylaws Format Response a. How many members make up the board or oversight body? Number b. The presence of how many members make a quorum? Number c. Number of meetings held from January 1, 2016 thru Present Day with a quorum. Number d. Total number of board meetings held from January 1, 2016 thru Present Day. Number e. Percentage of meetings with a quorum present January 1, 2016 thru Present Day. Percentage (c/d)

Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 2.3 Indicate how frequently the board or Development/Update of 20 oversight body has a strategic Strategic Plan planning meeting and develops – or Annually: 20 points updates and reaffirms - a strategic Every 2 years: 15 points plan for a specified period of time. Every 3 years: 10 points Identify frequency: Every 4-5 years: 5 points

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 2.4 In the table below, provide the Board or oversight body 20 following information related to the authorizes organization to approval of contracts or contract enter into a grant amendments and the authority agreement/contract prior to granted to the executive director to agreement being signed by enter into contracts or amend organizational contracts. representative: 1. Yes: 15 points No: 0 points

2. Yes: 5 points No: 0 points

Section 2.4 - Table: Approval of Contracts Answer (Y/N) 1. Does the board or oversight body approve budgets and performance activities related to a grant award, prior to the executive director entering into a contract for the award? 2. Does the board or oversight body approve amendments to contracts or amendments to budgets or performance activities, prior to executive director requesting and approving the contract amendment?

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 2.5 In the table below, provide Frequency of finance 20 information on the frequency of committee meetings: board or oversight body finance  8 - 10 times during the committee (or the committee 14-month period: Award responsible for financial matters) = 20 points meetings held January 1, 2016 thru  At least 4 but less than 8 Present Day. times during the 14- month period: Award = Note: Provide the reports 10 points presented to the board or oversight  Less than 4 times a year: body or the minutes from the Award = 0 points committee meetings. Note: If meeting minutes are not provided, the meeting will not be counted. Section 2.5 - Table: Date of Finance Committee Meeting (MM/DD/YYYY) Minutes and/or Reports attached? (Y/N)

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 2.6 In the table below, indicate the types Type and frequency of 20 of financial reports presented and Programmatic Reports discussed at Board meetings held provided to the Board. January 1, 2016 thru Present Day and Minutes need to reflect provide a copy of the financial financial reporting and reports provided during the past 14 financial reports need to be months. provided to receive points:  8 - 10 times during the 14-month period: Award = 20 points  At least 4 times in the 14 month period: Award = 15 points  Less than 4 times in the 14 month period, but at least twice: Award = 5 points Points will be awarded for only one of the time periods. Section 2.6 - Table: Do board minutes Indicate reflect Attachment financial name & reporting? page # for Y/N financial Less than 4 List the date Indicate reports. times in the of the board Attachment Should 8-10 times At least 4 14-month minutes that name and indicate during the times in the period, but indicate page # for date 14-month 14-month at least 2 financial board provided to Type of Financial Report period period times updates. minutes board. Statement of Financial Position Statement of Activities Statement of Functional (by function) Expenses Statement of Cash Flows Notes to Financial Statements Budgeted Amounts compared to Expenditures Form 990 Submitted to IRS n/a n/a

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 2.7 In the table below, provide Frequency of program 20 information on the frequency of board committee meetings: or oversight body program committee  8 - 10 times during (or the committee responsible for the 14-month period: program performance) meetings held Award = 20 points January 1, 2016 thru Present Day.  At least 4 times in the Note: Provide the program committee 14-month period: reports presented to the board or Award = 15 points oversight body or the minutes for the  Less than 4 times in committee meetings. the 14 month period: Award = 0 points Points will be awarded monthly, quarterly, biannual, or annual, but not for more than one. Note: If meeting minutes are not provided, the meeting will not be counted. Section 2.7 - Table: Date of Program Committee Meeting (MM/DD/YYYY) Minutes and/or Reports attached?

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 2.8 In the table below, indicate the types Type and frequency of 20 of Programmatic Data provided to Programmatic Reports the board or oversight body held provided to the board or from January 1, 2016 thru Present oversight body: Day and the frequency of the performance data by grant provision the reports to the board or program/funding source: oversight body.  8 - 10 times during the 14-month period (if board or oversight body met monthly and minutes indicate performance data is provided): Award = 20 points  Quarterly reports (if board or oversight body met quarterly and minutes indicate performance data is provided ): Award = 15 points  Biannual or Annual reports: Award = 5 points Points will be awarded monthly, quarterly, biannual, or annual, but not for more than one. Note: If meeting minutes are not provided, the meeting will not be counted. Section 2.8 - Table: Do board minutes Reflect 8-10 times program reporting? Y/N during 14- List the date of the board month minutes that indicate Type of Performance Data period Quarterly Bi-annually Annually program update. Performance data by grant program/funding source Status report on meeting performance targets by grant program

Part 3: Financial Information Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 3.1 Submit the most recently completed Three Scoring Areas: -170 Single Audit or third-party audit. 1. Audit Findings for Also include management letters and current audit period responses to management letters as  Audit with no applicable. findings/deficiencies: Findings/Deficiencies, questioned -0 points costs, disallowed costs, or  Audit with deficiencies or concerns identified in some the Single Audit or third-party audit. findings/deficiencies (not significant): -15 If the audit indicates that the points per finding findings/deficiencies, questioned  Audit with costs, disallowed costs, or significant deficiencies/ concerns are those findings/deficiencies raised in the monitoring reports (Note that significant already addressed in Section 1.6, the findings/deficiencies application will not lose points in can deem an both areas for those items. Section application ineligible: 1.7 will be scored first, and any -100 points additional point deductions will be applied here. 2. Disallowed Costs for current audit period  No disallowed costs: 0 points  Questioned costs: -25 points  Disallowed costs (significance based on other than minor administrative error): -50 points if disallowed costs are 5% or more of the related grant award. If below 5% of the related grant award, deduct -15 points. 3. Deficiencies or Concerns for current audit period  No deficiencies or concerns: 0 points  Deficiencies or Concerns: -20

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) points 4. No Audit: -170 3.2 Submit financial statements as of Response: -50 the end of the organization’s most Cash Ratio Calculation recent fiscal year including a balance sheet, income statement and a Cash Ratio: statement of cash flow. If a financial statement, including a balance sheet,  Cash Ratio > 0.5: income statement and a statement of Deduct 0 points cash flow is part of the Single Audit,  Cash Ratio 0.1 – applicant does not need to submit an 0.5: Deduct -30 points additional copy of the financial  Cash Ratio < 0.1: statement. If the information is Deduct -50 points included in the audit, please respond below. Failure to submit the requested documents will result in a -50 point deduction. Are the requested documents part of the Single Audit that is being submitted with the application? Yes or No: What is applicant's Cash Ratio as shown on the applicant's Financial Statements? Note: Applicant is to show the calculation. Show Cash Ratio Calculation Cash Ratio = Cash plus Cash Equivalents/Current Liabilities

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Part 4: Efficiency Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 4.1 In the table below, provide Percentage of CSBG costs 100 information on the costs that are budgeted for programmatic proposed to be charged to the CSBG costs plus direct client grant. assistance costs (which can include caseworkers salary Administrative expenditures include and fringe): those expenses related to management staff such as the 81-100%: 100 points executive director, accounting staff, 71-80%: 90 points human resource staff, administrative 61-70%: 80 points personnel, and overhead costs 51-60%: 70 points related to same staff. 41-50%: 60 points Programmatic costs relate to staff 31-40%: 50 points costs of who provide direct client 21-30%: 40 points services and carry out duties such as 11-20%: 30 points intake, client interview, casework, Less than 11%: 0 points case management, referrals, and follow-up. It also includes the overhead costs related to these direct client program staff. Note the budget form (Attachment J) has the overhead costs on Budget Support Sheet B.5. In the table below, break out the part of the Overhead Costs that are administrative and programmatic. Direct service costs relate to costs for direct services to clients such as tuition assistance, rent and other emergency assistance, and other purposes allowable per the CSBG Act.

Section 4.1 – Table: Proposed CSBG Budget Format Answer a. Administrative costs, including salaries and fringe and overhead related to Dollar figure administrative staff (for example Ex Dir, CFO, admin staff) b. Programmatic costs, including salaries and fringe and overhead related to Dollar figure program staff (for example program directors, case workers) c. Direct client assistance costs (for example rent, food, education assistance Dollar figure such as tuition, etc.) NOTE: From Budget Support Sheet B6 d. Indirect costs (for applicants with an approved Indirect Costs Rate Plan) Dollar figure

e. Total CSBG budget requested Dollar figure a+b+c+d f. Percentage of CSBG costs budgeted for programmatic costs and direct Percentage client assistance costs (b+c)/e

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Proposed CSBG Budget Format Answer a. Administrative costs, including salaries and fringe and overhead related to Dollar figure administrative staff (for example Ex Dir, CFO, admin staff) Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 4.2 In the table below, provide Linkages and Coordination: 75 information on the types of entities  Award 5 points for each that your organization currently yes if description was coordinates services with in Dallas provided in the table up County – and indicate if a written to 60 points. agreement is in place with these  Award 0 points for each organizations; or if applicant is an no. adjacent provider, the types of entities that your organization will Points will not be awarded coordinate services with in Dallas unless description is provided County – and indicate if a written in table and written agreement is or will be in place with agreements are provided. these organizations. Be specific about these relationships and their Up to 15 points will be interplay with the CSBG funds you awarded for the specificity of propose to receive. this planned coordination Note: CSBG funds can be utilized to and the extent to which it is collaborate with other entities on well thought out. Write in the projects and/or to subcontract for text box below the table. client services. This question is not related to subcontracting. Provide copies of written agreements as an attachment. Section 4.2 – Table: If yes, describe the relationship and the process used to refer individuals and clients to Coordinate services and assistance Agreement Agreement Services provided by the identified in place attached Entity (Y/N) entities. (Y/N) (Y/N) State agency field office for TANF, Food Stamps, WIC, Medicaid, Medicare State TWC Office or Workforce Board School Districts Local Governments For Profit Businesses or Corporations Utility Providers Low-Income Housing Providers Financial Institutions Health Service Institutions Institutions for post secondary education/training Other non-profit organization serving

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County If yes, describe the relationship and the process used to refer individuals and clients to Coordinate services and assistance Agreement Agreement Services provided by the identified in place attached Entity (Y/N) entities. (Y/N) (Y/N) low-income persons Faith Based organizations

15 points will be awarded for the specificity of this planned coordination and the extent to which it is well thought out. Provide an explanation here for how services will be coordinated with partners:

Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 4.3 In the table below, provide Potential Subcontracted 75 information on the types of entities Services: that your organization may consider  Award 5 points for each subcontracting with in Dallas county yes if description was to provide assistance and services to provided in the table up CSBG clients. The Department does to 60 points. not anticipate that at this time the  Award 0 points for each applicant would have names of no. entities since a procurement process would have to be carried out to Points will not be awarded determine such. Subcontracts could unless description is provided include, but not be limited to, the use in table. of CSBG funds for payment of services for clients, fees to attend Up to 15 points will be classes, to cover materials/books, awarded for the specificity of etc. this planned coordination and the extent to which it is well thought out. Write in the text box below the table. Section 4.3 – Table: Subcontract Services If yes, describe the type of services and/or assistance Type of Service or Assistance (Y/N) that may be subcontracted for: Employment Related Assistance Education Related Services for Children & Youth Education Related Services/Classes/Workshops for Adults Family Counseling or Family Skills Financial Capability Skills Training or Credit Counseling Asset Building Mental & Behavioral Health

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Subcontract Services If yes, describe the type of services and/or assistance Type of Service or Assistance (Y/N) that may be subcontracted for: Leadership Skills Wellness Classes/Workshops Dental or Vision Assistance Other (specify) 15 points will be awarded for the specificity of this planned coordination and the extent to which it is well thought out. Provide an explanation below for how services will be coordinated with partners:

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 4.4 In the table below, indicate if your Evaluation of Programs: 60 organization has a formal process to  Award 10 points for each evaluate program results and to yes if description has evaluate the accomplishment of been provided in table. performance and expenditures  Award 0 points for each targets or benchmarks. no or if no description was provided for yes responses. Section 4.4 – Table: If Yes, briefly describe the evaluation process and provide Yes/ information on how the information is evaluated and used Evaluation process in place No to make improvements to programs and processes. Client Surveys Suggestion Box for Applicants and Clients Quarterly monitoring of meeting expenditure targets/benchmarks Quarterly monitoring of meeting performance targets/benchmarks Process for taking evaluation data and making improvements to programs and services An annual strategic planning process for staff

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Part 5: Services and Activities Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 5.1 In no more than two pages (11 point Award 75 points for a very 75 up to font, Standard 8½” x 11” page size thorough and detailed -20 point with 1” margins), provide a description of the deduction typewritten explanation of how your implementation plan, with organization will implement the CSBG timelines, and the plan program in the service area for which seems to be well thought out you have applied. Provide a timeline and readily implementable. for when service sites will open and Award 50 points for a less outreach will begin, parties with robust description of the whom you will coordinate services implementation plan. with, any plans to potentially subcontract with other non-profits Award 0 points for a for services to clients, and other limited/lacking in detail activities to get the CSBG program description of the operational in the related counties. implementation plan. Deduct -20 points for non- response to question.

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 5.2 Complete the table below and also Scoring for table below: To Be provide a one page (11 point font, Service center sites to Determined by Response Standard 8½” x 11” page size with 1” provide CSBG assistance in margins), typewritten document with Dallas County. description of how your organization Award 40 points for each will address providing services to all site that is operated 40 areas of Dallas County, including the hours a week by applicant. harder to reach areas, populations that are more challenging to assist, Award 20 points for each and populations least likely to apply site that is operated at least for the program. In the description, 20 hours a week by indicate if you propose to operate applicant. additional sites and if you do the area Scoring for one-page where they may potentially be submittal: Award 30 points located and the number of sites. for a comprehensive Applicant can provide a map outreach plan that (preferably note the location of specifically covers harder to facilities) in addition to the one page serve populations, etc. document. Award 10 points for a less A service center is a permanent thorough description. facility operated by the applicant. A Award 0 points for service center is not the same as an description which is outreach site where staff periodically limited/lacking much detail. go to a site and conduct outreach and intake. An outreach site is a facility, Deduct -10 points for no usually not owned or leased by the description. applicant, which the applicant will use to take CSBG applications and to conduct outreach and engagement. These sites are usually a public building or a building made available by another organization.

Section 5.2 - Table: EXISTING SERVICE CENTERS (excluding outreach sites) OPERATED BY APPLICANT (only list counties for which applicant is applying): Currentl y in Operati Is Facility Number of Address of Service Centers in on? Owned/Leased by Days of Hours of Dallas County (street address, Yes or Applicant or is it In- Operation Operation city, zip code) No Kind Space? Explain. Weekly Weekly

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 5.3 In the table below, provide Services and activities: 180 information on the types of services Award 20 points for each yes and activities provided during if description has been calendar year 2016. For any yes provided. response, include a brief narrative Award 0 points for each no or description of those services and the if no description was not number of unduplicated persons provided for yes responses. served with these services in calendar year 2016 in the table below. Points will only be awarded if description is provided. Section 5.3 – Table: Number of Unduplicated Provided persons or in 2016 households Service (Y/N) If Yes, briefly describe services. served in 2016 Employment Related Services to assist persons to obtain employment. Employment Supports, to provide assistance which reduces or eliminates barriers to employment. Education Related Services that assist persons to obtain skills or competencies required for employment or to further their education. Community Education Activities related to budgeting, nutrition, energy savings, etc. Family Support Assistance and/or Emergency Assistance for the following: rent, utility assistance, rent or utility deposits, food, clothes, transportation, etc. Youth development programs which assist in health or physical or social/emotional development, building leadership skills, increased academic skills, a reduction in risk- taking behavior, a reduction in criminal justice system, etc Child and Family Development enrichment programs, including, but not limited to Head Start. Before or after school child care programs Innovative community and neighborhood-based initiatives with the goal of strengthening families and encouraging effective parenting

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 5.4 In the table below, provide Services and activities: 115 information on the case management Award 10 points for each yes services and activities provided if description has been during calendar year 2016. provided and if Case Attach a copy of Case Management Management Standards and Standards, Procedures and Forms Procedures are provided and utilized by your organization. the applicable information For any yes response, include a brief listed in the table below is narrative description of those provided. services and the number of unduplicated persons served with Also, award 15 points if a these services in calendar year 2016. pre-assessment or integrated assessment form is provided and a service plan form is provided. Award 0 points for each no or if no documentation was provided for yes responses.

Section 5.4 – Table: Provided Unduplicated in 2016 If Yes, briefly describe case persons served Case Management Service (Y/N) management services. in 2016 Pre-Assessment Integrated Assessment Service Plan Goal Identification Process Action Steps to Accomplish Goal Process to Track Client’s Progress in Accomplishing Action Steps and Meeting Goals Service Coordination and Advocacy Documentation Procedures Case Management Closure Follow-up Processes

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 5.5 In the table below, provide Experience of management 50 information on staff personnel that staff that will manage and will be managing/administering the administer CSBG and Chief CSBG (include at a minimum the Financial Officer (CFO): CSBG Director overseeing the Program and the Executive Director) Award the indicated and the CFO. Please provide resumes experience points for each of each of these personnel as well as person listed. fill out the table below with: name,  CSBG experience of title, duties currently performed, CSBG Director, Executive experience in CSBG or similar Director and CFO totals programs, credentials, education. 15+ years: Award = 50 points If management is not yet on board,  Similar program indicate the titles of planned experience of Program management position(s) to be filled, Director, Executive a brief description of the duties to be Director and CFO totals performed by each person/position 15+ years or more: listed and the CSBG-related Award = 40 points experience requirements for the  CSBG experience of position(s). CSBG Director, Executive Director and CFO is 8-14 years: Award = 40 points  Similar program experience of Program Director, Executive Director and CFO 8-14 years: Award = 30 points.  CSBG or similar program experience of management and CFO totals less than 8 years: Award = 20 points  Management and CFO are not yet on board but descriptions and plan appear well thought out and able to be implemented: Award = 10 points.

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Section 5.5 - Table: Include, at a minimum, the person who will be the CSBG Director and the Executive Director, and the CFO) Program Administration Experience (non- CSBG CSBG, but direct Administration assistance Description of CSBG or Experience and program) and Similar Duties number of years of number of years of Name of Staff Title Currently Performed the experience. the experience

Score Maximum Self- (TDHCA Section Question Scoring Mechanism Points Score use only) 5.6 How many CSBG staff does the Number of proposed CSBG Up to 50 applicant propose will provide CSBG paid staff that will provide points services in Dimmit and La Salle CSBG services (excluding counties? administrative staff):

 Number of Part-Time Staff Award the indicated points: working on providing CSBG  Award 5 points for services 10-20 hours a week each staff working on providing CSBG  Number of Part-Time Staff services 10-20 hours working on providing CSBG a week services 21-30 hours a week  Award 10 points for each staff working on  Number of Full-Time Staff providing CSBG working on providing CSBG services 21-30 hours services 31+ hours a week a week  Award 15 points for each staff working on providing CSBG services 31+ hours a week

of 31 Community Services Block Grant (CSBG) Attachment B: Application Questions for Dallas County Checklist of Application Questions Requesting Attachments  Question Attachment Item Requested 1.7 Most recent monitoring reports for all grants identified in 1.4 and 1.5 2.1 Minutes from each Board meeting held from January 1, 2016 thru Present Day 2.5 Minutes or reports from Board finance committee meetings held from January 1, 2016 thru Present Day 2.6 Financial Reports to the Board held from January 1, 2016 thru Present Day 2.7 Minutes or reports from Board program committee meetings held from January 1, 2016 thru Present Day 3.1 Applicant agency’s latest Audit Report 3.2 Applicant agency’s End-of-Year Financial Statements 4.2 Written agreements 5.1 Narrative description of Implementation plan 5.2 Narrative description of Outreach plan 5.4 Case management standards, procedures and forms 5.5 Resumes of CSBG management staff that will manage and administer CSBG and Chief Financial Officer (CFO)

Application Question Sections (Scores to be completed by Department.) Points Scoring Section Maximum Points Received Part 1: Organization Capacity 215 - points to be determined based on submission (see below for possible deductions) Part 2: Board Governance 180 Part 3: Financial Information 0 – points to be determined based on submission (see below for possible deductions) Part 4: Efficiency 310 Part 5: Services and Activities 470 - points to be determined based on submission (see below for possible deductions) Total Maximum Points 1175 - minus deductions (if any) Deductions Maximum Points Points Deducted Part 1: Organization Capacity Deductions to be determined for Question 1.7 Deductions to be determined for Question 1.8 -75 point deduction Question 1.9 -40 point deduction Question 1.10 -30 point deduction Question 1.11 Part 3: Financial Information -170 point deduction Question 3.1 -50 point deduction Question 3.2 Part 5 Services and Activities -20 point deduction Question 5.1 -10 point deduction Question 5.2 Final Score (Minimum Score=700**)

**TDHCA reserves the right to reject funding for applications that do not exceed 700 points. ** ***TDHCA reserves the right to request further information related to the application for clarification purposes during the scoring review period.***