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Name of Organization <br />Name of Funded Program <br />Annual Accomplishment Goal <br />City of Santa Ana <br />I. Total number of unduplicated clients (Santa Ana and Non -Santa Ana Residents) anticipated to be served by the <br />funded program, named above, during the 12 -month contract period. <br />ti 34Z Persons <br />II. Number of unduplicated Santa Ana residents expected to be served by the funded program during the 12 -month <br />contract period. <br />84 Persons <br />Program and Funding Description <br />III. Description of Work - In the space below, describe the program to be funded during the 12 -month contract period. <br />What specific activities will be undertaken during the contract period. Please be concise in your response. Only the <br />viewable space will print. <br />Under our Emergency Services Program, individuals become clients during an initial telephone inquiry when <br />staff conducts a pre - screening interview to determine basic eligibility. Once we determine that the client meets <br />the basic eligibility criteria for rental or utility assistance, our Case Manager conducts a thorough intake and <br />assessment of the client's needs and reasons for requesting assistance. As she interviews the client, she <br />documents all the requisite data required for the HMIS entries and records the information for subsequent <br />reporting. Upon completion of the interview, the Case Manager will offer the client any other assistance that <br />may have surfaced during the discussion, e.g., food, clothing or referrals to other agencies. When appropriate, <br />we strenuously suggest that clients participate in a financial literacy class. Thereafter, when all the <br />documentation is reviewed and the client has signed the appropriate forms, the Case Manager gives the <br />client's file to the Supervisor for a quality review and a determination of the type of assistance the client is <br />eligible to receive and the dollar amount of that assistance. The Supervisor and Case Managerthen develop a <br />plan of action for making the payment directly to the vendor and subsequent case management actions. Once <br />we determine that a payment is appropriate, the Case Manager will conduct an onsite evaluation of the <br />residence to ensure that the household meet the specific HMIS requirements. On average, the entire process <br />takes 48 to 72 hours from client intake to vendor payment. We make every effort to ensure that there is no <br />chance for fraud in the program. <br />Our case management services for most clients entails following up with the client at three month intervals <br />up to a year following initial contact. We attempt to ensure that clients are aware of services that are available <br />Schedule of Performance <br />Estimate the number of unduplicated Santa Ana residents to be served by the funded program during the 12 -month <br />contract period per quarter. (Enter number of new Santa Ana clients served each quarter. If they were served in <br />quarter 1 do not count them again in quarter 2) <br />Quarter 1: July 1 - September 30 <br />Quarter 2: October 1 - December 31 <br />Quarter 3: January 1 - March 31 <br />Quarter 4: April 1 -June 30 <br />18 <br />22 <br />21' <br />84 <br />Persons <br />Persons <br />Persons <br />Persons <br />Total unduplicated Santa Ana Residents to be served. <br />Schedule of Invoicing <br />Estimate the amount of grant funds to be requested during the 12 -month contract period on a quarterly basis. <br />Quarter 1: July 1 -September 30 <br />Quarter 2: October 1 - December 31 <br />Quarter 3: January 1 - March 31 <br />Quarter 4: April 1 -June 30 <br />$4,200.00 <br />$8;800.00 -._ <br />$9,200:00 s... <br />$12,720 00 <br />$ 34,720.00 <br />Total Grant <br />Exhibit A <br />Page 1 of 1 <br />