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Name of Organization: <br />Name of Funded Program: <br />DUNS # <br />Contact Name and Address: <br />1601 W. 2nd <br />Street Outreach Shelter <br />ESG 2015 -2016 <br />Scope of Work <br />Homeless Preventi(XX <br />HMIS Coordinated Assessment /Centralized Intake YES <br />What is the total unduplicated number (both Santa Ana residents and Non -Santa Ana residents) that this program plans to serve <br />during 2015 -2016? <br />�� 120 <br />What is the total unduplicated number of Santa Ana residents that this program plans to serve during 2015 -2016? <br />80 <br />Program and Funding Description <br />Description of Work - In the space below, describe the program to be funded during the 12 -month contract period. What specific activities will be undertaken <br />during the contract period. Please be concise in your response. Only the viewable space will print. <br />Upon receipt of a telephone request for assistance, our staff will conduct a pre- screening interview to determine a client's basic <br />elibibility for financial assistance unde this program. Once we determine that a client meets the basic eligibility criteria for rental or <br />utility assistance, our Case Manager conducts a thorough intake and assessment of the client's needs and reason(s) for seeking <br />assistance and schedules an interview. Thereafter, during the course of the interview, she documents all the requisite data <br />required for HMIS. The Case Manager will also ascertain, during the interview, whether the client has any other needs and will <br />offer what we have available to him /her; e.g., food, clothing or referrals to other agencies. When appropriate, we strenuously <br />suggest that a client participate in a financial literacy class. Thereafter, when all the documentation is reviewed and the client has <br />signed the appropriate forms, the Case Manager gives the file to the Office Supervisor for quality review and determination of the <br />dollar amount for the assistance. The Supervisor and the Case Manager then develop a plan of action for making the payment <br />directly to the vendor and subsequent case management actions. The Case Manager will then conduct an onsite home visit to <br />ensure that the residence meet the specific HUD requirements. On average, the entire process takes 48 to 72 hours from client <br />intake to vendor payment. We make every effort to ensure that there is no fraud in the program. <br />Schedule of Performance /Goal Outcomes <br />Estimate the number of ONLY unduplicated Santa Ana participants to be served by the funded program during the 12 -month <br />contract period per quarter. (Enter number of new Santa Ana Participants served each quarter. If they were served in quarter 1 <br />do not count them again in quarter 2) <br />Quarter 1: July 1 - September 30 16 Participants <br />Quarter 2: October 1 - December 31 20 Participants <br />Quarter 3: January 1 - March 31 14 Participants <br />Quarter 4: April 1 -June 30 30 Participants <br />80 Total Santa Ana Participants 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 />Exhibit A <br />Page 1 of 1 <br />M33750.00 <br />Total Grant <br />Exhibit A <br />Page 1 of 1 <br />