Emergency Food & Shelter Program Pasco County Jurisdiction # Phase 30 Application THE EMERGENCY FOOD AND SHELTER PROGRAM

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THE EMERGENCY FOOD AND SHELTER PROGRAM The Emergency Food and Shelter Program was established March 24, 1983, with the signing of the Job Stimulus Bill Public Law 98-8. That legislation created a National Board, which has since been chaired by the Federal Emergency Management Agency and consists of representatives from the American Red Cross, Catholic Charities USA, the Salvation Army, Council of Jewish Federations, United Way of America and the National Council of Churches in Christ in the USA. The legislation establishing the program was re-authorized under the Stewart B. McKinney Homeless Assistance Act (P.L. 100-77 - signed into law on July 24, 1987 and subsequently re-authorized under P.L. 100-628, signed into law on November 7, 1988). The Emergency Food and Shelter Program is sponsored by the Federal Emergency Management Agency (FEMA) under the Department of Homeland Security which constitutes the National Board. In addition to chairing The National Board for the program, FEMA provides policy guidance, oversight, federal coordination and staff assistance to the National Board. The funds from the program are awarded from FEMA. At the end of the fiscal year, FEMA reports to the United States Congress the activities of the program in the Annual Interagency Council on the Homeless Report. United Way of America audits the Emergency Food and Shelter Program monitored by the Inspector General. Finally FEMA initiates federal collection procedures to collect funds due when efforts of the National Board have not been successful. The Emergency Food and Shelter Program is unique in that it has created a lasting public-private partnership. At the national level, the federal government and board member organizations have the legal responsibility to work together to set allocations criteria and establish program guidelines. This is also true for the local level in which a local board reflecting the National Board has similar and more specific responsibilities. Local Boards are responsible for specific funding decisions and for setting local program guidelines. The Emergency Food and Shelter Program (EFSP) was created to supplement the work of local social service agencies, both non-profit and governmental, in assisting people in need of emergency assistance. The funding should be used to target special emergency needs. These needs are primarily economic in nature, as opposed to disaster related. The funding supplements feeding and sheltering efforts in ways that make a difference to the community. The goal of the program is to create inclusive coalitions that meet regularly to determine the best use of funds and to monitor their use in respective communities; to asses community needs; encourage agencies to work together to emphasize their respective strengths; work out common problems and prevent duplication efforts; and examine if the program is helping to meet the needs of special populations in an area such as minorities, Native Americans, veterans, families with children, the elderly, and the handicapped. The program offers an opportunity for agencies to coordinate the assistance provided across agencies, to families and individuals applying for rental, mortgage, or utility assistance; enhance a food banking network that is economical in its cost and broad in its coverage; reinforce creative cooperation among feeding and sheltering sites so their communication ensures help for street populations most in need of such help; and establish or maintain a system that compliments rather than supplants existing private and governmental efforts to provide urgently needed assistance. Local providers can also

initiate dialogue with local offices of federal entities; pool agency efforts to gain federal and private foundation grants; leverage EFSP funds within the community by encouraging matches of local EFSP allocations from state and local governments and private resources; and exchange ideas to share administrative and accounting methods that can improve delivery of services and focus on collaborative rather than the competitive aspects of agency relations. A Local Recipient Organization (LRO) refers to the local private or public organization that will receive any award of funds from the National Board. An award refers to the award of funds made by the National Board to a local private or public organization on the recommendation of a Local Board. Since each award phase is new, the Local Board is a new entity in every phase. The National Board has designated the United Way of Pasco County as convener of the Local Board in this community. The convener will ask each core organization to designate or re-designate a representative each phase. As convener, United Way of Pasco County provides administrative support, staff, and acts as fiscal agent for the Local Board. On behalf of the Local Board, United Way alerts the community of the availability of funds, serves as point of contact for Local Recipient Organizations (LRO), prepares required reports for the National Board, coordinates the monitoring of the performance of the LRO s and facilitates integration with existing social service programs. Public Law 101-121, section 319 states that a recipient organization shall not use federally appropriated grant funds for lobbying activities. This condition bars the use of federal money for political activities, but does not in any way restrict lobbying or political activities paid for with non-federal funds. This condition prohibits the use of federal grant funds for the following activities: Federal, state or local electioneering and support of such entities as campaign organizations and political action committees. Direct lobbying of the congress and state legislature to influence legislation Grass roots lobbying concerning either federal or state legislation Lobbying of the executive branch in connection with decisions to sign or veto enrolled legislation and Efforts to utilize state or local officials to lobby the congressional or state officials. The Emergency Food and Shelter Program is an effective example of a public-private partnership in which most of the funds go directly to services. Administrative costs are absorbed by the broad collaboration that provides a multitude of support and networks for the program. This has made the Emergency Food and Shelter Program a model of collaboration and efficiency. For consideration for the next program phase, complete and return the following application by the deadline date. [Adapted from Emergency Food and Shelter Program RESPONSIBILITIES AND REQUIREMENTS]

APPLICATION DEADLINE INSTRUCTIONS: Application must be emailed to Judith Tilton at: efspunitedwaypasco@gmail.com by Friday, October 5, 2012, at 5:00 PM. (Please Note: Applications submitted after the deadline will NOT be accepted or reviewed.) Name of Organization: PASCO COUNTY COMMUNITY SERVICES/HUMAN SERVICES DIVISION PASCO COUNTY BOARD OF COUNTY COMMISSIONERS Program Name(s): Amount Requested 1. N/A $ N/A Food Amount Requested Shelter Services 2. N/A $ Amount Requested Financial Services 3. PAST DUE RENT/UTILITIES $ 22,500.00 Program Address: (Where services are 8620 GALEN WILSON BOULEVARD, PORT RICHEY, FL 34668 AND ALSO provided) 13583 15 TH STREET, DADE CITY, FL 33525 Organization Mailing Address: 8620 GALEN WILSON BOULEVARD, PORT RICHEY, FL 34668 CPO Name: NATASHA E. MARTIN Contact Information: Contact Name NATASHA E. MARTIN Phone Fax 727-834-3297 727-834-3339 Web Address WWW.PASCOCOUNTYFL.NET TOTAL ALL PROGRAMS AMOUNT REQUESTED: $ 22,500.00 Contact Title ACTING DIVISION MANAGER Email NMARTIN@PASCOCOUNTYFL.NET Previous EFSP Awards 0 1 2-5 5+ To the best of my knowledge and belief, the data in this proposal is true and correct and the governing body of the applicant has duly authorized the enclosed documents. I understand that incomplete applications or applications submitted after the deadline will not be accepted or reviewed. IN ADDITION, I ACKNOWLDEGE THAT IF FUNDING IS PROVIDED, I, (OR AN AGENCY REPRESENTATIVE) WILL ATTEND A MANDATORY GRANTEE MEETING. IN ACCORDANCE WITH APPROPRIATE FEDERAL OR STATE LAW, I AFFIRM THAT THE AGENCY WILL COMPLY WITH REQUIREMENTS TO USE THE HMIS/PATHWAYS SYSTEM FOR DOCUMENTATION OF ANY FINANCIAL OR SHELTER SERVICES (SHELTER, RENT, MORTGAGE, & UTILITY) PROVIDED WITH EFSP FUNDING. By signing below, the undersigned acknowledges having read and understood the program guidelines and will be able to fully comply with the provisions of these guidelines as well as any and all additional applicable federal, state and local requirements, including procurement and financial management. Applicant also acknowledges that if a funding recommendation is made for less than the full amount applied for, additional documentation to include but not limited to a revised budget, scope of work and proposed accomplishments may be requested prior to final funding determinations. CPO Signature: Natasha E. Martin, Human Services Mgr. Date: 10/5/12 Board Chair / President Signature: Date:

LOCAL RECIPIENT ORGANIZATION (LRO) CRITERIA: For an agency to be eligible for funding it must provide all of the following. Be nonprofit or an agency of government and must have completed local service delivery for a minimum of one (1) year. Have an accounting system or fiscal agent approved by the Local Board and include audited financial statements for the local agency and if the agency is affiliated with a state or federal organization the audited financials must show Pasco County financials. The statement provided must be from the most recent fiscal year. Have a Federal employer identification number (FEIN), (note: contact local IRS office for more information on securing FEIN and the necessary form (SS-4) (Web site: www.irs.gov). Conduct an independent annual audit if receiving $25,000 or more in EFSP funds; Practice nondiscrimination (those agencies with a religious affiliation wishing to participate in the program must not refuse services to an applicant based on religion or require attendance at religious services as a condition of assistance, nor will such groups engage in any religious proselytizing in any program receiving EFSP funds). If private, not-for profit, have a voluntary board. To the extent practicable, involve homeless individuals and families, through employment, volunteer programs, etc., in providing emergency food and shelter services; EFSP Shelter*, Rent, Mortgage and Utility LROs must be actively inputting data into the Pathways Compass Homeless Management Information System (HMIS/Pathways). If you anticipate receiving funding in EFSP Phase 30 (Shelter, Rent/Mortgage & Utility), you are encouraged to communicate with Eugene Williams, Executive Director, Coalition for the Homeless of Pasco, to become familiar with the program and ensure your agency meets all technical requirements. Note: there is no fee for access to/use of the Pathways system. Eugene Williams can be reached at: 727-835-3445 or ewilliams@pascocountfl.net. All EFSP LRO Shelter*, Rent, Mortgage and Utility recipients must be registered with Pathways and be in compliance with all terms identified in licensing requirements and any additional contracts or MOU s required by the respective management information system provider. *For shelter services other than domestic violence shelters. ****************************************************************************************************************************************** EFSP LOCAL BOARD/PROGRAM ADMINISTRATIVE OFFICE Contact: United Way of Pasco County, Judith Tilton, EFSP Liaison, Community & Partnership Development Tel: (727) 835-2028 Fax: (727) 845-3032 Email: jtilton@unitedwaypasco.org Mail: http://www.unitedwaytampabay.wordpress.com/p.o. Box 609, Port Richey, FL 34673-0609 Website: www.unitedwaypasco.org

AGENCY NAME: PASCO COUNTY COMMUNITY SERVICES/HUMAN SERVICES DIVISION PASCO COUNTY BOARD OF COUNTY COMMISSIONERS PART A: EFSP REQUIREMENTS CHECKLIST: Please submit the following documentation: (Important Note: Applications that do not meet ALL of the program requirements listed below or do not submit ALL the necessary documentation by the application deadline will not be accepted or reviewed. THERE WILL BE NO EXCEPTIONS.) A copy of your 501(c)(3) tax-exempt status letter for your organization. If your organization does not have one, you must utilize the FEIN of a fiscal agent A copy of your current Volunteer Board Member Roster (Please provide a list of current Board members and their terms of office) A copy of your agency s nondiscrimination policy for the provision of services (This is not your nondiscrimination policy for employment or volunteer services) Attach organization s audit or compilation (if gross income is less than $100,000) for the immediate past fiscal year Attach a copy of the most recent board-approved Agency Budget for this program Original Signed LRO Certification *Once approved LRO will be signed* Original signed certification regarding lobbying (for those agencies requesting $100,000 or more in EFSP funds) form Attached _X_ Attached _N/A_ Attached _X_ Attached_N/A_ Attached_X_ Attached_N/A_ Attached_N/A_ Does your agency attempt to involve homeless individuals and families in the provision of emergency food and shelter services (through employment, volunteer programs, etc.)? Yes (if yes, attach a description of how they are involved) No (if no, attach a description of how you plan to involve them through this program to the extent practical) Attached Attached_X_ Are your facilities and services compliant with the Americans With Disabilities Act (ADA)? Yes No (if no, attach a description of how you plan to become compliant) Attached * Audited financial statements must be for the local agency. If the agency is affiliated with a state or federal organization the audited financials must show the appropriate corresponding financials. The statement provided must be from the most recent fiscal year.

PART B: PROGRAM AND AGENCY INFORMATION: (please complete Part B for each program on a separate page and limit responses to this section to three pages with only requested attachments. Be sure to label each page with the organization name and program title.) 1. Please provide the mission of the organization. The Human Services Mission is to provide a variety of assistance through networking and coordinating services with other governmental entities, community human services agencies and area churches to improve the health and welfare of Pasco County s indigent and at risk populations. 2. Name of program for which you are requesting funding: Emergency Food & Shelter Program - FEMA Phase 30 3. Total program budget: $ 22, 500.00 4. Describe the agency (or fiscal agents ) accounting process by which you would manage EFSP funding and what procedures your agency has implemented to prevent fraud and misuse of funds should they be awarded. Social Workers will verify resident s identification, income, past due notices on bills, input client information into HMIS to document assistance that has been approved to avoid duplication and submit invoices to the fiscal department for payment. 5. Please provide a succinct summary of the program for which you are requesting funding to include the following: The Emergency Food and Shelter Program funds will be utilized to pay past due electric bills and past due rent for the previous month s rent for Pasco County residents who meet the established income and asset eligibility criteria and who currently reside in the home. Other eligibility criteria may include, but not be limited to, residents who have lost their job, experienced a reduction in work hours, have documented outstanding expenses such as medical bills, car repair bills, etc. within the last month. The applicant must provide receipts or other documentation for these expenses/situations. Residents residing in homes, apartments and/or mobile homes are eligible for assistance. EFSP assistance will be provided one time only per contract period. For utility payments, the applicant must provide the most recent utility bill that reflects the past due amount for the applicant s current address. The Social Worker will call the utility company to verify the past due amount to determine the least amount necessary to keep the power on or to have the power reinstated. Payments will not exceed the established maximum allowable benefit per household. Payments will be paid directly to the vendors. EFSP funds will not be utilized for utility deposits. For past due rent payments, the Social Worker will contact the landlord to verify the least amount needed to keep the family housed and from being homeless. The Landlord s Statement of Past Due Rent is mandatory for rental assistance through the EFSP. Rental payments will not exceed the established maximum allowable

benefit per household. All payments will be made to the landlord or the management company and not the applicant. Late fees, legal fees nor deposits are eligible. Human Services has only been able to assist 58 households with past due rent in the past year and only 44 households with past due electric bills in the past year who did not qualify for the Elderly Energy Assistance program. EFSP funds will be able to greatly supplement the current funding Human Services has to assist Pasco County residents with past due rent and past due electric bills. The greatest impact will be assisting citizens who reside in mobile homes and households with members who are below 60 years of age. (a) target population; (b) number of clients currently served without EFSP funding; (c) a general description of program activities and processes used by the agency to deliver services; and (d) how the EFSP funds will be used to enhance the current services. 6. Please describe program collaboration with all local partnerships. Human Services will continue to work closely with all local agencies to assist residents with rent and utility bill assistance via phone calls and emails. Human Services will be utilizing the HMIS system to enter client assistance and check for other assistance provided by other agencies to avoid duplication of services. 7. Please list: Human Services has three locations to service residents: 8620 Galen Wilson Blvd., Port Richey, FL 34668 727-834-3297/727-834-3339 FAX 13853 15 th St., Dade City, FL 33525 352-521-5173/352-521-5176 FAX 4111 Land O Lakes Blvd., Land O Lakes, FL 727-834-3297/727-834-3339 FAX Port Richey/Dade City open M-F 8-5pm except for holidays Land O Lakes open Tuesdays 8-5pm except for holidays Human Services employs four Social Workers who will take applications and verify documentation, enter information in HMIS, make payment guarantees to vendors and write vouchers and submit to fiscal services. There is one Human Services Specialist who will make appointments and pre-screen residents for eligibility. (a) all of the proposed service locations for the program for which EFSP funds are being requested; (b) hours of operation; and the (c) number of paid and unpaid staff members at each site, and their role in providing these services. 8. Describe the eligibility criteria for individuals requesting services and how is this documented? Income eligibility is determined by FEMA. Social workers will evaluate an applicant to ensure they are meeting eligibility requirements in accordance with agency standards, loss of income will be documented through expenditure receipts or selfdeclaration as a last resort. All of this information will be contained in the case file and entered into HMIS.

9. How will services be coordinated with other programs within your agency and within the community? Human Services will continue to work closely with all local agencies to assist residents with rent and utility bill assistance via phone calls and emails. Human Services will be utilizing the HMIS system to enter client assistance and check for other assistance provided by other agencies to avoid duplication of services. 10. Please describe what procedures your agency has implemented to prevent fraud and misuse of EFSP funds, should they be awarded. Consistent use of HMIS will prevent duplication of services. Pasco County Human Services reviews all approved cases to ensure there is no misuse of funds. FOR MASS SHELTER APPLICANTS ONLY N/A 1. What is your shelter bed capacity? 2. What is your bed utilization for last fiscal year? 3. How many bed nights will be funded by EFSP funds? FOR RENT AND MORTGAGE ASSISTANCE ONLY NOTE: Rent/Mortgage and Utility funding recipients must be able to demonstrate organizational and case management capacity. Capacity to deliver programs should illustrate the following: Human Services will not utilize ESFP for mortgage assistance. ESFP assistance will be advertised through the UW 211 service, the Pasco County website, notifications to partner agencies, posted flyers in county offices and by word of mouth. Customer service feedback is encouraged at intake through our customer service comment cards and mailed to the Board of County Commissioner s office. Pasco County Human Services has an extensive history of providing utility and rental assistance in compliance with our contracts. Pasco County Human Services has received ESFP funding for the past thirteen (13) grant phases with noted deficiencies. Our standards of documentation exceed requirements and our experience with HMIS has made us a leader in our community. a. How the program will be marketed to the community; b. How customer feedback is encouraged and monitored; and, c. Describe your organizational capacity to deliver services.

Emergency Food & Shelter Program Emergency Food & Shelter Program PART C: OVERALL REQUEST SUMMARY AGENCY NAME: PASCO COUNTY COMMUNITY SERVICES/HUMAN SERVICES DIVISION - PASCO COUNTY BOARD OF COUNTY COMMISSIONERS Complete Part C below indicating the amount requested for each cost category and estimate the number of meals/bed nights/bills to be provided. Total the dollars in each category and enter on the Grand Total line. Also, complete Part D Geographic Information and Part E Planning and Budgeting Information. 1. Please complete the table below and indicate number of units, cost per unit, and total amount of your request for each line item for which you are requesting EFSP funding. Please Note: Transportation costs should be included in the cost per unit for each line item for which it s applicable. FOOD SERVICES Served Meals A B C D E AVG COST Previous Year PER UNIT Units Served NUMBER OF UNITS TOTAL EFSP REQUEST (A x B = C) Current Year Units Served Other Food TOTAL SHELTER SERVICES Mass Shelter TOTAL A B C D COST PER UNIT NUMBER OF UNITS (Bed Nights) TOTAL EFSP REQUEST (A x B = C) Previous Year Units Served ( # of bed nights) (# of individuals served) Current Year Units Served ( # of bed nights) (# of individuals served) FINANCIAL SERVICES A B C D AVG COST TOTAL EFSP PER UNIT REQUEST NUMBER OF UNITS (Bed Nights) (A x B = C) Rent, Mortgage, Utility Assistance $22,500.00 TOTAL Previous Year Units Served Current Year Units Served GRAND TOTAL ALL SERVICES $22,500.00

Emergency Food & Shelter Program Emergency Food & Shelter Program AGENCY NAME: PASCO COUNTY COMMUNITY SERVICES/HUMAN SERVICES DIVISION - PASCO COUNTY BOARD OF COUNTY COMMISSIONERS FOR MASS FEEDING PROGRAMS ONLY There are two options for eligible costs. One option must be selected at the beginning and continued throughout the phase. Please select one: Actual direct eligible cost reimbursement OR Per meal allowance of $2 per meal served FOR MASS SHELTER PROGRAMS ONLY There are two options for eligible costs. One option must be selected at the beginning and continued throughout the phase. Please note the EFSP board affirms the level of per diem if per diem is the candidate LRO s choice. Please select one: Actual direct eligible cost reimbursement OR Per diem allowance ($7.50/$12.50 EFSP board choice dependent on level of client service) PART D: EFSP GEOGRAPHIC INFORMATION Please check off all of the geographic areas listed below that are served by your agency: East Pasco Central Pasco Dade City Lacoochee Zephyrhills Land O Lakes Wesley Chapel Other West Pasco Hudson Holiday New Port Richey Port Richey Trinity All of Pasco

Emergency Food & Shelter Program Emergency Food & Shelter Program PART E: PLANNING AND BUDGETING INFORMATION AGENCY NAME: PASCO COUNTY COMMUNITY SERVICES/HUMAN SERVICES DIVISION - PASCO COUNTY BOARD OF COUNTY COMMISSIONERS The intent of the Emergency Food and Shelter Program is to supplement and expand current available resources and not to substitute or reimburse ongoing programs and services or to start new programs. Services for which funding is being requested must already be provided by your agency through other funding sources. 1. For each EFSP line item for which you are requesting funding, please reflect other agency funds available and the source of this funding by filling in the grid below: Food Current Program Non-EFSP Funds Sources of Current Non-EFSP Program Funds EFSP Funds Requested Served Meals Other Food Total Mass Shelter Total Rent, Mortgage, Utility Rent & Mortgage None None $15,500.00 Utility Elderly Energy Assistance Area Agency on Aging-Pinellas/Pasco $7,000.00 Total $22,500.00 TOTAL $22,500.00 2. Please complete a current operating budget (enclosed) to include revenue and expenditures for this/these programs using the provided standard budget form. If there is a budget deficit, please explain how your organization will ensure that EFSP funds are not used to meet that deficit below. Funds are approved by Board action; a Resolution is prepared by our Office of Management and Budget to recognize revenue and appropriate expenditures. All prospective clients are interviewed by Social Workers to determine eligibility. A spreadsheet is maintained to track all reimbursable requests, which is then reconciled to our Accounting system (FASBE). There are multiple approvals levels for each step in this process.

Emergency Food & Shelter Program Emergency Food & Shelter Program 3. Does your organization have a process or ability to expend funds if released late during the calendar year or term of phase? Yes No END OF APPLICATION