Embed Size (px)
Citation preview
DEPARTMENT OF HUMAN SERVICES
DIVISION OF FAMILY DEVELOPMENT
CONTRACT ADMINISTRATION UNIT
CONTRACT AWARD PACKAGE
FY 17 SNAP E&T
FY 17 SNAP E&T Instructions and Deadlines
Important Deadlines and Reminders:
1. The renewal package must be submitted to the DFD Contract Administrator before December 1, 2016.
2. DFD will not authorize any service without the timely receipt of a contract renewal package. Until final DFD approval of the scope of work detailed in the Annex A, DFD assumes no liability for the services rendered and the costs incurred.
3. Any contract not submitted in accordance with the instructions and within the timeframe required or failure to respond to all requests for additional documentation that prevents the execution of the contract within the timeframes set by the contract administrator may result in rescission of the contract award.
4. The renewal package submitted must be the FY 17 package and forms.
New for FY 17
1. The Food and Nutrition Service (FNS) requires the State to submit an annual report of outcome data to monitor the effectiveness of the SNAP E&T Program. This is required for any component which services 100 participants or more per year. The data is for the period of FFY 17 (October 2016 through September 2017). The Annex A identifies the reporting measures and suggested data sources for the E&T component as well as that this data must be submitted to DFD by November 2017 as part of the State’s annual report.
2. The Annex B must include a written, detailed budget narrative explaining the proposed costs included in the budget. The narrative should explain all proposed staff and costs in the budget and how the costs were estimated.
3. DFD no longer accepts printed and mailed contract renewal packages. Please submit your contract package via email. The subject line should include your current contract number and please “cc” your contract administrator. Package should be submitted to: [email protected]
Specific comments regarding proposed program staff, subcontractors, vendors, and consultants, indirect cost rates (including fringe benefits and General and Administrative (G&A) must be included in the narrative. The narrative should explain the source(s) of funding when the DFD contract is not the sole source of funding for the program.
1
The Annex B and narrative should include details of all fringe benefits, indirect cost pool, indirect cost base, and allocation methodology for the allocation of the indirect costs.
DFD must easily understand the total proposed budget and identify what services are being provided and at what cost – both direct and indirect. The budget should be very detailed and include specific proposed costs for all expenditures (office supplies, travel, provider training, staff development training, postage, printing, meeting expense, conference, mileage, etc.). The budget narrative should then explain the purpose of each expense included in the proposed budget, how the cost was estimated (i.e. number of trips/mileage to be reimbursed at $.xx per mile) and also include commentary on the purpose for the expense and explain the relationship to the delivery of service and accomplishment of the program goals and objectives.
Annex A Reminders:
The Annex A consists of two parts; Part I is the written narrative that must be thorough and include specific details of the program services, manner and method of delivery including program services, client eligibility, subcontractor and/or vendors that will provide services. The narrative should include commentary regarding the client universe, eligibility factors, determination methods, documentation and level of service to be provided. This requires a detailed discussion for each service component, including vendor, projected level of service to be provided, number of clients, rates and total cost.
The lack of details and incorrect data in the Annex A prevent the timely approval of program services and will delay the approval of the contract. Any contract not submitted in accordance with the instructions and the timely manner required or failure to respond to all requests for additional documentation that prevents the execution of the contract within the timeframe set by the contract administrator may be rescinded.
Subcontract agreements should be submitted to DFD and approved before the start of the contract, but are due to DFD no later than February 1. Failure to submit and obtain approval will result in disallowed costs and risk of reduction in the contract ceiling.
Annex B Reminders:
All budgeted costs must adhere to the DHS cost principles contained in the DHS Cost
2
Reimbursement Manual – specifically Section 4. DFD will review the budgeted costs for allowability, allocability and reasonableness.
Please note the special contract terms for:
Salary – See SLD P2.01, Sections 5.16 and 5.17
Conferences/Meetings – See SLD P2.01, Section 5.22 and CRM Section 4.6 (requires 30 days pre-approval)
Travel – See SLD P2.01, Section 5.20 and CRM Section 4.6
Subcontracts – See SLD P2.01, Section 5.02, CRM Section and DHS Policy P99.2
3
ANNEX B - Helpful Hints
Detailed instructions for completing the Annex B including the DHS Cost Reimbursement Manual (CRM), Section 5.3 and an Annex B tutorial are located at
http://www.state.nj.us/humanservices/dfd/info/
The budget should detail all costs to administer program and meet program goals and objectives in accordance with required cost principles and instructions of the CRM.
The budget must:
Be prepared in accordance with GAAP and reflect an agency-wide budget Include details of all other grants/contracts and specify those also contributing
towards funding the program Specify all proposed costs as direct or indirect For all indirect costs - identify the indirect cost basis of allocation Detail all subcontract/vendor services
Have two (2) different original signatures on the summary page
Copies of consultant and subcontract agreements must be submitted
4
Other Important Reminders
Required Documents: (DHS Policy P1.01)
All required contract documents, forms, signatures (original) with the required number of copies and signatures must be returned.
Modifications: (DHS Policy P1.10) (final request due to DFD no later than 5/15/16)
Reporting: (Detailed in the Annex A and SLD Section 3.02)
Contract Acquired Equipment and Disposal: (DHS Policy P4.05)
5
Contract Renewal Package
Annex A:
Contract Summary Sheet
Authorized Signatures
Service Delivery Information
Part I - Program Narrative
Part II – Questions
Projected Level of Service – if required
Renewal Documents:
Index of Required Contract Documents
Contract Checklist
Document Verification Sheet (DVS)
Executive Order 129
Certification of Suspension and Debarment
FAFTA
Disclosure of Investment Activities in IRAN
List of Contracts/Grants
Contract Forms (List of Required Documents Available on DFD Website)
Federal Award Information
Grant Number: 1NJ400404
CFDA Number: 10.561
6
ANNEX A-FORMS INSTRUCTIONS
Contract Summary Sheet
Enter all data requested in the form. Enter Agency Official responsible for the program administration.
Authorized Signatories
Enter Authorized Signatory for the Contract (as authorized by Agency Bylaws or Board Resolution).
IMPORTANT - This is the address where the signed contract and all relevant legal correspondence will be mailed – so please ensure this is the accurate address.
Service Delivery Information
Please complete all details for the service delivery
7
STATE OF NEW JERSEY - DIVISION OF FAMILY DEVELOPMENT
ANNEX A – CONTRACT SUMMARY SHEET – FY 17 SNAPProvider Agency Contract #Mailing Address
Federal ID
Telephone Number
Provider Agency Fiscal Year End
Agency
Contract Effective Date
to
Contract Ceiling
$
Organization Type
AgencyBoard of Social ServicesCWANon-Profit
SNAP Program
Agency Official Executive Officer
Title Mailing
Address
Telephone Number
Fax Number E-Mail
Address
All routine notices relevant to the administration of the program should be sent to:Name & Title
Mailing Address
Telephone Number
Fax Number E-Mail
Address
Do you currently receive payment by Automatic Deposit (ACH) for this contract? Yes No
8
Division of Family DevelopmentAnnex A - Authorized Signatures – FY 17 SNAP
List names and positions of persons authorized to sign the following and number of persons required to sign each transaction.
Name/Address Position# of Signatures
Required
Contract1
2 3
Quarterly and Final Financial Reports
1
2 3
ContractBudget Modification
1
2 3
Checks1
2 3
Other Contract Documents: Program
Reports
1
2 3
Note: - Enter Authorized Signatory for the Contract (as authorized by Agency Bylaws or Board Resolution). This is the address where the signed contract and all relevant legal correspondence will be mailed. This should be the individual who signs the SLD (page 23). This may not be the same individual as noted in the Annex A summary sheet. In the event of emergency notification, please include e-mail and fax number.
Contract Signatory Title Mailing Address
Telephone Number Fax Number E-Mail Address
9
FY 17 SNAPDivision of Family Development
Annex A -Service Delivery Information
Program Name: Site Address:
City, State, and Zip Site Phone Number:
Program Director/Coordinator
Telephone #: Fax:
E-Mail:
Service will be provided as follows (designate time):From To
Sunday Monday Tuesday
Wednesday Thursday
Friday Saturday
Services will not be provided on the following occasions: # Holidays _______
Date (s) Occasion
Emergency Provisions: Describe any special arrangements which have been made to handle emergencies, e.g. voice mail instructions, special telephone numbers etc.:_________________________________________________
10
Contract #
Division of Family DevelopmentANNEX A - PROGRAM OPERATIONS
Introduction and Instructions:Following are the contract components to be administered for the program. The Provider Agency shall describe the components as they are administered internally. The Annex A, Program Description information should reconcile to the details included in the Annex B - Budget.
The Provider Agency must provide information in the Annex A narrative describing how each service component of this contact will be administered including internal processes and controls for each program/service component. Answer all questions by providing information that is quantifiable and qualifiedly measurable to the extent feasible.
Key Statutory and Regulation Requirements of the contract
a. Determine who is eligible to receive Federal and State financial assistance;b. Have internal controls and performance measures to determine that all Federal and State rules
are accurately applied;c. Adherence to applicable Federal rules and State program compliance requirements; andd. Assurance of appropriate use of allowable government funds to carry out the goals and
objectives of the program.
The Provider Agency assures that it will comply with the following statutory requirements and ensure Federal and State funds are applied to:
Eligible Clients – By statue – only clients that meet program eligibility criteria.
Staffing - The agency agrees that a minimum it will provide notification of any program administration staff changes to the DFD Contract Administrator and Program Representative within 20 days of the change.
Personnel Requirements
The Agency Director or program designee must attend and participate in DFD-sponsored in-person meetings and trainings and conference calls as directed by the DFD Contracts and Program Staff.
Fiscal Standards and Accountability
Recipients and sub-recipients of Federal and State funds are responsible for the proper use of such fund. Funds must only be used for the intended purpose and in compliance with all Federal, State and contract regulations. All parties are responsible for the transparency and accountability for the funds and are subject to administrative, contractual and legal sanctions for the misuse and/or improper use of these funds. Provider Agencies are considered sub-grantee/recipients under this contract and are subject to Federal laws, regulations and provisions of this contract as set forth in this document; and must ensure adherence to all applicable regulations.
The agency must meet all contract expectations as described in the RFP as well as those detailed in this contract. Failure to meet any performance standard and contract expectations can be grounds for revision of the contract whereby current funding is reduced, contract is suspended or terminated and can affect future consideration for funding.
11
In addition to the core areas of program delivery, Provider Agencies must maintain administrative and fiscal accountability, meet reporting requirements, and ensure program integrity to meet all program compliance and performance standards. As recipients of government funds, all agencies must adhere to all Federal and State laws and regulations as stated above.
Grant Cost Principles – Costs incurred for the delivery of the services will be based on Federal and State cost principles and include only those costs deemed allowable, allocable and reasonable per the regulations.
Fiscal Requirements:
The agency is a third party provider of services to DFD subject to administrative, fiscal and programmatic monitoring and oversight from DFD. The provider agencies are responsible to adhere to all DHS and DFD contract rules and regulations and to follow all directives issued by DFD. Provider Agencies’ acceptance and use of Federal and State funds from this contract constitutes the agency’s acceptance of these terms and conditions.
Recipients and sub-recipients of Federal and State funds are responsible for the proper use of such funds. Funds are used for the intended purpose and in compliance with all Federal, State and contract regulations. All parties are responsible for the transparency and accountability for the funds and are subject to administrative, contractual and legal sanctions for the misuse and/or improper use of these funds. Provider agencies are considered sub-grantee/recipients under this contract and are subject to federal laws, regulations and provisions of this contract as set forth in this document and must ensure that:
Contract funds are allocated to meet program objectives and for the purpose as intended; Fiscal and accounting procedures are sufficient to permit the preparation of required reports and
the proper reconciliation of expenditures to adequate source documentation to establish funds have been used appropriately for the intended purpose in accordance with all applicable laws, regulations, and contract cost principles;
Annual completion of the Single Audit, as required; Funds are not used to support inherently religious activities, such as religious instruction or
activities; Funds are not used to support lobbying activities to influence proposed or pending Federal or
State legislation or appropriations; and Funds are expended in accordance with all pertinent laws and regulations.
Allowable Cost
The determination of allowable costs is defined in the SLD, RFP, DHS and DFD Cost Reimbursement Manual (CRM) and the DHS Contract Policy and Information Manual (CPIM). Expenditures are defined as those costs which are restricted to activities related to programmed plan development; complaint files management; public hearing information; program monitoring and coordination; report preparation; evaluation of program outcomes; personnel management; travel; equipment; supplies; audits and response management; and indirect costs such as maintenance of facilities, utilities, and general management staff.
Reporting Requirements
12
The agency is required to submit program and fiscal reports within the required timeframes. At a minimum, the following reports are required:
I. Fiscal Reports
A. Report of Expenditures (ROE)
Fiscal reporting is required on a quarterly basis combining subcontracted and direct agency expenditures. Actual expenditures must be reported using the Annex B form on a cumulative basis by the 20th day of the following month after the close of each calendar quarter.
The Final ROE is due 120 days after the contract period ends.
The expenditure reports must contain an original signature of the CEO and fiscal officer designated by the agency for this program.
Payments will be issued upon the successful accomplishment of the performance standards detailed in the RFP and Annex A.
All reports must be sent to:
DFD, Office of Contract AdministrationEmail: [email protected]
II. Program Reports
Program reports are to be submitted to the DFD Program Office as specified in the Annex A with a copy submitted to your contract administrator.
III. Payment Terms
Payments are issued to the provider agencies after submission and DFD verification of the performance standards detailed in the RFP.
13
SNAP BACKGROUND:
The Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program, puts healthy food on the table for millions of low income Americans every month. The program supplements the budgets of low-income people by providing benefits via an electronic benefit card which is used like a debit card at most food retailers. Through nutrition education partners, the program helps clients learn to make healthy eating and active lifestyle choices. The Food and Nutrition Service (FNS), United States Department of Agriculture (USDA), reports that as of September 2016, New Jersey serves a total of 857,779 SNAP recipients.
On April 15, 2013, Governor Christie signed legislation, Pub. L. 2013, Chapter 45, establishing a Supplemental Nutrition Assistance Program Employment and Training Provider Project (NJ SNAP ETP supplementing Title 44 of the Revised Statutes) in an effort to assist eligible SNAP participants obtain job training and develop the necessary skills to find and keep regular employment.
PURPOSE OF FUNDING:
The purpose of the new law is for DHS/DFD to form partnerships with qualifying agencies to provide employment and training services to eligible participants under NJ SNAP ETP and receive Federal reimbursements for those services. Pursuant to this legislation, subsequent to the competitive Request for Proposal (RFP), DHS obtained approval for the demonstration projects that will be funded.
DHS/DFD announced the availability of funds for the New Jersey Supplemental Nutrition Assistance Program Employment and Training Provider Project in 2014. This program is intended to provide funding under which DHS shall form partnerships with qualifying agencies to provide employment and training services to eligible participants under NJ SNAP ETP and receive Federal reimbursements for those services. These services include assisting SNAP recipients with acquiring the skills, training, work, or experience necessary to obtain regular employment.
Funding of up to 45 percent of the Federal SNAP reimbursement is made available for State Fiscal Year (SFY) 2017
The four-year funding period will be from October 8, 2014 through October 8, 2018. The Department reserves the right not to issue a grant for a subsequent year of this project under certain circumstances, such as, but not limited to, the availability of Federal funds, the unsatisfactory performance of the partnering provider, failure to submit required contract documentation within prescribed timeframes, or failure to meet contract requirements.
SCOPE OF SERVICES:
New Jersey Employment and Training Provider Project (E&T)
As a result of a law passed in 2013, the DHS, DFD has established the New Jersey Supplemental Nutrition Assistance Program Employment and Training Provider Demonstration Project. For the project, the DHS has formed partnerships with qualifying agencies to provide services to eligible participants under NJ SNAP E&T and receive Federal reimbursements for those services. Participation in the project by NJ SNAP E&T participants is voluntary.
The DHS shall consult with the Department of Labor and Workforce Development (DLWD) and the county welfare agencies (CWAs) with respect to the establishment and oversight of the demonstration project. Under the law, the state issued a RFP.
14
The RFP requested the provider agencies to propose innovative programs to provide participants necessary job skills and training to enhance their competitive edge with practical and tacit knowledge, which will better position each participant to secure immediate employment support, leading to career based opportunities.
The provider must provide a detailed narrative of the scope of work to be provided under the award. The provider must document the activity/component of the program they will implement and include specific commentary on:
1. Program specifics – description of the component including activities, purpose/objective, time period of activities
2. Geographic areas to be served3. Targeted Population (including criteria for participation)4. Participant Outreach and Recruitment5. Performance Goals and Outcomes6. Retention7. Match Funding
The provider must include details of the:
PROGRAM OUTCOMES and DELIVERABLES:
1) Performance Deliverables
2) Performance Standards
See the program narrative instructions later.
STRATEGIC PROGRAM GOALS:
The overall goal of the NJ SNAP ETP is for DHS to establish partnerships with qualifying agencies that will provide the necessary services, such as job skills and job training, to lead eligible NJ SNAP recipients to regular employment and self-sufficiency, eliminating their dependence on SNAP. The targeted population includes, but is not limited to, SNAP recipients who are either unemployed youth/adults aged 16 to 24 years of age, or individuals with substance abuse barriers.
TARGET POPULATION / ELIGIBILITY:
Provider Agencies are to:
Serve SNAP recipients with significant barriers to employment, including, but not limited to: able-bodied adults without dependents (ABAWDs) required to participate in employment and training programs as a condition of receiving SNAP benefits; individuals with low literacy or limited English proficiency; veterans who are not eligible for other employment and training programs; individuals with a history of substance abuse; and persons who are 16 through 24 years of age;
Serve unemployed or underemployed parents, including non-custodial parents and parents who have exceeded their Work First New Jersey TANF 60-month lifetime limit on cash assistance;
Provide training in both vocational and technical skills, as well as “soft skills,” including, but not limited to: workplace preparation training, teamwork, problem solving, time management, and conflict resolution;
15
Provide training that results in marketable credentials and that prepares participants for employment or reemployment in industries with projections of growth, as DHS identifies those industries in collaboration with the DLWD;
Provide 100% matching funds. Matching funds can be produced from cash donations or in-kind contributions but must come from a non-federal source. Matching funds means the total 50% to match Federal funding. The agency can expect to receive 45% back in reimbursements from the State. The State will not reimburse the agency unless and until Federal funds are made available to DFD and incorporated in the DFD budget for this purpose. The State is not responsible for any changes in Federal funding availability;
Conduct job development activities and identify how job opportunities will be secured to maximize SNAP recipients’ permanent placement in employment providing compensation at the level of a living wage and opportunities for wage progression; and
Demonstrate a proven history of job placement and retention.
Continuation of funding in subsequent years will be based on performance standards that relate to community outreach expectations; being compliant with DFD program monitoring; and accuracy of fiscal and contract level of service reporting.
ALLOWABLE USE OF FUNDS:
Each provider agency shall be required to perform the following financial functions and to maintain sufficient capacity to perform the functions effectively:
(1) Maintain cash flow necessary to manage the delay from program outlays to SNAP ETP reimbursements;
(2) Manage Federal grants, track expenditures, and ensure that non-federal resources and program expenditures qualify for Federal SNAP ETP reimbursements;
(3) Perform cost allocation using multiple funds;
(4) Track staff time devoted to NJ SNAP ETP activities under the project; and
(5) Maintain records for State audits.
DHS may solicit, receive, and accept grants, funds, or anything of value from any public or private entity and receive and accept contributions of money, property, labor, or any other thing of value from any legitimate source to support the project, provided the DHS does not have reason to believe that the entity may have a vested interest in the decisions of the DHS concerning the selection of specific partnering providers. Funds provided by the selected partnering providers for the RFP should be able to provide the full match of the Federal dollars.
The department may reserve up to 5% of the Federal SNAP ETP reimbursements generated as a direct result of the activities of the partnering providers and received by the State pursuant to P.L. 2013, Chapter 45, the NJ SNAP ETP Act, for operating expenses and staff directly related to the administration, oversight, and evaluation of this project. The remaining Federal SNAP ETP reimbursements will be generated as a result of the activities of the partnering providers. When received by the State, they will be paid to the providers as appropriate.
PERFORMANCE EVALUATION:
16
DFD shall establish performance standards for partnering providers conducting project activities including, but not limited to, standards for performing required programmatic and financial functions pursuant to the NJ SNAP ETP Act, Public Law 2013, Chapter 45. Funding will be contingent upon the individual progress of the SNAP participant, and agency progress in reaching certain benchmarks.
If DFD finds that a partnering provider has not conducted its project activities in accordance with the established performance standards, or that a provider has otherwise failed to comply with the requirements of Public Law 2013, Chapter 45, DHS may take such action to correct the deficiencies of the provider and/or terminate the partnering provider’s participation in the project if the provider fails to take remedial action.
PERFORMANCE STANDARDS:
Performance standards are the performance-based standards that will be used by the DHS to measure the capacity for, and progress of, partnering providers conducting educational training, job-training; certificate-based training, and providing assistance with getting and keeping a job.
In order to receive the allowable Federal reimbursement of 45%, partnering providers must meet all of the following performance standards:
Enrollment for educational and training programs will be measured by capacity and attendance. The minimum required capacity for enrollment shall be at least 80% per class or training.
Participant Involvement: Participants must have a minimum attendance rate of 90%.
Successful outcomes shall include completion of the class, obtaining the certificate, and/or successfully finding employment.
For partnering providers who conduct educational and/ or job-related certificate training, the Federal reimbursement of 45% will be earned by successfully meeting these benchmarks:
50% of the provider’s share of the 45% Federal reimbursement will be provided when the minimum attendance rate is at least 90% (This is applicable to all participants); and
50% of the provider’s share of the 45% Federal reimbursement will be provided when a class is successfully completed.
For partnering providers who provide job search activities, the Federal reimbursement of 45% will be earned by successfully meeting the following benchmarks:
50% of the provider’s share of the 45% Federal reimbursement will be provided when the minimum attendance rate is at least 90% (This is applicable to all participants); and
50% of the provider’s share of the 45% Federal reimbursement will be provided when the participant successfully completes the program by finding employment, and is still employed 90 days later.
No more than half of the contracted unduplicated number of participants may be serviced only in either the educational/job-related certificate training component or the job search activity component. Please note that partnering providers will be obligated to provide support services for 90 days to those participants who have obtained a job to assist with job retention. Providers must submit 90 day retention report to DFD Program on a quarterly basis. Providers may use an existing agency template for such a 90 day report with prior approval from the DFD SNAP Unit.
17
BENCHMARKS:
In addition to meeting the applicant qualifications and performance standards defined in the RFP, the selected agency will required to:
Keep individual client records.
Report progress among program participants.
Report benchmarks around training.
Report benchmarks around achieving goals with the program recipient.
QUALITY ASSURANCE AND MONITORING:
DFD will monitor all program activities.
OTHER – MATCH REQUIREMENT:
Provider agencies must be able to provide 100 percent matching funds from non-federal sources. 100% matching funds means that providers give the total 50% to match the amount of Federal funding. A qualifying agency means a local government, non-profit entity, institution of higher education, foundation or other eligible community-based organization that qualifies for allowable federal SNAP reimbursement pursuant to the Federal “Food and Nutrition Act of 2008,” Public Law 110-246(7 U.S.C. s.2011 et seq.) by providing allowable services that help SNAP recipients acquire the skills, training, work, or experience necessary to obtain regular employment. A qualifying agency may also include a consortium of organizations.
GENERAL REQUIREMENTS OF THE CONTRACT:
Provider agencies must ensure compliance with the:
1) Contract Policy and Information Manual and the Provider Agency Contract Reimbursement Manual.
2) Standard Language Document
3) Annex A
4) RFP
PERFORMANCE REQUIREMENTS OF THE CONTRACT:
1) The Provider Agency shall implement the program model according to the Annex A, RFP and technical guidance and specifications issued from DFD as communicated by the DFD Project Coordinator(s).
REPORTING REQUIREMENTS:
DHS shall, in consultation with the county welfare agencies and the DLWD:
Submit requests for Federal SNAP ETP reimbursements and fulfill all reporting and other SNAP ETP administrative responsibilities required by the Food and Nutrition Service in the United States Department of Agriculture;
18
Distribute Federal SNAP ETP reimbursements received by the State under this project to the partnering providers whose non-federal resources and program expenditures generated the Federal reimbursements;
Collect data concerning partnering providers and project participants, activities, and outcomes; and
Audit partnering providers on a routine basis to ensure fiscal and program integrity.
PROGRAM REPORTING:
Submit Monthly and Quarterly reports as specified no later than the 15th of the following month/quarter to the DFD SNAP Unit on:
a) Program Deliverables and Client Servicesi) National Reporting Measures Outcome Progressii) Ad Hoc reposts as requested by DFD.
b) Goals and Functions of the Program
i) Program Quality Management
ii) Clients Outcomes on Training Activities, Attendance, Engagement, Employability, Retention, and other related activities.
c) Performance Standards i) Client statistics, class data including capacity, student attendanceii) Student progress for class completion and Employmentiii) Employability Statusiv) Other data as required by DFD.
FISCAL REPORTING REQUIREMENTS:
Quarterly Report of Expenditures is due to DFD on the 20th days after the close of the quarter.
Final Report of Expenditures is due to DFD 120 days after the completion of the contract.
Payments will be issued upon the provider agencies submission and DFD verification of the performance standards detailed above.
19
ANNEX A - PROGRAM NARRATIVE
Part 1 - Annex A – Scope of Work Narrative
Please provide a written narrative of the proposed program. The program description should present a clear picture of the program’s structure, staffing, description and implementation of services and service delivery, referral process, coordination with other agencies and local service providers and other community stakeholders and work force development agencies. Also, the agency’s description should explain the services and where, how, and for whom services will be provided, and evidence of the need for the service.
The provider must provide a detailed narrative of the scope of work to be provided under the award. The provider must document the activity/component of the program they will implement and include specific commentary on:
1. Program specifics – description of the component including activities, purpose/objective, time period of activities2. Geographic areas to be served3. Targeted Population (including criteria for participation)4. Participant Outreach and Recruitment5. Performance Goals and Outcomes6. Retention7. Match Funding
The provider must include details of the:
PROGRAM OUTCOMES and DELIVERABLES:
1. Performance DeliverablesState agencies are required to submit annual reports to FNS with outcome data for the State’s E&T program as a whole as well as for individual components. As a third party partnership with the State, vendors must collect data on the National Reporting Measures for each E&T component offered designed to serve at least 100 participants during the FFY. The Annex A must provide a clear description of how each E&T reporting measure will be collected, including the data source and the methodology used to obtain the data for the annual report. The vendor must submit this reporting measure data to the DFD SNAP Unit quarterly with a final annual report due November 2017.
2. Performance Standards
The required National Reporting Measures include the following:
• The number and percentage of E&T participants and former participants who are in unsubsidized employment during the second quarter after completion of participation in E&T;
• The number and percentage of E&T participants and former participants who are in unsubsidized employment during the fourth quarter after completion of participation in E&T;
• The median quarterly earnings of all the E&T participants and former participants who are in unsubsidized employment during the second quarter after completion of participation in E&T; and
20
• The number and percentage of participants that completed a training, educational, work experience or an on-the-job training component.
• The number of all E&T participants who:a. Are voluntary vs. mandatory participants;b. Have received a high school degree (or GED) prior to being provided with E&T services;c. Are able- bodied adults without dependents (ABAWDs);d. Speak English as a second language;e. Are male or femalef. Are within each of the following age ranges: 16-17, 18-35, 36-49, 50-59, 60 or older.
• Of the number and percentage of E&T participants to be reported in the first four measures bulleted above, a disaggregation of the number and percentage of those participants by the characteristics listed in a, b, and c. A participant may have more than one characteristic.
The narrative should include a detailed discussion of the program plan describing how the agency’s activities under the project would fulfill the purposes of NJ SNAP ETP. The program plan shall include, but not be limited to the following information:
The program goals and objectives, including the agency’s priorities for serving eligible participants in the state;
The program design, including: strategies for targeting and recruiting eligible participants; educational skills and training activities; work-related activities; job preparation, placement, and retention activities; strategies for coordinating with the county welfare agencies and DLWD; and strategies for providing support services, including case management, early intervention, career counseling, and referrals to additional programs and services;
The program budget narrative, including the overall resources to be used to support the agency’s NJ SNAP ETP activities, the specific non-federal SNAP ETP reimbursements, and the intended utilization of anticipated Federal SNAP ETP reimbursements;
The extent to which community partners, including subcontractors, will be involved in the agency’s activities; and
The ability to demonstrate a proven history of job placement and retention.
Part 2 - Please concisely respond to the questions below.
1. Describe your agency’s purpose, philosophy, goals, and objectives.
2. How does the mission of the project align with your agency mission? How does the program benefit/impact the community?
3. Identify and describe any unique capabilities of your agency in delivering the service.
4. Provide a description of the implementation plan for the completion of the program specifically addressing the goals, objectives and deliverables.
21
5. Describe how your agency will meet the objectives, goals, and deliverables detailed in the RFP and Annex A above.
6. Describe the performance goals for the Project.
7. What systems are in place to ensure that accurate records are maintained for completing all required program and fiscal reports?
8. Describe staff positions, responsibilities and provide staffing structure information. (Provide their position, titles, duties, and the percentage of time worked in the program).
9. Will any of these services be provided by agency staff or consultant/subcontractors? If consultant/subcontractor, please provide information about the trainer’s experience with group training and the number of hours weekly that the consultant’s will spend on this program.
10. Describe the agency’s outreach efforts and communication efforts for the program.
11. Identify past year program goals and summarize performance outcomes. Provide a summary of select agency accomplishments.
12. Identify any changes, challenges, limitations, restrictions, and priorities on service delivery.
13. Please describe the agency’s strategy for addressing the challenges.
14. If this is a renewal contract, describe at a minimum how has your program developed and made progress toward its goals in the past year?
15. What barriers, if any, have impacted your agency’s ability to meet program goals?
16. Describe how your agency plans to evaluate the effectiveness of the program. Explain how your agency plans to collect data. In addition, please submit a copy of your agency’s Quality Assurance Monitoring Policies and Procedures.
17. How are services evaluated? What are the results? Identify strengths and weaknesses noted in evaluations.
18. If fees will be collected from recipients of any services outlined in the Contract Requirements, state the anticipated annual amount of revenue. Also state how those revenues will be used to offset the contract’s costs.
22
STATE OF NEW JERSEY
DIVISION OF FAMILY DEVELOPMENTCONTRACT
ADMINISTRATOR: CONTRACT NUMBER:
NAME OF AGENCY:
CONTRACT PERIOD:
INDEX OF REQUIRED CONTRACT DOCUMENTS
This index provides details of all required documents that must either be included with the contract package (see checklist) or must be available on site for inspections as noted in the Document Verification Sheet (DVS). Forms that are not included in the following pages, can be found by accessing the website at www.state.nj.us/humanservices/dfd/info and clicking on the link for Standard Contract Documents.
Document
Required with first Contract and as
Amended
Required Annually
and as Amended Checklist
Required for on-site Verification - DVS
Form
Check if submitted
with package
Contract DocumentsStandard Language Document (SLD) with original signatures (additional copies requested must also have original signature) ●
Annex A (including summary sheet and supporting schedules) ●
Annex B – Budget Form with all required forms, schedules, and signatures and required Budget Narrative. ●
Executive Order 129 (Public Law 2005, Chapter 92) Source Disclosure Certification Form ●
Federal Funding Accountability and Transparency Act (FFATA) Worksheet (if applicable) ●
Certification of Suspension and Debarment ●Disclosure of Investment Activities in Iran Form ●
1. AgreementsCopies of Subcontract/Consultant Agreement(s) ●Private/Public Donor Agreement (s) for Match Responsibilities ●
HIPAA Business Associate Agreement (BAA) ● ●
A copy of the Acknowledgement of Receipt of the New Jersey State Policy and Procedures for EEO/AA ●
2. Insurances/Licenses/CertificatesLiability Insurance Declaration Page and/or Malpractice Insurance ●
Bonding Certificate ●
Applicable Licenses (business and professional licenses) ●
Current Affirmative Action Certificate or copy of renewal application sent to Treasury (AA302 – Affirmative Action Employee Information Report)
●
Health/Fire Certificates, Certificate of Occupancy ●
Page 2 DocumentRequired with first
Required Annually
Required for on-site
Check if submitted
23
Rev. 201
Contract and as
amended
and as Amended Checklist
Verification – DVS
Form with package
.Lease or Mortgage for Property and Equipment ●
Certificate of Incorporation●
New Jersey Business Registration Certificate with the Division of Revenue (Public Law 2001, Chapter 134)
●
Documents Required for Non Profit Agencies and as applicable for Profit Agencies
S. Dated List of Names, Titles, Addresses, and Terms of Board of Freeholders or Directors
●
Copy of the most recently approved Board Minutes ●
Agency By-Laws ●
Tax Exempt Certification ● ●
Form 990 – Return of Organization Exempt From Income Tax ●Documents Required for Profit Agencies onlyU.S. Corporation Income Tax Return, Form 1120 ●
Chapter 51/Executive Order 117 Vendor Certification and Disclosure of Political Contributions (formerly known as Executive Order 134) and copy of NJ Business Registration Certificate (see separate link)
bi-annual
Ownership Disclosure Form (Chapter 51) bi-annual
Agency Policies and Organizational Information
Organizational Chart ●
Personnel Manual and Employee Handbook (including job descriptions of staff)
●
Affirmative Action Policy/Plan ●
Conflict of Interest Policy ●
Procurement Policy ●Equipment Inventory (contract acquires property with DFD funds) ●
AuditNotification of Licensed Public Accountant (NLPA) - include copy of Accountant’s Certification (see separate link) ●
Copy of Single Audit or Independent Audit for recent FY ●Other Supporting DocumentsAnnual Report to Secretary of State ●Annual Report – Charitable Organizations ●
24
Page 3 DocumentRequired with first contract
Required Annually
and as Amended
Required for on-site Verification – DVS
Form
Check if submitted
with package
ACH – Credit authorization for automatic deposits (for new requests only) ●
W-9 Form (for new Agencies only) ●
Additional Division/Office Specific Forms
Document Verification Sheet (DVS) ●
List of Agency Grants / Contracts ●
Standard Board Resolution (indicating authorized signatories for contracts)
●
Checklist and Copy of Award Letter ●
Other:
The agency agrees to submit, to the DFD Contract Administrator, any and all changes regarding the information presented in these documents during the term of the contract. All documents should be current and reflect the approval of the agency officials, when applicable.
The index is for reference and is not required to be retuned with the contract package. All documents noted here are either included in the Checklist or Document Verification Sheet (DVS). The checklist and DVS must be returned with the contract package.
25
DFD OFFICE OF CONTRACT ADMINISTRATIONCONTRACT CHECKLIST
CONTRACT ADMINISTRATOR:
CONTRACTNUMBER:
NAME OFAGENCY:
CONTRACTPERIOD:
PROVIDER INSTRUCTIONS: This checklist must be completed and returned with all documents prior to contract approval. The correct number of copies and any additional Division documents must be returned to your Contract Administrator. Forms that are not included in the following pages, can be found by accessing the website at www.state.nj.us/humanservices/dfd/info and clicking on the link to Standard Contract Documents.
DocumentNumber of copies to
be submitted
Please check if submitted with
package
If not submitted with package, indicate anticipated date of submission or reason
for non-submission
Complete copy of signed DHS Standard Language Document (SLD) 1
Checklist, DVS and Award Letter 1 Executive Order 129 Source Disclosure 1 Certification of Suspension or Debarment 1 Standardized Board Resolution indicating who is authorized to sign: Contracts and Checks 1
Annex A – Parts I and II (including summary sheets, supporting schedules and LOS).
1
Annex B –Budget Form (Expense Summary, Details and Schedules 1-6) and required Budget Narrative.
1
List of Grants / Contracts 1
Contract Acquired Equipment Inventory 1
Liability Insurance 1 Bonding Certificate 1
Names, Titles, Addresses and Terms of Board of Freeholders / Directors 1
Copy of Audit Report 1
Current Affirmative Action Certificate or copy of renewal application sent to Treasury (AA302)
1
Disclosure In Investment Activities in Form 1
Federal Funding Accountability and Transparency Act (FFATA) Worksheet (if applicable) 1
Copies of Subcontracts 1
26
Document Number of Copies to
be submitted
Notification of Licensed Public Accountant (NLPA) (include copy of Accountant’s Certification)
1
Private/Public Donor Agreement for Match Responsibilities 1
Organization Chart 1
Conflict of Interest Policy 1
1
Disclosure In Investment Activities in Form 1
As Applicable:
ACH – Credit authorization for automatic deposits (for new requests only) 1
W-9 Form (for new providers) 1
Other: 1
1
27
NEW JERSEY DEPARTMENT OF HUMAN SERVICESDIVISION OF FAMILY DEVELOPMENT
DOCUMENT VERIFICATION SHEET (DVS)
Contract Number Contract Period
The Provider Agency hereby certifies that the following documents are on file and are available to the Division of Family Development (DFD) for review. The contracting Provider Agency also agrees that it will inform the DFD contract administrator of any and all changes involving these documents that may occur during the term of the contract. All documents should be current and reflect board approval.
Please do not submit documents listed below with renewal package.
Please Check as Appropriate On FileNot
Applicable
1. Certificate of Incorporation and NJ Business Registration Certificate (filed with the Division of Revenue)
2. Annual Report to Secretary of State and Ownership Disclosure Form
3. Annual Report - Charitable Organization
4. Agency By-Laws and Copy of Board Meeting Minutes5. Business Associate Agreement (unless new provider or revised
agreement)
6. Business and Professional Licenses7. Personnel Manual and Employee Handbook (including current job
descriptions for staff)
8. Tax Exempt Certification, Copy of Form 990
9. U.S Corporation Income Tax Return, Form 1120
10. Procurement Policy11. Certificate of Occupancy or Continued Certificate of
Occupancy and Health and Fire Certificates12. Property Lease/Mortgage and Equipment Leases
13. Affirmative Action Policy and copy and acknowledgment of NJ State Police Policy on EEO/AA
I hereby certify that all documents are current and are available for review.
Agency Director (Please Print or Type) Agency Director’s Signature
Agency Date
28
EXECUTIVE ORDER 129 CERTIFICATION
SOURCE DISCLOSURE CERTIFICATION FORM
Bidder: Solicitation Number:
I hereby certify and say:
I have personal knowledge of the facts set forth herein and am authorized to make this Certification on behalf of the Bidder.
The Bidder submits this Certification as part of a bid proposal in response to the referenced solicitation issued by the Division of Purchase and Property, Department of the Treasury, State of New Jersey (the “Division”), in accordance with the requirements of Executive Order 129, issued by Governor James E. McGreevy on September 9, 2004 (hereinafter “E.O. No. 129”).
The following is a list of every location where services will be performed by the bidder and all subcontractors.Bidder or Subcontractor Description of Services Performance Location(s) by
Country
Any changes to the information set forth in this Certification during the term of any contract awarded under the referenced solicitation or extension thereof will be immediately reported by the Vendor to the Director, Division of Purchase and Property (the “Director”).
I understand that, after award of a contract to the Bidder, it is determined that the Bidder has shifted services declared above to be provided within the United States to sources outside the United States, prior to a written determination by the Director that extraordinary circumstances require the shift of services or that the failure to shift the services would result in economic hardship to the State of New Jersey, the Bidder shall be deemed in breach of contract, which contract will be subject to termination for cause pursuant to Section 3.5b.1 of the Standard Terms and Conditions.
I further understand that this Certification is submitted on behalf of the Bidder in order to induce the Division to accept a bid proposal, with knowledge that the Division is relying upon the truth of the statements contained herein.
I certify that, to the best of my knowledge and belief, the foregoing statements by me are true. I am aware that if any of the statements are willfully false, I am subject to punishment.
29
30
Bidder: Name of Organization or Entity
By: Title: Print Name: Date:
New Jersey Department of Human ServicesDivision of Family Development
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary ExclusionLower Tier Covered Transactions
1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by an Federal or State department or agency.
2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.
Name and Title of Agency Official __________________________________
Signature _________________________
Date _____________________________
This certification is required by the regulations implementing Executive order 12549, Debarment and Suspension, 29 CFR Part 98, Section 98.510
31
STATE OF NEW JERSEYDIVISION OF FAMILY DEVELOPMENT
STANDARDIZED BOARD RESOLUTION FORM – page 1 of 2
Supporting Information for Contract #:
Contract Period: to
Agency:
Certification:
We certify that the information contained in, or attached to, this contract document is accurate and complete.
__________________________________ ________________________Chair, Board of Directors Date
(Original signature)
__________________________________ ________________________Executive Director Date (Original signature)
Please List Authorized Signatories for contract documents, checks, and invoices:(List full name and title)
Name Title
Name Title
Name Title
32
STANDARDIZED BOARD RESOLUTION FORM – page 2 of 2
The Board endorses the following commitments as defined in this document:
1. Health Insurance Portability and Accountability Act (HIPAA)*
Specific to HIPAA (Health Insurance Portability and Accountability Act), the above noted Provider Agency is deemed a covered entity and must submit the required Business Associate Agreement.
Once executed, the BAA will be included in the Department’s official contract file. The BAA will be considered applicable for this contract. Any changes in the Provider Agency’s status, information or the content of the BAA, is the responsibility of the contracted Provider Agency to revise the BAA.
The Board agrees to notify the Department of any change in its BAA Status and provide the appropriate information within 10 business days.
2. Legal Advice
The Board acknowledges that the Division of Family Development does not and will not provide legal advice regarding the contract or any facet of its relationship with the Provider Agency. The Board further acknowledges that any and all legal advice must be sought from the Provider Agency's own attorneys and not from the Division of Family Development.
3. Public Law 2005, Chapter 51
The Board agrees that the Public Law 2005, Chapter 51 (formerly known as Executive Order 134) compliance forms submitted with the contract is accurate.
4. Public Law 2005, Chapter 92
The Board agrees that the Public Law 2005, Chapter 92 (formerly known as Executive Order #129) compliance forms submitted with the contract are accurate.
33
STATE OF NEW JERSEYDIVISION OF FAMILY DEVELOPMENT
List of Contracts/Grants
Check here if this information already appears on the Annex B, Schedule 2 - Contract Information Form. If so, then it is not necessary to duplicate the information here.
Contracting Division/Offic
eProgra
m Name
Type of
Service
Contract
NumberContract Term
Amount
Division/Office
Contact Person and
Phone Number
Provider Agency Contact Person
and Phone Number
34
CONTRACT FORMS
Available at the DFD website:
AA 302
Federal Financial Accountability Transparency Act (FFATA) Worksheet
Notification of Licensed Public Accountant
Disclosure of Investment Activities in Iran
35
