RES 2008-1190 - Grant award for greater Omaha healthy communities/healthy youth coalition f ,
g -
DMAHA,n,F �" W .—' R T .4i--
" " Office of the Mayor
• z i n• I 1819 fake Street,Suite or
o ' tea; Omaha,Nebraska 68183 0300
.154 v
O' D FEBR��y �• t '; ;�'- FAX ( )444-5000
;_:.:'. (402)444-6059
City of Omaha 'Ni H A, r`e _..',.
Mike Fahey,Mayor
Honorable President
and Members of the City Council,
Attached is a Resolution authorizing the Cityto acceptarant award in the amount of of Omahag
$60,634.00, from the Nebraska Department of Health and Human Services, Region 6 Behavioral
Health Care for the Greater Omaha Healthy Communities/Healthy Youth Coalition. The project
period for this grant is July 1, 2008 to June 1, 2009. There is no match requirement for this grant.
The Greater Omaha Healthy Communities/Healthy Youth Coalition will provide speakers and
other resources to promote positive, responsible behavior for all the youth in the Greater Omaha
area, while protecting them from the harmful effects of alcohol, tobacco and other drug usage.
Your favorable consideration and adoption of this Resolution is respectfully requested.
Respectfully submitted, Approved:
____k 1_.„__.Ca)0 of. 7 1.0 6 bt
Mike Fahey, Mayor Date Gail Kinsey-Thomps n Date
Human Rights and Relations Director
Approved as to Funding:
Carol A. Ebdon Date
Finance Director
P:\MAY\1018k1c
am, in the amount of $125,000.00, the
program will help identify and prevent delinquent behaviors, intervention to gang activities and
youth violence, promote positive relationships between students and law enforcement, and
develop positive concepts of social obligations and responsibilities, the project and budget period
is from June 1, 2008 to November 30, 2008, the total project cost is $150,553.00; this includes a
match of$25,553.00 from the Omaha Police Department general funds.
APPROVED AS TO FORM:
2 -C- 14-o
D:P Y CITY ATTORNEY DATE
By 40410,0 qCember
P:�MAY\1017klc
Adopted Ep - 9 2008 9-6'
City Cler����
Approvedh ... �
Mayor
G.R.E.A.T.FUNDS FOR 2006,PLEASE MARK N/A.
FUNDS SPENT TO DATE FOR LAST AWARD PERIOD$ 22,152 AS OF 11-30-2007 (DATE)
DID NOT RECEIVE 2006 G.R.E.A.T.FUNDING BUT RECEIVED FUNDING IN_N/A_(YEAR)AMOUNT RECEIVED$ N/A
he purpose of
student registration and program information.
• 3.ROUTINE USES: Disclosure upon request to the individual,to the individual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
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Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
4 f �f.
,. Behavioral Healthcare
• y {
Cass • Dodge • Douglas • Sarpy • Washington
Kraig Lofquist,Interim Chair
Greater Omaha Healthy Communities/Healthy Youth Coalition
5606 South 147th Street
Omaha,NE 68137
Re:Block Grant Award Notification
Dear Mr.Lofquist:
On Wednesday,May 21,2009 the Region 6 Regional Governing Board announced the FY09 Prevention Substance Abuse
• Block Grant Awards.The Greater Omaha Healthy Communities/Healthy Youth Coalition is a conditional recipient of
$60,634 for FY09 fiscal year.The submitted award request has been modified and only the following requests will be
funded.
•
• Reduction of grant achieved through the elimination of multi-year funding request;the coalition initially
requested funding for two years.Multi-year contracts are awarded based upon performance.
• ADDED-$3,802 Evaluation Services
The Regional Governing Board has ordered the following contingencies be added to the coalition's award notification:
1. The coalition shall complete a BH-5 worksheet outlining their goals,activities,and outcomes.
2. The coalition needs to create and demonstrate a more developed evaluation plan for their proposed work plan.
3. The coalition shall provide at least one outcome incorporated into the work plan,to address inclusion of cultural
competency into goals,strategies and activities. Documentation of this change shall be provided in a BH-5 '
worksheet. The progress for this outcome should be tracked by the coalition through quarterly reporting,Quality
Improvement Documents,and the MDS/NPIRS system.
4. The coalition shall provide data and evaluation in regard to the National Outcome Measures.The current proposal
does not address the project proposal impact in relation to National Outcome Measures.
Congratulations on your award.Please note,I am making a modification to the RFP based on rising fuel costs.For FY09,
the contracted rate for mileage will rise to.505 per mile.This amendment does not raise the total amount allocated for
travel through this grant;it merely amends the reimbursed rate.We look forward to working with you during the coming
year.
Sincerely,
Jeffrey W.Helaney,
Manager of Prevention System Services
Region 6 Behavioral Health Care
3801 I-Iarney Street • Omaha,NE 68131-3811 • Phone:402-444-6573 • FAX: 402-444-7722 • 1-800-311-8717 • www.regionsix.com
DID NOT RECEIVE 2006 G.R.E.A.T.FUNDING BUT RECEIVED FUNDING IN_N/A_(YEAR)AMOUNT RECEIVED$ N/A
he purpose of
student registration and program information.
• 3.ROUTINE USES: Disclosure upon request to the individual,to the individual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
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Page 3 of 4
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Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
Region 6 Behavioral Healthcare - Greater Omaha Healthy Community/Healthy Youth
GRANT#06-JA-601
FUND XXXXX, ORGANIZATION XXXXXX
AWARD XXX, PROJECT XXXX
GRANT PERIOD July 1, 2008-June 1, 2009
• EXPENDITURE DETAIL FOR PERIOD ENDING
FEDERAL MATCH FEDERAL MATCH FEDERAL MATCH
BUDGET BUDGET EXPENDED EXPENDED ENCUMBERED REMAINING REMAINING
PERSONAL SERVICES •
01.01 Community Liason $ 20,000.00 $ 20,000.00 $ -
01.02 HC/HY Speakers $ 5,000.00 $ 5,000.00
01.03 Keynote Speaker $ 6,000.00 $ 6,000.00
$ 31,000.00 . - - - - $ 31,000.00 -
OPERATIONS
02.01 Office Supplies $ 365.00 $ 365.00
02.02 Evaluation Supplies $ 250.00 $ 250.00
02.03 Postage $ 6,335.00 $ 6,335.00
02.04 Books and Subscriptions $ 6,075.00 $ 6,075.00
02.05 Conference Venue $ 1,000.00 $ 1,000.00
02.06 Conference Sustanance $ 2,750.00 $ 2,750.00
02.07 Printing and Advertising $ 1,875.00 $ 1,875.00 -
$ 18,650.00 - - - - $ 18,650.00 -
TRAVEL
03.01 Board and Lodging $ 600.00 $ 600.00
03.02 Meals $ 450.00 $ 450.00
03.03 Commercial Transportation $ 3,000.00 - $ 3,000.00 -
03.04 Mileage $ 632.00 - $ 632.00 -
$ 4,682.00 - - - - $ 4,682.00 -
OTHER EXPENSES
04.01 Evaluation Services $ 3,802.00 - $ 3,802.00 -
04.02 Grant Administration $ 2,500.00 $ 2,500.00
•
$ 6,302.00 $ 6,302.00
TOTALS $ 60,634.00 $ 60,634.00
GENERAL LEDGER TOTAL
REPORTED TOTAL
DIFFERENCE -
t allocated for
travel through this grant;it merely amends the reimbursed rate.We look forward to working with you during the coming
year.
Sincerely,
Jeffrey W.Helaney,
Manager of Prevention System Services
Region 6 Behavioral Health Care
3801 I-Iarney Street • Omaha,NE 68131-3811 • Phone:402-444-6573 • FAX: 402-444-7722 • 1-800-311-8717 • www.regionsix.com
DID NOT RECEIVE 2006 G.R.E.A.T.FUNDING BUT RECEIVED FUNDING IN_N/A_(YEAR)AMOUNT RECEIVED$ N/A
he purpose of
student registration and program information.
• 3.ROUTINE USES: Disclosure upon request to the individual,to the individual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
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•
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Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
Request for Proposal
FY09 Prevention Block
COVER SHEET
Coalition Name: Greater Omaha Healthy Community/Healthy Youth
Mailing Address: 16910 Holmes Circle, Omaha, NE 68135
Name of Contact Person: Kraig J. Lofquist
Mailing Address: 16910 Holmes Circle, Omaha, NE 68135
E-mail Address: klofquist(a�yahoo.com
Telephone: (402) 932-1074
Name of Fiscal Agent: City of Omaha, Office of the Mayor .
Mailing Address: 1819 Farnam Street, Ste 300, Omaha, NE 68183
E-mail Address: gbraun(c�ci.omaha.ne.us
Telephone: (402) 444-5286
Type of Fiscal Agency: Public: X Private, Non-Profit:
Federal Identification Number (FIN): 47-6006304
Fiscal Agent Representative Signature: ati-- ,
Name (typed): Allen Herink
Title: City Comptroller
Date: April 30, 2008
Coalition Representative Signature: V %,,,--, "
Name (typed): Kraig . Lofquist
Title: Interim Board Chairperson
Date: April 30, 2008
1
02.05 Conference Venue $ 1,000.00 $ 1,000.00
02.06 Conference Sustanance $ 2,750.00 $ 2,750.00
02.07 Printing and Advertising $ 1,875.00 $ 1,875.00 -
$ 18,650.00 - - - - $ 18,650.00 -
TRAVEL
03.01 Board and Lodging $ 600.00 $ 600.00
03.02 Meals $ 450.00 $ 450.00
03.03 Commercial Transportation $ 3,000.00 - $ 3,000.00 -
03.04 Mileage $ 632.00 - $ 632.00 -
$ 4,682.00 - - - - $ 4,682.00 -
OTHER EXPENSES
04.01 Evaluation Services $ 3,802.00 - $ 3,802.00 -
04.02 Grant Administration $ 2,500.00 $ 2,500.00
•
$ 6,302.00 $ 6,302.00
TOTALS $ 60,634.00 $ 60,634.00
GENERAL LEDGER TOTAL
REPORTED TOTAL
DIFFERENCE -
t allocated for
travel through this grant;it merely amends the reimbursed rate.We look forward to working with you during the coming
year.
Sincerely,
Jeffrey W.Helaney,
Manager of Prevention System Services
Region 6 Behavioral Health Care
3801 I-Iarney Street • Omaha,NE 68131-3811 • Phone:402-444-6573 • FAX: 402-444-7722 • 1-800-311-8717 • www.regionsix.com
DID NOT RECEIVE 2006 G.R.E.A.T.FUNDING BUT RECEIVED FUNDING IN_N/A_(YEAR)AMOUNT RECEIVED$ N/A
he purpose of
student registration and program information.
• 3.ROUTINE USES: Disclosure upon request to the individual,to the individual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
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•
2." liT -5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
• Executive Summary
The Greater Omaha Healthy Community/Healthy Youth Coalition is comprised of
several different community sectors which include: community schools, juvenile
justice agencies, youth serving agencies, faith based community, health and
mental health providers, law enforcement, as well as the mayor's office. Our
vision is to create a community that is invested in providing a nurturing
environment that empowers all youth to thrive.
Our overall mission regarding the grant you are making available is to promote
positive, responsible behavior within all of the youth in the greater Omaha area,
while simultaneously protecting them from the harmful elements that are
seemingly everywhere in our culture such as alcohol, tobacco and other drug
usage.
We propose to address this goal by implementing the "40 Developmental Asset"
framework developed by the Search Institute. This research based framework
overwhelmingly shows that young people with more Developmental Assets are
more likely to thrive on a variety of indicators and successfully avoid negative
social influences.
We propose to utilize grant dollars from the Behavioral Health Prevention Block
Grant by:
• Engaging adults from all walks of life in the greater Omaha area. We see
the shared "Developmental Asset" language as an extremely powerful
piece of our project. We want to "saturate" our community with strength
based language to positively describe, as well as build our youth. We
believe that if we are all using the same research backed asset language
we will increase the capacity of our community to build assets in our
young people.
• Mobilizing young people to use their power as "asset builders". This
means listening to their input and including them in decision making.
• Continuing to build upon the "sectors" that have already been
activated within the community such as schools, congregations,
businesses, youth, human service, and healthcare organizations to create
an asset-building culture and to contribute fully to young people's healthy
development.
• Invigorating current programs to become more "asset rich" and
"intentional" in their efforts to assist young people.
• Influencing civic decisions by working with policy makers, community
leaders, media, and other organizations in support of a positive
transformation for the greater Omaha area.
2
T.FUNDING BUT RECEIVED FUNDING IN_N/A_(YEAR)AMOUNT RECEIVED$ N/A
he purpose of
student registration and program information.
• 3.ROUTINE USES: Disclosure upon request to the individual,to the individual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
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Applicant s,�Narne " n__. ......
•
2." liT -5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
We will do this by:
1. Providing "training of trainers" for Healthy Community/Healthy Youth
Coalition.
2. Conference for 500 people (each year, 2 years equals 1,000 people).
3. Provide other trainings by our Healthy Community/Healthy Youth
"speaker's bureau".
4. Creating a library of resources which can be accessed by anyone who
attends the conference or training session.
5. Developing a quarterly newsletter for Healthy Community/Healthy Youth
members which will provide information and tips for implementing the
Developmental Assets.
6. Providing an "action planning" process for all participants.
.7. Working directly with a "community liaison" to promote a conference to be
held on an annual basis. This community liaison will also disseminate the
research based message regarding the importance of Developmental
Assets and follow up with conference attendees.
•
•
•
ssets are
more likely to thrive on a variety of indicators and successfully avoid negative
social influences.
We propose to utilize grant dollars from the Behavioral Health Prevention Block
Grant by:
• Engaging adults from all walks of life in the greater Omaha area. We see
the shared "Developmental Asset" language as an extremely powerful
piece of our project. We want to "saturate" our community with strength
based language to positively describe, as well as build our youth. We
believe that if we are all using the same research backed asset language
we will increase the capacity of our community to build assets in our
young people.
• Mobilizing young people to use their power as "asset builders". This
means listening to their input and including them in decision making.
• Continuing to build upon the "sectors" that have already been
activated within the community such as schools, congregations,
businesses, youth, human service, and healthcare organizations to create
an asset-building culture and to contribute fully to young people's healthy
development.
• Invigorating current programs to become more "asset rich" and
"intentional" in their efforts to assist young people.
• Influencing civic decisions by working with policy makers, community
leaders, media, and other organizations in support of a positive
transformation for the greater Omaha area.
2
T.FUNDING BUT RECEIVED FUNDING IN_N/A_(YEAR)AMOUNT RECEIVED$ N/A
he purpose of
student registration and program information.
• 3.ROUTINE USES: Disclosure upon request to the individual,to the individual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
*t*t rt gi mar,.,: --` . ; .a ae ,.- r .�� ,a...:' 4,&. 't'
Applicant s,�Narne " n__. ......
•
2." liT -5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
Capacity Development Plan •
A. Program Narrative
1. Organizational Capability
The Greater Omaha Healthy Community/Healthy Youth Coalition was
created to enhance research based "asset building" opportunities for all
youth. In late 2004 and early 2005 we intentionally organized dedicated
individuals from several community sectors to positively change the
culture for the benefit of our youth. We have members from several
counties including Douglas, Washington and Sarpy and our group
continues to grow.
The headquarters of our organization is currently at 16910 Holmes Circle,
Omaha, NE. This location is within the Douglas County boundaries. With
our plan, we will serve individuals and organizations in Cass, Douglas,
Dodge, Sarpy and Washington Counties.
The Greater Omaha Healthy Community/Healthy Youth Coalition is
capable of providing training regarding "Developmental Assets" to each
agency. Over the past few years, we have actively sought out, built
relationships and worked with diverse community groups to promote the
research based Developmental Asset framework. Through this work we
have identified and are working on common goals. We have shared how.
this research relates to other organizations, their mission and goals, and
more importantly, how it relates to the youth they serve. Sharing this
information has also increased our membership. Our capabilities continue
to grow because of our diverse membership from numerous community
sectors.
The Greater Omaha Healthy Community/Healthy Youth Coalition is
es an equal
ed of a diverse membershippopulation. q
comprised This includes
P
male and female representation as well as several members from different
ethnic backgrounds, not to mention diverse community groups. This
membership is dedicated to promoting our work with each gender,
different cultures and ethnic groups. It is also worth noting that the
research our organization uses is not gender or ethnic biased. Rather, it
focuses on assisting all youth.
Our plans will be operational prior to July 1, 2008. We have already been
in contact with relevant parties who have agreed to promote the
Developmental Asset Framework. Additionally, we have reserved a
sizeable venue for a salient part of our plan. If our plan is selected, minor
detailed information such as purchasing and printing materials, brochures
etc, will need to be addressed. However, this will not require a significant
amount of time.
4
t to the individual,to the individual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
*t*t rt gi mar,.,: --` . ; .a ae ,.- r .�� ,a...:' 4,&. 't'
Applicant s,�Narne " n__. ......
•
2." liT -5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
2. Purpose
The purpose of our coalition is to create a community that is invested in
providing a nurturing environment that empowers all youth to thrive by
promoting positive, responsible behavior within all of the youth in the
greater Omaha area, while simultaneously protecting them from the
harmful elements that are seemingly everywhere in our culture such as
alcohol, tobacco and other drug usage.
Our results will include a greater understanding of the research. based
Developmental Assets by individuals and organizations that receive the
information. Therefore, there will be a significant increase in the
understanding of a "common language" and youth will receive a consistent
message no matter what sector they attend within the Greater Omaha
Area (ie: medical, faith based, community school, extra-curricular etc.).
Finally, young people will increase the number of Developmental Assets
they have, which will protect them from the harmful elements of our culture
while simultaneously promoting positive, healthy behaviors.
3. Need
Although the Greater Omaha Healthy Community/Healthy Youth Coalition
did not apply for the FY 08 Mini Block Prevention Grant, it is very likely
that the work completed will complement the positive product of the
aforementioned grant.
4. Target Population and Geographic Area
Community members from a variety of"sectors" will learn how to
implement the research and ideas we will share. This, in turn, will benefit
all youth that will interact with each agency or sector. The specific
populations to be served will be a variety of community members,
including youth and adults from the following sectors: community schools,
juvenile justice agencies, youth serving agencies, faith based community,
health and mental health providers, law enforcement, as well as the
mayor's office.
All youth and adults from the aforementioned sectors will benefit from our
proposal. Our proposal is not limited to age, race, gender or ethnicity. All
will be invited to work with us to promote the positive, researched based
Developmental Assets message. Youth who attend any of these sectors
will also benefit by understanding the power of the information and best
practices that will be shared.
5
izeable venue for a salient part of our plan. If our plan is selected, minor
detailed information such as purchasing and printing materials, brochures
etc, will need to be addressed. However, this will not require a significant
amount of time.
4
t to the individual,to the individual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
*t*t rt gi mar,.,: --` . ; .a ae ,.- r .�� ,a...:' 4,&. 't'
Applicant s,�Narne " n__. ......
•
2." liT -5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
•
We will collect data regarding young people from a variety of sources.
First, we will collect relevant research about young people from the
Search Institute which is located in Minneapolis, MN. Also, we will obtain
information from the Nebraska Department of Education, the Office of the
Mayor, as well as Region Six Behavioral Health. Data will be used to
inform us of relevant demographics and specific numbers related to the
issues we wish to address. These issues will be directly impacted by the
use of a strategic prevention framework (Developmental Assets) while
preventing the use of alcohol, tobacco and other drugs. The data will also
be used to change social norms through strategies we will share based on
the data.
We will also collect data pertaining to adults from different sources,
including, but not limited to the Omaha Chamber of Commerce, the
Omaha Community Partnership and the University of Nebraska at Omaha.
The frequency of our service will be recurring. Specifically, we will have a
large, annual conference and we will also have follow up training sessions
in each of the community sectors that are represented.
The interventions we are proposing are "universal", "selective" as well as
"direct". The annual conference will have a general session that shares
"universal" interventions.and information relating to the research. Breakout
sessions will follow with "selective" interventions being discussed for
specific sectors. "Direct" interventions will be discussed in follow-up
training sessions to address the unique needs that may arise that were not
addressed at the annual conference.
Costs per person to attend the conference will include materials, supplies,
sustenance and expenditures for keynote speaker such as travel, meals,
board and lodging. This cost comes to approximately $15.00 per
conference attendee.
Other costs will include brochures, postage, resource library materials and
additional training sessions. Due to the size of certain organizations, such
as health care institutions, church congregations, businesses etc. it is
difficult to give a per person cost of the additional services that we will
share.
5. General Overview
The Greater Omaha Healthy Community/Healthy Youth will work directly
with a "community liaison" to promote a conference to be held on an
annual basis which will disseminate the research based message
regarding the importance of Developmental Assets. The conference will
start with a general session and a keynote speaker will address how
6
idual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
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Page 3 of 4
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•
2." liT -5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
Developmental Assets "protect" young people, while "promoting positive,
healthy behaviors". Individualized break out sessions will follow which will
enable different community sectors to learn how to implement this
strategic framework into the direct work they do with youth.
Each attendee or group of attendees will complete a specific action plan
which will outline how they will build Developmental Assets in the next six
months. The "community liaison" will follow up with each agency regarding
the specifics of their action plans to provide support. The resource library
will ensure the action plans are implemented to the greatest extent
possible. V
A post conference assessment will be completed by each participant when
the general session reconvenes at the end of the day. This assessment
will include both adults and youth. After the assessment, follow up training
will be promoted. An additional assessment will be sent out by the
"community liaison" six months after the conference to evaluate progress
• on action plans.
The "community liaison" will set follow-up training sessions with each
business, school or community agency that attended the conference. The
"liaison" will also promote the Developmental Assets framework to those
individuals, groups, businesses or agencies from the five county area
(Cass, Douglas, Dodge, Sarpy and Washington Counties) who were
unable to attend the conference. Quarterly newsletters will be sent out to
all conference attendees which will include research, success stories,
resources and other information pertaining to the Healthy
Community/Healthy Youth Coalition.
6. Goals
• We will implement a strategic prevention framework
(Developmental Assets) that will prevent, or significantly reduce the
use of alcohol, tobacco and other drugs, while simultaneously
promoting positive behaviors within all youth.
• We will change social norms through strategies that will be shared
which focus on the researched based Developmental Assets.
Short term benefit-All participants will have a "common language"and
"purpose" (both goals).
Long term benefit-All participants will positively affect youth by
implementing researched based strategies they have learned, and will
continue to learn by their involvement (both goals).
7
annual basis which will disseminate the research based message
regarding the importance of Developmental Assets. The conference will
start with a general session and a keynote speaker will address how
6
idual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
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•
2." liT -5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
Process Indicators:
The service will include an Annual Conference where an initial total of 500
people (1,000 people over 2 years) will benefit from learning about the
research based ideas on how to help young people thrive. A "community
liaison" will help promote the annual conference. A nationally recognized
expert will be the keynote speaker at each of the conferences. This
speaker will be complemented by personnel from the Search Institute
where the Developmental Assets originated. Breakout sessions will
include presentations from a variety of sectors. Kraig Lofquist and Scott
Butler will be two of the five speakers for the breakout sessions.
The conference breakout sessions will give detailed, researched based
ideas to each member of the conference. The information that is shared
will be individualized to each person and/or agency. The participants who
will benefit will be from community schools, juvenile justice agencies,
youth serving agencies, faith based community, health and mental health
providers, law enforcement and civic organizations such as the mayor's
office.
The results of the evaluations from the conferences "general session" as
well as the"breakout sessions" will be tabulated by the Community
Liaison. Action plans will also be logged and follow up will take place six -
months later via a survey.
Any agency that did attend the conference and requests follow-up.
information about the Developmental Assets will be provided with the
training. A member of the Greater Omaha Healthy Community/Healthy
Youth Speaker's Bureau will provide the training. These training sessions
will take place once per month.
Additionally, training sessions will be conducted for any agency that was
not able to attend the conference. The training will be given by a member
of the Healthy Community/Healthy Youth Speaker's Bureau. These
training sessions will take place once per month.
The resource library will be developed using a variety of information
including books, periodicals, research articles, internet sites, etc. This will
be developed and maintained by the "community liaison" and will be
promoted in the quarterly newsletter.
The Greater Omaha Healthy Community/Healthy Youth quarterly
newsletter will be sent to all identified agencies within the five county area.
8
annual basis which will disseminate the research based message
regarding the importance of Developmental Assets. The conference will
start with a general session and a keynote speaker will address how
6
idual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
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•
2." liT -5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
•
Outcome Indicators:
Community and organizational changes will include the use of a "common
language" based on the Developmental Asset framework. This "common
language" promotes "Social Connectedness" and is "Evidence Based" as
identified by the National Outcome Measures (NOMs). The culture in the
Greater Omaha area will change in a positive way due to the consistency of
the language and the ubiquitous nature of the Developmental Asset
framework. While the framework is individualized or agency specific, a
cultural shift will place the importance on building positive, resilient young
people within all community sectors.
Program effectiveness will be accounted for through follow up surveys. These
surveys will be gathered after the conference and focus on the general and
breakout sessions. Also, specific "action plans" that are developed by each
individual or agency at the conference will be evaluated to determine the
growth that has been identified using the Developmental Asset framework.
7. Assessment Process
The Annual Conference
All participants will fill out an evaluation tool regarding the annual conference.
Additionally, each "individualized" breakout session will have an evaluation to
be completed at the end of the session. Action plans will be developed by
each participant (agency).
A six month follow-up evaluation instrument will be used to determine the
effectiveness of the action plans that were written on the day of the
conference.
Participants who are of school age will be given the Developmental Asset
Profile to determine the level of"assets" they have. This information can be
used as baseline data. A post assessment using the Developmental Asset
Profile will be given toward the end of the school year to determine the
amount of growth a student achieved.
Finally, a survey will be sent to determine the effectiveness of the "resource
library" and the "quarterly newsletters".
8. Specific Services
We will provide an annual conference to community sectors within the five
county area (Cass, Dodge, Douglas, Sarpy and Washington). These sectors
will include community schools, juvenile justice agencies, youth serving
9
ified agencies within the five county area.
8
annual basis which will disseminate the research based message
regarding the importance of Developmental Assets. The conference will
start with a general session and a keynote speaker will address how
6
idual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
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•
2." liT -5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
agencies, the faith based community, health and mental health providers, law
enforcement, as well as civic offices such as the mayor. The conference will
be promoted by a "Community Liaison". During the annual conference,
research will be shared with each agency regarding the power of the
Developmental Assets. Each agency will be able to attend breakout sessions
that will give numerous ideas on how to positively affect the youth in their
communities using the Developmental Asset framework. Specific strategies
will focus on the areas of"Support", "Empowerment", "Boundaries &
Expectations", "Constructive Use of Time", "Commitment to Learning",
"Positive Identity", "Positive Values" and "Social Competencies".
Follow up trainings will be provided to each agency upon request to develop
specific strategies to overcome obstacles that may surface during initial
implementation. Additional trainings will be provided upon request by our
Healthy Community/Healthy Youth Speaker's Bureau.
We will create a library of resources which can be accessed by anyone who
attends the conference or training session. The library will consist of books,
periodicals, posters and "work kits" that are designed to promote
Developmental Assets to diverse groups.
Our Quarterly newsletter for Healthy Community/Healthy Youth members will
provide information and tips for implementing the Developmental Assets.
9. Community Prevention Involvement
The Greater Omaha Healthy Community/Healthy Youth Coalition has
members from community schools, juvenile justice agencies, youth serving
agencies, faith based community, health and mental health providers, law
enforcement, as well as the mayor's office. This group currently meets every
six weeks, but will meet more frequently due to the grant. Each member will
be actively involved in promoting the annual conference and follow up
trainings. Several of these members will help comprise the Greater Omaha
Healthy Community/Healthy Youth Speaker's Bureau that will do follow up
trainings and presentations.
10. Service Staffing
Our proposal includes a "community liaison" who will hold at minimum a
Bachelor's Degree, preferably in the Human Services (or related) field. This
person will have a significant understanding of the Developmental Asset
framework and how to implement it in a variety of community sectors. This
implementation will include "direct" and "indirect" services.
10
start with a general session and a keynote speaker will address how
6
idual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
*t*t rt gi mar,.,: --` . ; .a ae ,.- r .�� ,a...:' 4,&. 't'
Applicant s,�Narne " n__. ......
•
2." liT -5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
The.Greater Omaha HealthyCommunity/Healthy Youth Speaker's Bureau
Y Y p
will consist of four (4) people who will also be trained to provide "direct"
services regarding the promotion of the Developmental Asset framework.
The "community liaison" and the people that constitute the "speaker's bureau"
will be supervised by the Greater Omaha Healthy Community/Healthy Youth
Coalition Interim Board Chairperson and/or the Greater Omaha Healthy
Community/Healthy Youth Board of Directors if a "speaker" is a member of
the board. The Grant Administrator from the Mayor of Omaha will also assist
in a supervisory capacity.
11. Quality Assurance
All annual conference participants will fill out an evaluation tool. Additionally,
each "individualized" breakout session will have an evaluation to be
completed at the end of the session. These "quality indicators" will enable us
to understand the level of our success as related to our objectives. Also,
action plans will be developed by each participant (agency) at the end of the
conference. This indicator will be very descriptive which will include goals and
objectives. The indicator will enable us to follow up with each individual or
agency with accuracy and develop quality assistance plans in the event they
are necessary.
Results of the conference evaluation forms will be tabulated and shared with
the Greater Omaha Healthy Community/Healthy Youth Coalition Board of
Directors. These results and indicators will be used to help the coalition
understand the strengths and weaknesses of the conference.and its breakout
sessions. The results will assist in planning for the next annual conference,
and will also help to develop stronger follow up training plans.
The detailed six month follow-up evaluation instrument will be used to
determine the effectiveness of the action plans that were written on the day of
the conference.
Participants who are of school age will be given the Developmental Asset
Profile to determine the level of"assets" they have in the following categories:
"Support", "Empowerment", "Boundaries & Expectations", "Constructive Use
of Time", "Commitment to Learning", "Positive Identity", "Positive Values" and
"Social Competencies". This information can be used as baseline data. A
post assessment using the Developmental Asset Profile will be given toward
the end of the school year to determine the amount of growth a student
achieved. This quality indicator will also enable us to understand the quality
of the service that is being provided to each student.
11
6
idual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
*t*t rt gi mar,.,: --` . ; .a ae ,.- r .�� ,a...:' 4,&. 't'
Applicant s,�Narne " n__. ......
•
2." liT -5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
Finally, a survey will be sent to determine the effectiveness of the "resource
library" and the "quarterly newsletters". This "anonymous" quality indicator will
give us feedback on how to better serve constituents in the five county area.
•
12
Service Provided Computation Cost
N/A
Sub-Total $0.00
Consultant Expenses
Item Location Computation Cost
N/A
Sub-Total $0.00
Contracts
Item Cost
N/A
Sub-Total $0.00
TOTAL CONSULTANTS/CONTRACTS $0.00
•
City of Omaha-Omaha Police Department FY2008 GREAT Program
Level 1-Middle School and Summer School Components
12/13//2007 • Budget Detail Worksheets Page 5 of 7
Z
Michael L.Alston
Director
cc: Grant Manager
Financial Analyst
& It:?/u/a1Approve
BH - 20a
PROGRAM REVENUE SUMMARY
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency:Greater Omaha Healthy
Community/Healthy Youth Coalition
Division of Health and Well-Being Region:6
Office of Mental Health and Substance Abuse Date Submitted: April 30,2008
Revenues for the Time Period From: To:
Check one for this document: X Plan of Expenditures Development Capacity Actuals
Categories\Programs (1)Service: (2)Service: (3)Service: (4)Service Total
REVENUES
(A)1ST/3RD PARTY
Client Fees
Private Insurance
Medicaid
Medicare
Title XX
Other:
****SUBTOTAL****
(B)FEDERAL FUNDS
MH Block Grant
SA Block Grant
Indian Health Service
Other Federal:
•
****SUBTOTAL****
(C)STATE FUNDS
MH-general 113,663 113,663
SA-general
HHS/Social Service
Other State:
****SUBTOTAL****
(D) LOCAL TAX FUNDS
Mental Health Tax
Substance Abuse Tax
****SUBTOTAL****
(E)OTHER FUNDS
Donations
Foundations
Contracts for Services
Interest
Other
****SUBTOTAL****
(F) TOTAL REVENUE 113,663 113,663
Rev 4\97
1'3
velop quality assistance plans in the event they
are necessary.
Results of the conference evaluation forms will be tabulated and shared with
the Greater Omaha Healthy Community/Healthy Youth Coalition Board of
Directors. These results and indicators will be used to help the coalition
understand the strengths and weaknesses of the conference.and its breakout
sessions. The results will assist in planning for the next annual conference,
and will also help to develop stronger follow up training plans.
The detailed six month follow-up evaluation instrument will be used to
determine the effectiveness of the action plans that were written on the day of
the conference.
Participants who are of school age will be given the Developmental Asset
Profile to determine the level of"assets" they have in the following categories:
"Support", "Empowerment", "Boundaries & Expectations", "Constructive Use
of Time", "Commitment to Learning", "Positive Identity", "Positive Values" and
"Social Competencies". This information can be used as baseline data. A
post assessment using the Developmental Asset Profile will be given toward
the end of the school year to determine the amount of growth a student
achieved. This quality indicator will also enable us to understand the quality
of the service that is being provided to each student.
11
6
idual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
*t*t rt gi mar,.,: --` . ; .a ae ,.- r .�� ,a...:' 4,&. 't'
Applicant s,�Narne " n__. ......
•
2." liT -5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
1
BH - 20b
Program Expense Summary
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency:Greater Omaha Healthy
Community/Healthy Youth Coalition
•
Division of Health and Well-Being Region: 6
Office of Mental Health and Substance Abuse Date Submitted: April 30, 2008
Expenses for the Time Period From: July 1, 2008 To:June 1, 2010
Check one for this document: X Plan of Expenditures Development Capacity _Actuals
Categories\Programs (1)Service: (2)Service: (3) Service: (4)Service Total
EXPENDITURES
Personal Services 67,000 67,000
Operating 37,300 37,300
Travel 9,363 9,363
Capital Outlays 0 0
Other 0 0
TOTAL- 113,663 113,663
Allocation of
Indirect Administration
•
•
Total Units
•
Reimbursement Rate
Rev 4/97
•
I1
THER FUNDS
Donations
Foundations
Contracts for Services
Interest
Other
****SUBTOTAL****
(F) TOTAL REVENUE 113,663 113,663
Rev 4\97
1'3
velop quality assistance plans in the event they
are necessary.
Results of the conference evaluation forms will be tabulated and shared with
the Greater Omaha Healthy Community/Healthy Youth Coalition Board of
Directors. These results and indicators will be used to help the coalition
understand the strengths and weaknesses of the conference.and its breakout
sessions. The results will assist in planning for the next annual conference,
and will also help to develop stronger follow up training plans.
The detailed six month follow-up evaluation instrument will be used to
determine the effectiveness of the action plans that were written on the day of
the conference.
Participants who are of school age will be given the Developmental Asset
Profile to determine the level of"assets" they have in the following categories:
"Support", "Empowerment", "Boundaries & Expectations", "Constructive Use
of Time", "Commitment to Learning", "Positive Identity", "Positive Values" and
"Social Competencies". This information can be used as baseline data. A
post assessment using the Developmental Asset Profile will be given toward
the end of the school year to determine the amount of growth a student
achieved. This quality indicator will also enable us to understand the quality
of the service that is being provided to each student.
11
6
idual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
*t*t rt gi mar,.,: --` . ; .a ae ,.- r .�� ,a...:' 4,&. 't'
Applicant s,�Narne " n__. ......
•
2." liT -5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
BH - 20c
PERSONAL SERVICES
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency:Greater Omaha Healthy
Community/Healthy Youth Coalition
•Division of Health and Well-Being Region: 6
Office of Mental Health and Substance Abuse Date Submitted: April 30 ,2008
Expenses for the Time Period From: July 1, 2008 To:June 1, 2010
List each position Percent of Annual Fringe TOTAL HHS/BH Total Project Funds
or person Time in Program Salary Benefits FUNDS REQUESTED (includes HHS&other)
Community Liaison(08-09) 50 20,000 20,000
Community Liaison(09-10) 50 20,000 20,000
HC/HY Speaker#1 10 2,000 2,000
HC/HY Speaker#2 10 2,000 2,000
HC/HY Speaker#3 10 2,000 2,000
HC/HY Speaker#4 10 2,000 2,000
HC/HY Speaker#5 10 2,000 2,000
Keynote Speaker(2008) 5 6,000 6,000
Keynote Speaker(2009) 5 6,000 6,000
Grant Administrator 10 5,000 5,000
Total I 67,000 67,000
Rev.4/97
5
Interest
Other
****SUBTOTAL****
(F) TOTAL REVENUE 113,663 113,663
Rev 4\97
1'3
velop quality assistance plans in the event they
are necessary.
Results of the conference evaluation forms will be tabulated and shared with
the Greater Omaha Healthy Community/Healthy Youth Coalition Board of
Directors. These results and indicators will be used to help the coalition
understand the strengths and weaknesses of the conference.and its breakout
sessions. The results will assist in planning for the next annual conference,
and will also help to develop stronger follow up training plans.
The detailed six month follow-up evaluation instrument will be used to
determine the effectiveness of the action plans that were written on the day of
the conference.
Participants who are of school age will be given the Developmental Asset
Profile to determine the level of"assets" they have in the following categories:
"Support", "Empowerment", "Boundaries & Expectations", "Constructive Use
of Time", "Commitment to Learning", "Positive Identity", "Positive Values" and
"Social Competencies". This information can be used as baseline data. A
post assessment using the Developmental Asset Profile will be given toward
the end of the school year to determine the amount of growth a student
achieved. This quality indicator will also enable us to understand the quality
of the service that is being provided to each student.
11
6
idual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
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Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
BH - 20d
OPERATIONS
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency:Greater Omaha Healthy
Division of Health and Well-Being Community/Healthy Youth Coalition
Office of Mental Health and Substance Abuse Date Submitted:April 30.2008
Expenses for the Time Period From: July 1, 2008 To:June 1, 2010
Operating Expenses by Category Unit Number of TOTAL HHS/BH Total Project Funds
(list each separately) Cost Units FUNDS REQUESTED (includes HHS&other)
Office Suppplies(paper) 35 4 140
Office Suppplies(Pens) 10 4 40
Office Supplies(Folders) .5 1,100 550
Office Supplies(Evaluations/Surveys) .10 5,000 500
Maintenance&Repairs
Janitorial Services
Telephone&Pagers
Postage(Invitations) .51 2,000 10,200
Postage(Newsletters) .51 4,000 2,040
Postage(Business Return for Surveys) .43 1,000 430
Insurance
Books&Subscriptions(for library) 25 250 6,250
Books&Subscriptions(for conferences) 1 1,100 1,100
Books&Subscription(Dev.Asset Profile) 3 1,600 4,800
Conference Venue 1,000 2 - 2,000
Conference Sustanance 5 1,100 5,500
Membership&Dues
Tuition&Training
Staff Development
Professional Fees
Printing&Advertising(Posters) 5 100 500
Printing&Advertising(Newsletters) .5 4,000 2,000
Printing&Advertising(Brochures) .25 5,000 1,250
Rent
Contract Labor
Fire Alarm
Data Processing
Non-Capital Equipment
Regional Controller
ENHSA Administration
Total 20,152 37,300
Rev.4/97
I
p to develop stronger follow up training plans.
The detailed six month follow-up evaluation instrument will be used to
determine the effectiveness of the action plans that were written on the day of
the conference.
Participants who are of school age will be given the Developmental Asset
Profile to determine the level of"assets" they have in the following categories:
"Support", "Empowerment", "Boundaries & Expectations", "Constructive Use
of Time", "Commitment to Learning", "Positive Identity", "Positive Values" and
"Social Competencies". This information can be used as baseline data. A
post assessment using the Developmental Asset Profile will be given toward
the end of the school year to determine the amount of growth a student
achieved. This quality indicator will also enable us to understand the quality
of the service that is being provided to each student.
11
6
idual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
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Applicant s,�Narne " n__. ......
•
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Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
BH - 20e
TRAVEL
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency:Greater Omaha Healthy
Division of Health and Well-Being Community/Healthy Youth Coalition
'Office of Mental Health and Substance Abuse Date Submitted: April 30,2008
Expenses for the Time Period From: July 1, 2008 To:June 1, 2010
Itemize by Number of Reimbursement TOTAL HHS/BH Total Project Funds
Trip/Location Days/Miles Rate FUNDS REQUESTED (includes HHS&other)
Board and Lodging(2008-09) 4 150 600
Board and Lodging(2009-10) 4 150 600
Meals(2008-09) 4 75 600
Meals(2009-10)) 4 75 300
Commercial Transportation(2008-09) 4 750 3,000
Commercial Transportation(2009-10) 4 750 3,000
Vehicle Mileage 2,500 .505 1,263
Total 9,363
Rev.4/97
Analyst
& It:?/u/a1Approve
BH - 20f
CAPITAL OUTLAYS
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency:Greater Omaha Healthy
Division of Health and Well-Being Community/Healthy Youth Coalition
'Office of Mental Health and Substance Abuse Date Submitted:April 30,2008
Expenses for the Time Period From: July 1, 2008 To:June 1, 2010
Unit Number TOTAL HHS/BH Total Project Funds
Itemize Cost of Units FUNDS REQUESTED (includes HHS&other)
N/A
Total 0 0
Rev.4/97
150 600
Board and Lodging(2009-10) 4 150 600
Meals(2008-09) 4 75 600
Meals(2009-10)) 4 75 300
Commercial Transportation(2008-09) 4 750 3,000
Commercial Transportation(2009-10) 4 750 3,000
Vehicle Mileage 2,500 .505 1,263
Total 9,363
Rev.4/97
Analyst
& It:?/u/a1Approve
BH - 20g
OTHER EXPENSES
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency:Greater Omaha Healthy
Division of Health and Well-Being Community/Healthy Youth Coalition
Office of Mental Health and Substance Abuse Date Submitted:April 30,2008
Expenses for the Time Period From: July 1, 2008 To:June 1, 2010
Unit Number TOTAL HHS/BH Total Project Funds
Itemize Cost of Units FUNDS REQUESTED (includes HHS&other)
N/A
Total 0 0
Rev.4/97
19
Board and Lodging(2009-10) 4 150 600
Meals(2008-09) 4 75 600
Meals(2009-10)) 4 75 300
Commercial Transportation(2008-09) 4 750 3,000
Commercial Transportation(2009-10) 4 750 3,000
Vehicle Mileage 2,500 .505 1,263
Total 9,363
Rev.4/97
Analyst
& It:?/u/a1Approve
Budget Justification Narrative
Personal Services
Each line item found on form BH-20c has been calculated for a two year
obligation. First, we will hire a "Community Liaison" to promote and disseminate
the information pertaining to the Developmental Assets. This person will also
build our resource library, tabulate survey and evaluation data and present
information pertaining to the initiative to groups and/or agencies. The cost of this
individual was arrived at by dividing a workable annual salary by two as we view
it as a position that will not be full time.
Each Healthy Community/Healthy Youth Speaker will conduct initial and follow
up trainings regarding the Developmental Assets. These "speakers" will be
trained to present the research and will have specific, agency related ideas on
how to build assets with youth in certain sectors, such as the faith based
community, civic organizations, health care institutions etc. The cost of this
service was determined by a minimum of five training sessions per year, which
makes the cost of each presentation $200.00.
The keynote speaker for each year the conference is held will also understand
the Developmental Assets and how its implementation will assist the Greater
Omaha area. These keynote speakers are well known authors who are in high
demand and will also bring a greater interest to conference attendees. The cost
of these speakers was arrived at by calling agents that represent such speakers.
For example, Dr. David Walsh receives $5,000 plus expenses.
The grant administrator will spend significant time managing the accounts and
keeping the details up-to-date. The expense for this line item is inexpensive
given the duties this person will perform. The cost of this line item was also
broken down into two years, which makes the cost $1,250/year which equals just
over $100.00/month.
Operations (BH-20d)
There are four specific line items that constitute "office supplies". These line
items will specifically be used to promote the conference, produce evaluations
and surveys. The paper will also be used so conference participants can make
"action plans". Pens and folders are necessary to provide adequate materials to
conference participants. The cost of these items were determined by visiting local
retail stores to determine what a 10 pack box of paper (in reams). The same
strategy was use to determine the cost of folders to be used for the conference
as well as the pens.
A
determine the amount of growth a student
achieved. This quality indicator will also enable us to understand the quality
of the service that is being provided to each student.
11
6
idual's parent agency,or to any other individual or agency at the request of the individual to the
G.R.E.A.T.staff or other governmental official is on a need-to-know basis.
4.EFFECT OF NONDISCLOSURE: Disclosure of your social security number,which is solicited under the authority of Executive Order 9367,is also voluntary,and no
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
*t*t rt gi mar,.,: --` . ; .a ae ,.- r .�� ,a...:' 4,&. 't'
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•
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Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
The postage is necessary to promote the annual conference and the follow up
trainings that will be completed. It is also necessary to have participants return
surveys they have completed. This will enable us to better evaluate the services
we will provide. Finally, the postage is a necessity for the quarterly newsletter
that will be created. Cost of standard postage at this time is $.41 for a regular
letter. We used $.51 for several mailings for we felt the cost may increase and
some mailings would be more due to content (such as Resource Library
information). We used a smaller rate for return postage.
The books and subscriptions will be shared at the annual conference, and will
also be used to build the resource library. We will also use this line item to
purchase the Developmental Asset Profile (DAP). This instrument will allow us to
evaluate how well progress is being made with individual youth in the community.
Data can also be tabulated by groups or agency. The cost of the Developmental
Asset Profile is $3.00/administration. We are planning on using it with 800 young
people each year. We took the average price of books listed on the Search
Institute to determine a cost of books that will be placed in the Resource Library.
The printing and advertising will allow us to develop brochures that will promote
the Developmental Assets in an easy to understand manner. It will also help us
to share the asset message with numerous groups. The brochures can be
tailored to meet the unique needs of any of the sectors that we will be activating
including community schools, the faith based community, civic organizations,
. health care institutions, etc. Posters and newsletters will also assist us in
saturating the Greater Omaha/five county area with promoting this positive
message. Cost of comparable posters at this time is $5.00 per poster while we
expect an acceptable "newsletter" to cost $.50 a piece due to paper quality. We
visited with a local company on the cost of a quality brochure and the cost is
$.25/unit.
Travel (BH-20e)
Board and lodging will need to be provided to the keynote speaker and to those
who will provide breakout sessions during the annual conferences. Meals will
also need to be provided for the aforementioned presenters. Finally, commercial
transportation will be necessary for the individuals to travel to and from Omaha.
We used $150/day for the going hotel room rate. This should leave ample room
for taxes etc. We also factored in $25.00/meal for each presenter, understanding
that breakfast would probably cost less and lunch and dinner more. Finally, air
travel has increased significantly so we budgeted $750/person.
Mileage was also added so the "speakers" from the Greater Omaha Healthy
Community/Healthy Youth Speaker Bureau will be able to travel to numerous
agencies within the five county area. This will allow the research to be shared
and specific follow up training to take place. We used the going IRS rate to
determine this mileage figure.
I
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
*t*t rt gi mar,.,: --` . ; .a ae ,.- r .�� ,a...:' 4,&. 't'
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•
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Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
Financial Audit Information
XPENSES
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency:Greater Omaha Healthy
Division of Health and Well-Being Community/Healthy Youth Coalition
Office of Mental Health and Substance Abuse Date Submitted:April 30,2008
Expenses for the Time Period From: July 1, 2008 To:June 1, 2010
Unit Number TOTAL HHS/BH Total Project Funds
Itemize Cost of Units FUNDS REQUESTED (includes HHS&other)
N/A
Total 0 0
Rev.4/97
19
Board and Lodging(2009-10) 4 150 600
Meals(2008-09) 4 75 600
Meals(2009-10)) 4 75 300
Commercial Transportation(2008-09) 4 750 3,000
Commercial Transportation(2009-10) 4 750 3,000
Vehicle Mileage 2,500 .505 1,263
Total 9,363
Rev.4/97
Analyst
& It:?/u/a1Approve
•
MG'
KPMG LLP
Suite 1501 Suite 1600 •
Two Central Park Plaza 233 South 13th Street
Omaha,NE 68102 Lincoln, NE 68508-2041
•
Independent Auditors' Report on Compliance with Requirements
Applicable to Each Major Program and on Internal Control over • '
Compliance in Accordance with OMB Circular A-133
The Honorable Mayor and Members
of the City Council
City of Omaha,Nebraska:
Compliance
We have audited the compliance of the City of Omaha, Nebraska (the City) with the types of compliance
requirements described in the U.S. Office of Management and Budget(OMB) Circular A-133 Compliance
Supplement that are applicable to each of its major federal programs for the year ended December 31,
2006. The City's major federal programs are identified in the summary of auditors' results section of the
accompanying schedule of findings and questioned costs. Compliance with the requirements of laws,
regulations, contracts, and grants applicable to each of its major federal programs is the responsibility of
the City's management. Our responsibility is to express an opinion on the City's compliance based on our
audit.
•
The City's financial statements include the operations of Metropolitan Entertainment and Convention
Authority(MECA). Our audit,described below, did not include the operations of MECA.
We conducted our audit of compliance in accordance with auditing standards generally accepted in the
United States of America; the standards applicable to financial audits contained in Government Auditing
Standards, issued by the Comptroller General of the United States; and OMB Circular A-133,Audits of
States, Local Governments, and Non-Profit Organizations. Those standards and OMB Circular A-133 •
require that we plan and perform the audit to obtain reasonable assurance about whether noncompliance
with the types of compliance requirements referred to above that could have a direct and material effect on
a major federal program occurred. An audit includes examining, on a test basis, evidence about the City's
compliance with those requirements and performing such other procedures as we considered necessary in
the circumstances. We believe that our audit provides a reasonable basis for our opinion. Our audit does
not provide a legal determination on the City's compliance with those requirements.
In our opinion, the City complied, in all material respects, with the requirements referred to above that are
applicable to each of its major federal programs for the year ended December 31, 2006.
•
• KPMG LLP,a U.S.limited liability partnership,is the U.S. I,
member firm of KPMG International.a Swiss cooperative. J_S/
agencies within the five county area. This will allow the research to be shared
and specific follow up training to take place. We used the going IRS rate to
determine this mileage figure.
I
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
*t*t rt gi mar,.,: --` . ; .a ae ,.- r .�� ,a...:' 4,&. 't'
Applicant s,�Narne " n__. ......
•
2." liT -5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
Internal Control over Compliance
The management of the City is responsible for establishing and maintaining effective internal control over
compliance with requirements of laws, regulations, contracts, and grants applicable to federal programs. In
planning and performing our audit, we considered the City's internal control over compliance with
requirements that could have a direct and material effect on a major federal program in order to determine
our auditing procedures for the purpose of expressing our opinion on compliance and to test and report on
internal control over compliance in accordance with OMB Circular A-133.
Our consideration of the internal control over compliance would not necessarily disclose all matters in the
internal control that might be material weaknesses. A material weakness is a reportable condition in which
the design or operation of one or more of the internal control components does not reduce to a relatively
low level the risk that noncompliance with applicable requirements of laws, regulations, contracts, and
grants caused by error or fraud that would be material in relation to a major federal program being audited
may occur and not be detected within a timely period by employees in the normal course of performing
their assigned functions. We noted no matters involving the internal control over compliance and its
operation that we consider to be material weaknesses.
This report is intended solely for the information and use of the Mayor, members of the City Council,
management, and federal awarding agencies and pass-through entities and is not intended to be,and should
not be used by anyone other than these specified parties.
J(`PMC LLB
Omaha,Nebraska
September 11,2007
aZ"?
rofit Organizations. Those standards and OMB Circular A-133 •
require that we plan and perform the audit to obtain reasonable assurance about whether noncompliance
with the types of compliance requirements referred to above that could have a direct and material effect on
a major federal program occurred. An audit includes examining, on a test basis, evidence about the City's
compliance with those requirements and performing such other procedures as we considered necessary in
the circumstances. We believe that our audit provides a reasonable basis for our opinion. Our audit does
not provide a legal determination on the City's compliance with those requirements.
In our opinion, the City complied, in all material respects, with the requirements referred to above that are
applicable to each of its major federal programs for the year ended December 31, 2006.
•
• KPMG LLP,a U.S.limited liability partnership,is the U.S. I,
member firm of KPMG International.a Swiss cooperative. J_S/
agencies within the five county area. This will allow the research to be shared
and specific follow up training to take place. We used the going IRS rate to
determine this mileage figure.
I
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
*t*t rt gi mar,.,: --` . ; .a ae ,.- r .�� ,a...:' 4,&. 't'
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•
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Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
•
CITY OF OMAHA NEBRASKA
Schedule of Findings and Questioned Costs ,61a_
7 December 31, 2006
(1) Summary of Auditors' Results
(a) The type of report issued on the basic financial statements: Unqualified opinion
(b) Significant deficiencies in internal control were disclosed by the audit of the basic financial
statements: Yes
Material weaknesses: Yes
(c) Noncompliance which is material to the basic financial statements: No
(d) Reportable conditions in internal control over major programs: No
Material weaknesses: No
(e) The type of report issued on compliance for major programs: Unqualified
(f) Any audit findings which are required to be reported under Section 510(a) of OMB Circular A-133:
No
(g) Major programs: HOME Investment Partnership Program (14.239); Community Development
Block Grant(14.218);and Capitalization Grants for Clear Water State Revolving Funds(66.458)
(h) Dollar threshold used to distinguish between Type A and Type B programs: S1,411,495
(i) Auditee qualified as a low-risk auditee under Section 530 of OMB Circular A-133: No
(2) Findings Related to the Basic Financial Statements Reported in Accordance with Government
Auditing Standards
Finding#06-01
Program: Not applicable.
Federal Grantor Agency: Not applicable.
Criteria: Governments are required to establish internal control over financial reporting to ensure the
financial statements are complete and accurate.
Condition: Internal controls were not in place to ensure the following was accurately reported:
• Accounts payable—the current process did not ensure accounts payable was accurately recorded
• Compensated absences—the City did not record the balance in accordance with the updated policy
Questioned Costs: None.
Context: Significant adjustments were recorded for each of the above areas.
Cause: The control system in place did not prevent or detect the errors.
a5
on
a major federal program occurred. An audit includes examining, on a test basis, evidence about the City's
compliance with those requirements and performing such other procedures as we considered necessary in
the circumstances. We believe that our audit provides a reasonable basis for our opinion. Our audit does
not provide a legal determination on the City's compliance with those requirements.
In our opinion, the City complied, in all material respects, with the requirements referred to above that are
applicable to each of its major federal programs for the year ended December 31, 2006.
•
• KPMG LLP,a U.S.limited liability partnership,is the U.S. I,
member firm of KPMG International.a Swiss cooperative. J_S/
agencies within the five county area. This will allow the research to be shared
and specific follow up training to take place. We used the going IRS rate to
determine this mileage figure.
I
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
*t*t rt gi mar,.,: --` . ; .a ae ,.- r .�� ,a...:' 4,&. 't'
Applicant s,�Narne " n__. ......
•
2." liT -5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
CITY OF OMAHA,NEBRASKA ,0—„?alb 0101'
`•,.
Schedule of Findings and Questioned Costs
December 31,2006 a44. O:'
Effect: Errors were not identified.
Recommendation: We recommend that the City review its current control system and develop policies
and procedures to ensure the financial statements are free from material misstatement.
Management Response:
Accounts payable
Corrective Action Plan:
Accounts payable staff were not actively reviewing the fiscal year information when processing
payments against encumbrances. This has since been corrected. In addition, employees in the
operating departments will be trained on appropriate procedures for entering data into the accounting
system. As an added safeguard to ensure accuracy, project accountants will review year-end
payments as necessary.
Anticipated Completion Date: Immediately
Contact: Allen Herink
Compensated absences
Corrective Action Plan:
This issue resulted from a lack of communication within the Finance Department. The compensated
absence balance was calculated in the Budget and Accounting Division without direct assistance
from the staff in the Payroll Division who have the most up-to-date knowledge of these liabilities. In
future, after the liability calculation is completed in Budget and Accounting, the computation will be
thoroughly reviewed and approved by the Manager of the Payroll Division.
• Anticipated Completion Date: Immediately
Contact: Allen Herink
(3) Findings and Questioned Costs Relating to Federal Awards
None.
,Sto
s did not ensure accounts payable was accurately recorded
• Compensated absences—the City did not record the balance in accordance with the updated policy
Questioned Costs: None.
Context: Significant adjustments were recorded for each of the above areas.
Cause: The control system in place did not prevent or detect the errors.
a5
on
a major federal program occurred. An audit includes examining, on a test basis, evidence about the City's
compliance with those requirements and performing such other procedures as we considered necessary in
the circumstances. We believe that our audit provides a reasonable basis for our opinion. Our audit does
not provide a legal determination on the City's compliance with those requirements.
In our opinion, the City complied, in all material respects, with the requirements referred to above that are
applicable to each of its major federal programs for the year ended December 31, 2006.
•
• KPMG LLP,a U.S.limited liability partnership,is the U.S. I,
member firm of KPMG International.a Swiss cooperative. J_S/
agencies within the five county area. This will allow the research to be shared
and specific follow up training to take place. We used the going IRS rate to
determine this mileage figure.
I
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
*t*t rt gi mar,.,: --` . ; .a ae ,.- r .�� ,a...:' 4,&. 't'
Applicant s,�Narne " n__. ......
•
2." liT -5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
Assurances
•
0q7
ALTH AND HUMAN SERVICES Agency:Greater Omaha Healthy
Division of Health and Well-Being Community/Healthy Youth Coalition
Office of Mental Health and Substance Abuse Date Submitted:April 30,2008
Expenses for the Time Period From: July 1, 2008 To:June 1, 2010
Unit Number TOTAL HHS/BH Total Project Funds
Itemize Cost of Units FUNDS REQUESTED (includes HHS&other)
N/A
Total 0 0
Rev.4/97
19
Board and Lodging(2009-10) 4 150 600
Meals(2008-09) 4 75 600
Meals(2009-10)) 4 75 300
Commercial Transportation(2008-09) 4 750 3,000
Commercial Transportation(2009-10) 4 750 3,000
Vehicle Mileage 2,500 .505 1,263
Total 9,363
Rev.4/97
Analyst
& It:?/u/a1Approve
REGION 6 BEHAVIORAL HEALTHCARE BEHAVIORAL HEALTHCARE
Prevention Department
SUBGRANT TERMS AND ASSURANCES
Fiscal Year 2009
This is a subgrant of state and/or federal financial assistance. By accepting this subgrant, the
Subrecipient agrees to comply with the terms and conditions described herein.
A. Programs. Subrecipient must operate the program(s) in compliance with the documents
governing the award. The following documents and any revisions made during the program
period govern the Subgrant and are hereby incorporated by this reference as though fully
set forth herein.
1. Region 6 Behavioral Healthcare and/or the primary funding agencies' Request for
Application;
2. Subrecipient Project(s)Application;
3. Subrecipient Reporting Requirements (Fiscal and Programmatic);
4. Program Specific Requirements;
5. Region 6 Behavioral Healthcare Administrative and Audit Guidance for Subgrants,
the attached certifications; and
6. Region 6 Behavioral Healthcare's letter of award which includes the award period,
amount of funds awarded, and any contingencies to the Subgrant award.
B. Report. Subrecipient must submit data, program, and financial reports according to the
reporting requirements. Extensions for the submission of reports and reimbursement must
be submitted in writing no later than 15 business days prior to the reporting deadline
to Region 6 Behavioral Healthcare for approval to prevent withholding of payment.
Notification shall be sent by United States mail and signed by the authorized agency official
or authorized designee on file with Region 6 Behavioral Healthcare.
C. Administrative Requirements. Subrecipient must perform Subgrant activities, expend funds,
and report financial and program activities in accordance with Federal grants administration
regulations, U.S. Office of Management and Budget Circulars governing cost principles and
audits listed, and comply with, complete, and return the certifications attached hereto.
D. Program Specific Requirements. Subgrant activities must comply with any program specific
requirements included in the Region 6 Behavioral Healthcare Request for Application (RFA)
or that of the primary granting agency.
E. Nondiscrimination. The Subrecipient acknowledges that the Subgrant activities must be
operated in compliance with civil rights laws and any implementing regulations, and makes
the following assurances:
The Subrecipient warrants and assures that it complies as applicable with Title VI of the
Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of
the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, the Americans with
Disabilities Act of 1990, to the effect that no person shall, on the grounds of race, color,
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
this mileage figure.
I
right,benefit,or privilege by law will be denied as a result of not disclosing it. Not providing all or any part of the requested
information may result in the application not being registered for the requested program.
Page 3 of 4
.
*Apiicanf's,Name:
Page 3 of 4
*t*t rt gi mar,.,: --` . ; .a ae ,.- r .�� ,a...:' 4,&. 't'
Applicant s,�Narne " n__. ......
•
2." liT -5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
national origin, sex, age, handicap or disability, be excluded from participation in, denied
benefits of, or otherwise be subjected to discrimination under any program or activity for
which the Subrecipient receives federal financial assistance.
The Subrecipient shall not discriminate against any employee or applicant for
employment, to be employed in the performance of this Subgrant with respect to hire,
tenure, terms, conditions or privileges of employment because of the race, color,
religion, sex, disability or national origin of the employee or applicant.
F. Reimbursement. Subrecipient must submit claims for reimbursement for actual, allowable,
allocable and reasonable expenditures in accordance with the approved budget. Region 6
Behavioral Healthcare will make reimbursement, subject to the following conditions:
1. Subrecipient's submission of reports according to the reporting requirements.
2. Availability of governmental funds to support this project. In the event that funds
cease to be available, this Subgrant shall be terminated, or the activities shall be
suspended until such funds become available, at the sole discretion of Region 6
Behavioral Healthcare.
3. Pursuant to the Nebraska Prompt Payment Act.
4. Suspension or termination for cause or convenience as described in the federal
grants administration regulations applicable to the Subrecipient.
5. Cash advances may be requested in writing with justification of anticipated
_expenses. Subrecipient must comply with guidelines -established by Region 6
Behavioral Healthcare and prospective payment request must be approved by
Region 6 Behavioral Healthcare prior to the first reimbursement request.
G. Budget Changes. Prior approval is required for all budget transfers of the current total
approved budget. Requests for transfers shall be addressed in writing to the Region by
authorized agency official or authorized designee. Region 6 Behavioral Healthcare shall
approve or disapprove the request in writing within 45 days of its receipt. Subrecipients
must strictly adhere to and complete the budget change requirements established by Region
6 Behavioral Healthcare prior to submitting any requests for payment.
H. Nonsupplantation. The Subrecipient agrees that no funds supplied through this subgrant
will be used to supplant existing funds or maintain existing otherwise funded activities, and
all strategies and services will be new strategies and services or substantial enhancements
and/or expansions of existing strategies and services. Any exceptions must be authorized
by Region 6 Behavioral Healthcare prior to service delivery.
I. Programmatic Changes. The Subrecipient shall request in writing to Region 6 Behavioral
Healthcare approval for programmatic changes. Requests shall be made by the authorized
agency official or authorized designee. Region 6 Behavioral Healthcare shall send
notification regarding the request to the Subrecipient within 45 days of its receipt.
J. Technical Assistance. Region 6 Behavioral Healthcare will provide training and materials,
procedures, assistance with quality assurance procedures, and site visits by representatives
of Region 6 Behavioral Healthcare and the state granting agency in order to review program
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
-5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
accomplishment, evaluate management control systems and other technical assistance as
needed or requested.
K. Subrecipient Procurement. Subrecipient shall be the responsible authority regarding the
settlement and satisfaction of all contractual and administrative issues, without recourse to
Region 6 Behavioral Healthcare, arising out of procurement entered into by connection with
the subgrant. Such issues include, but are not limited to, disputes, claims, protests of
award, source evaluation and other matters of a contractual nature.
L. Subgrant Close-Out. Upon the expiration or notice of termination of this Subgrant, the
following procedures shall apply for close-out of the subgrant:
1. Upon request from Subrecipient, any allowable reimbursable cost not covered by
previous payments shall be paid by Region 6 Behavioral Healthcare.
2. Subrecipient shall make no further disbursement of funds paid to Subrecipient,
except to meet expenses incurred on or prior to the termination or expiration date,
and shall cancel as many outstanding obligations as possible. Region 6 Behavioral
Healthcare shall give full credit to Subrecipient for the federal share of non-
cancelable obligations properly incurred by Subrecipient prior to termination.
3. Subrecipient shall immediately return to Region 6 Behavioral Healthcare any un-
obligated balance of cash advanced or shall manage such balance in accordance
with Region 6 Behavioral Healthcare instructions.
4. Within a maximum of 30 days following the date of expiration or termination,
Subrecipient shall submit all financial, performance, and related reports required by
the terms of the Agreement to Region 6 Behavioral Healthcare. Region 6 Behavioral
Healthcare reserves the right to extend the due date for any report and may waive, in
writing, any report it considers to be unnecessary.
5. Region 6 Behavioral Healthcare shall make information available regarding any
necessary adjustment upward or downward in the federal share of costs made by the
state funding agency.
6. The Subrecipient shall assist and cooperate in the orderly transition and transfer of
Subgrant activities and operations with the objective of preventing disruption of
services.
7. Close-out of this Subgrant shall not affect the retention period for region or state or
federal rights of access to, Subrecipient records. Nor shall close-out of this Subgrant
affect the Subrecipient's responsibilities regarding property or with respect to any
program income for which Subrecipient is still accountable under this Subgrant. If no
final audit is conducted prior to close-out, Region 6 Behavioral Healthcare reserves
the right to disallow and recover an appropriate amount after fully considering any
recommended disallowances resulting from an audit which may be conducted at a
later time.
M. Documents Incorporated by Reference. All laws, rules, regulations, guidelines, directives
and documents, attachments, appendices; and exhibits referred to in these terms and
assurances shall be deemed incorporated by this reference and made a part of this
Subgrant as though fully set forth herein.
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
3Q
Human Services System Documents in 2005
-5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
N. Independent Contractor. The Subrecipient is an independent contractor and neither it nor
any of its employees shall be deemed employees of Region 6 Behavioral Healthcare for any
purpose. The Subrecipient shall employ and direct such personnel as it requires to perform
its obligations under this Subgrant, shall exercise full authority over its personnel, and shall
comply with all worker's compensation, employer's liability, and other federal, state, county,
and municipal laws, ordinances, rules, and regulations required of an employer providing
services as contemplated by this Subgrant.
O. Release and Indemnity. The Subrecipient shall assume all risk of loss and hold Region 6
Behavioral Healthcare, its employees, agents, assignees and legal representatives
harmless from all liabilities, demands, claims, suits, losses, damages, causes of action, fines
or judgments and all expenses incident thereto, for injuries to persons and for loss of,
damage to, or destruction of property arising out of or in connection with this Subgrant, and
proximately caused by the negligent or intentional acts or omissions of the Subrecipient, its
officers, employees or agents; for any losses caused by failure by the Subrecipient to
comply with terms and conditions of the Subgrant; and, for any losses caused by other
parties which have entered into agreements with the Subrecipient.
P. Assignability. Subrecipient agrees not to assign or transfer any interest, rights, or duties in
this subgrant to any person, firm or corporation without prior written consent of the Region.
Q. Conflict of Interest.
1. An employee of the Subrecipient shall not have any interest, financial or otherwise,
direct or indirect, or engage in any business or transaction or professional activity or
incur any obligation of any nature which is in conflict with the proper discharge of
his/her duties under this subgrant.
2. An employee of the Subrecipient shall not engage in disparaging remarks or other.
activity that is meant to put the Region, the State or Division at fault for otherwise
normal operational activities and decisions.
•
R. Drug-Free Work-Place Policy. The Subrecipient assures Region 6 Behavioral Healthcare
that it has established and does maintain a drug-free work-place policy.
S. Acknowledgment of Support. Publications by the Subrecipient, including news releases and
articles, shall acknowledge the financial support of Region 6 Behavioral Healthcare and the
state granting agency.. Exact language will be provided.
"This project is supported in part by Region 6 Behavioral Healthcare through funding
provided by Nebraska Health and Human Services System/Tobacco Free Nebraska
Program as a result of the Tobacco Master Settlement Agreement."
or
"This project is supported in part by Region 6 Behavioral Healthcare through the
Substance Abuse Block Grant of the Department of Health and Human Services
System."
T. Copyright. The Subrecipient may copyright any work that is subject to copyright and was
developed, or for which ownership was purchased, under an award. The federal awarding
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
31
e Nebraska Department of Health and Human Services System Documents in 2005
3Q
Human Services System Documents in 2005
-5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
agency and Region 6 Behavioral Healthcare reserve a royalty-free, nonexclusive and
irrevocable right to reproduce, publish, or otherwise use the work for Federal, State and
Regional purposes, and to authorize others to do so.
U. Notices. All notices given under the terms of this Subgrant shall be sent by United States
mail, postage prepaid, addressed to the respective party at the address set forth on the
signature page hereof, or to such other addresses as the parties shall designate in writing
from time to time.
Any notice required to be given under the terms of this subgrant shall be deemed sufficient if
in writing, and if delivered or mailed to the Region 6 Behavioral Healthcare contact listed
below:
FAX: Patricia E. Jurjevich
Regional Program Administrator
402-444-7722
US Mail: Patricia E. Jurjevich
Regional Program Administrator
Region 6 Behavioral Healthcare Behavioral Healthcare
3801 Harney
Omaha, NE 68131
V. Breach of Contract. The Region may terminate the subgrant immediately upon written
notice to Subrecipient upon breach of the terms of the subgrant by the Subrecipient. The
Region shall pay Subrecipient only for such performance as has been properly completed.
This provision shall not preclude the pursuit of other remedies for breach of subgrant as
allowed by law.
W. Authorized Official. The person executing the Application Cover Sheet and/or the Agency
Contact Form is an official of the Subrecipient who has the authority to bind the Subrecipient
to the terms and assurances of this Subgrant of federal financial assistance.
X. Public Counsel. In the event the Subrecipient provides health and human services to
individuals on behalf of Region 6 Behavioral Healthcare under the terms of this Subgrant,
Subrecipient shall submit to the jurisdiction of the Public Counsel under Neb. Rev. Stat. 81-
8,240 to 81-8,254 with respect to the provision of services under this subgrant. This clause
shall not apply to grants or contracts between Region 6 Behavioral Healthcare and long-
term care facilities subject to the jurisdiction of the state long-term care ombudsman
pursuant to the Long-Term Care Ombudsman Act.
Y. Unavailability of Funding. Due to possible future reductions in State and/or Federal
appropriations, Region 6 Behavioral Healthcare cannot guarantee the continued availability
of funding for this Subgrant notwithstanding the consideration stated above. In the event
funds to finance this Subgrant become unavailable either in full or in part due to such
reductions in appropriations, Region 6 Behavioral Healthcare may terminate the Subgrant or
reduce the consideration upon notice in writing to the Subrecipient. Said notice shall be
delivered by certified mail return receipt requested or in person with proof of delivery.
Region 6 Behavioral Healthcare shall be the final authority as to the availability of funds. The
effective date of such Subgrant termination or reduction in consideration shall be specified in
the notice as the date of service of said notice or the actual effective date of the state or
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
3a
Nebraska Department of Health and Human Services System Documents in 2005
3Q
Human Services System Documents in 2005
-5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
apply federal funding reduction, whichever is later. Provided, that reductions shall not pp y to
payments made for services satisfactorily completed prior to said effective date. In the event
of a reduction in consideration, the Subrecipient may cancel this Subgrant as of the effective
date of the proposed reduction upon the provision of advance written notice to Region 6
Behavioral Healthcare.
Z. Nebraska Technology Access Standards. LB352 (2000) requires the Commission for the
Blind and Visually Impaired, Nebraska Information Technology Commission, and the Chief
Information Officer, in consultation with other state agencies and after at least one public
hearing, to develop a technology access clause to be included in all contracts entered into
by state agencies on or after January 1, 2001. The technology access standards are in
response to this Legislation. When development, procurement, maintenance, or use of
electronic and information technology does not meet these standards, individuals with
disabilities will be provided with the information and data involved by an alternative means of
access. The complete Nebraska Technology Access Standards can be found on the Internet
at: http://www.nitc.state.ne.us/standards/accessibility/tacfinal.htm
•
AA.Coordinating Agency Standards. Subrecipients contracted to provide coordination services
on behalf of a community/coalition within the Region 6 Behavioral Healthcare Prevention
System shall adhere to Coordination Guidelines. Coordination activities are designed to
assist communities in sustaining outcomes that support reductions in alcohol, tobacco and
other drug use by youth and adults overtime. Such activities shall be guided by The Five
Steps of the Substance Abuse and Mental Health Services Administration (SAMHSA)
Strategic Prevention Framework. Subrecipient performance measures established by
Region 6 Behavioral Healthcare shall reflect this requirement.
ACCEPTED FOR THE FISCAL AGENT AND/OR SUBRECIPIENT:
City of Omaha
Agency Name
Authorized official signing on behalf of the Subrecipient Date
Federal Tax Identification Number(FTIN) 47-6006304
Adapted from the Nebraska Department of Health and Human Services.System Documents in 2005
33
and/or Federal
appropriations, Region 6 Behavioral Healthcare cannot guarantee the continued availability
of funding for this Subgrant notwithstanding the consideration stated above. In the event
funds to finance this Subgrant become unavailable either in full or in part due to such
reductions in appropriations, Region 6 Behavioral Healthcare may terminate the Subgrant or
reduce the consideration upon notice in writing to the Subrecipient. Said notice shall be
delivered by certified mail return receipt requested or in person with proof of delivery.
Region 6 Behavioral Healthcare shall be the final authority as to the availability of funds. The
effective date of such Subgrant termination or reduction in consideration shall be specified in
the notice as the date of service of said notice or the actual effective date of the state or
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
3a
Nebraska Department of Health and Human Services System Documents in 2005
3Q
Human Services System Documents in 2005
-5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
•
CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE
Public Law 103-227, also known as the Pro-Children Act of 1994 (Act), requires that smoking
not be permitted in any portion of any indoor facility owned or leased or contracted for by an
entity and used routinely or regularly for the provision of health, day care, early childhood
development services, education or library services to children under the age of 18, if the
services are funded by Federal programs either directly or through State or local governments,
by Federal grant, contract, loan, or loan guarantee. The law also applies to children's services
that are provided in indoor facilities that are constructed, operated, or maintained with such
federal funds. The law does not apply to children's services provided in private residences;
portions of facilities used for inpatient drug or alcohol treatment; service providers whose sole
source of applicable Federal funds in Medicare or Medicaid; or facilities where WIC coupons are
redeemed. Failure to comply with the provisions of the law may result in the imposition of a civil
monetary penalty of up to $1000 for each violation and/or the imposition of an administrative
compliance order on the responsible entity.
By signing this certification, the applicant/subgrantee certifies that the submitting organization
will comply with the requirements of the Act and will not allow smoking within any portion of any
indoor facility used for the provision of services for children as defined by the Act, nor in
violation of any State Statute or City Ordinance.
9, -2,v
Signa�re auth Is
ed official signing on Date
behalf of applica Ibgrantee
• h
Na an t of o i is signing for organization .
Organization name j
•
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
311
Healthcare shall reflect this requirement.
ACCEPTED FOR THE FISCAL AGENT AND/OR SUBRECIPIENT:
City of Omaha
Agency Name
Authorized official signing on behalf of the Subrecipient Date
Federal Tax Identification Number(FTIN) 47-6006304
Adapted from the Nebraska Department of Health and Human Services.System Documents in 2005
33
and/or Federal
appropriations, Region 6 Behavioral Healthcare cannot guarantee the continued availability
of funding for this Subgrant notwithstanding the consideration stated above. In the event
funds to finance this Subgrant become unavailable either in full or in part due to such
reductions in appropriations, Region 6 Behavioral Healthcare may terminate the Subgrant or
reduce the consideration upon notice in writing to the Subrecipient. Said notice shall be
delivered by certified mail return receipt requested or in person with proof of delivery.
Region 6 Behavioral Healthcare shall be the final authority as to the availability of funds. The
effective date of such Subgrant termination or reduction in consideration shall be specified in
the notice as the date of service of said notice or the actual effective date of the state or
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
3a
Nebraska Department of Health and Human Services System Documents in 2005
3Q
Human Services System Documents in 2005
-5..& 7
Date: 1 ( 1° Agency: OW1cL�- To I I c t: par ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
• TRAVEL AND EXPENSE POLICIES
Traveling expenses for which reimbursement will be made are strictly confined to those
essential to the transaction of official business. Expense is allowed for travel by train, bus or
aircraft; ground transportation to and from terminals; meals (including tip and taxes); lodging;
parking; tolls; baggage handling; taxi (including tips); telephone and postage. All expenses
claimed shall reflect only those amounts actually expended.
Original receipts must be submitted in support of the following expenses: (a) airline, train, or
bus tickets; (b) lodging; (c) postage; (d) toll fees exceeding one dollar; (e) registration or
conference fees; and (f) claims for chartered or personally rented aircraft or automobiles.
Region 6 Behavioral Healthcare approval must be obtained prior to engaging in any travel at
Region expense. For out-of-state travel, advance approval must be obtained by submitting an
Out-of-State Travel Request (supplied by the Region) which specifies anticipated expenses for
which reimbursement will be requested. No reimbursement may be made for alcoholic
beverages.
Travel by chartered aircraft, privately-owned aircraft, or rented aircraft is subject to prior '
authorization by Region 6 Behavioral Healthcare to assure that all State policies and regulations
are strictly followed. Details of reimbursement will be provided at the time prior authorization is
requested.
Automobile rentals are generally not a reimbursable expense. Prior authorization may be
granted under exceptional circumstances. Reimbursement policies and specific instructions will
be provided when prior authorization is requested.
No charges may be billed to the Region. The Region may arrange airfare, registrations or
lodging at Region 6 Behavioral Healthcare expense to be billed directly to the Region if
requested and approved in advance.
Lodging Expense — Lodging shall be reserved only in the event that the training or conference
occurs within a minimum of two consecutive days or more and is at least three hours away from
home city. Receipts for lodging must be submitted, and must be on hotel/motel statement forms
and be properly receipted or have credit card charge form attached. The "State Rate" or
"Commercial Rate" must be requested on all occasions.
Only the single rate for lodging is reimbursable. If you are accompanied by another individual
not on official Region 6 Behavioral Healthcare business, you will be responsible for all charges
in excess of the appropriate single rate.
For in-state travel every effort should be made to reserve a room which does not exceed the
maximum in-state lodging rate (currently $48.00 plus tax). The Region will assist you, if
requested, in obtaining proper lodging. There is no maximum out-of-state lodging rate at this
time, but the Region requests that you seek the most reasonable rate possible.
Meals—Only actual amounts paid for meals may be claimed up to the maximum allowed.
When an employee leaves for overnight travel on or before 6:30 a.m., breakfast may be
reimbursed. If the employee returns to the headquarters from overnight travel on or after 7:00
p.m., the evening meal may be reimbursed. Employees leaving for overnight travel on or before
6:00 p.m. may be reimbursed for evening meal expenses. Noon meals may be reimbursed if -
the employee leaves on or before 11:00 a.m. (for overnight travel), or returns on or after 2:00
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
35
ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
p.m. (from overnight travel)At the Region's discretion, one-day travel meal expenses (breakfast
and supper only) may be reimbursed when it is deemed necessary because of working
conditions. IRS has taken the position that reimbursement for meal expenses incurred on one-
day travel is taxable income to the employee, unless such reimbursements are deemed
"occasional." If such reimbursements to an individual total $100 or more, in any one year, the
total of all reimbursements will be considered taxable income. When an individual leaves for
one-day travel at or before 6:30 a.m. or 1.5 hours before the normal work day begins, whichever
is earlier, breakfast may be reimbursed. Noon meals for one-day travel are not reimbursable.
When an individual returns from one-day travel after 7:00 p.m. or 2 hours after the normal work
day ends, whichever is later, the evening meal may be reimbursed. (NOTE: The time
limitations set forth for reimbursement of meal expenses incurred for one-day travel do not
include the time taken for the meal.)
Meal expenses cannot be paid if incurred in your residence city. Meals may not be charged
directly to the Region.
For in-state travel, the maximum meal allowances shall be set by the grant parameters. In cases
where meal reimbursement amounts are not set forth in the grant, Region 6 Behavioral
Healthcare standard guidelines shall be utilized. For out-of-state travel, reimbursement will be
made for actual costs not to exceed the federally allowed maximums as found on the following
Website: http://policyworks.gov/orq/main/mt/homepage/mtt/perdiem/perd04d.html.
Miscellaneous Expenses - Taxi fares, airport limousine charges, and telephone charges are
reimbursable if necessary to conduct official State business. Receipts are required for all
miscellaneous expenses in excess of one dollar (with the exception of taxi fares, parking, and
airport limousine charges, which do not require a receipt).
Transportation Expenses — The lowest reserved seat fare for commercial air transportation will
be reimbursed. The original air fare ticket copy and receipt for payment must be submitted.
Reimbursement will be provided for use of a personal automobile for travel directly related to
Region business. Reimbursement will be at the approved rate (currently$.405 per mile).
When commercial air transportation is available, and an individual elects to travel by personal
automobile, reimbursement will be limited to the appropriate air fare, or the mileage
reimbursement, whichever is less.
This summary of expense policies is intended to be a guide dealing with the most common
types of expense items. If there are unusual circumstances, or if there is any question
whatsoever concerning anticipated expenses, please contact a Health and Human Services
Region representative for clarification prior to incurring the expense.
•
e 41e1 �tiT �� l� i4L YOv
•
Organization Name
n� . krVi371) 1.e *Ps (A-10/itlam) 2n
•
. Na @ nd i I o fficial Signing for Signature of OffiI
Organizatio
•
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
34
ed. Employees leaving for overnight travel on or before
6:00 p.m. may be reimbursed for evening meal expenses. Noon meals may be reimbursed if -
the employee leaves on or before 11:00 a.m. (for overnight travel), or returns on or after 2:00
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
35
ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
•
CERTIFICATION OF NON-ACCEPTANCE OF TOBACCO FUNDS
Please check and sign one of the two sections below.
For Non-College/University Applicants
{ 11 '1 ))
Company and Organization Name: (�l e�ky 0 tnAt �, ��f16 Co\fl;,,v h cm.14(j 0 1' \
hereby certifies that it will not accept fundingfrom nor have The applicant named above he y P
affiliation or contractual relationship with a tobacco company, any of its subsidiaries, parent
company, any other organizations funded by tobacco companies, or accept funds from
organizations providing funding directly related to the sale or promotion of tobacco products
during the term of the subgrant from Region 6 Behavioral Healthcare Behavioral Healthcare.
I, the official named below, hereby swear that I am duly authorized legally to bind the contractor
or subgrant recipient to the above described certification. I am fully aware that this certification,
executed on the date below, is made under penalty of perjury under the laws of the State of
Nebraska.
Certification f t e irector of Agency or Person with Signatory Authority:
0 06q
na r Print d Name
/ 1
/ 6 ( 2i -� ) h �i
Y t`v\ , ,o 0 �it?�-�r f eySo t/‘
Da a Title
For College or University Applicants
College or University Name:
The Principal Investigator for the proposed project in the College or University listed above
hereby certifies that he/she will not accept funding nor have an affiliation or contractual
relationship with a tobacco company, any of its subsidiaries, parent company, any other
organizations funded by tobacco companies or accept funds from organizations providing
funding directly related to the sale or promotion of tobacco products during the term of the
subgrant from Region 6 Behavioral Healthcare Behavioral Healthcare.
I, the Principal Investigator named below, am fully aware that this certification, executed on the
date below, is made under penalty of perjury under the laws of the State of Nebraska.
Certification of the Principal Investigator:
Signature Printed Name
Date Title
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
31
tation is available, and an individual elects to travel by personal
automobile, reimbursement will be limited to the appropriate air fare, or the mileage
reimbursement, whichever is less.
This summary of expense policies is intended to be a guide dealing with the most common
types of expense items. If there are unusual circumstances, or if there is any question
whatsoever concerning anticipated expenses, please contact a Health and Human Services
Region representative for clarification prior to incurring the expense.
•
e 41e1 �tiT �� l� i4L YOv
•
Organization Name
n� . krVi371) 1.e *Ps (A-10/itlam) 2n
•
. Na @ nd i I o fficial Signing for Signature of OffiI
Organizatio
•
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
34
ed. Employees leaving for overnight travel on or before
6:00 p.m. may be reimbursed for evening meal expenses. Noon meals may be reimbursed if -
the employee leaves on or before 11:00 a.m. (for overnight travel), or returns on or after 2:00
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
35
ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
l
CERTIFICATION OF NON-ACCEPTANCE OF ALCOHOL FUNDS
Please check and sign one of the two sections below.
For Non-College/University Applicants �)
Company and Organization Name: C,c�eoktn �� PCc.t4L C4 K-- iv'v ffir� iwt-tf y ov,4�
The applicant named above herebycertifies that it will not accept fund from nor have an
PP P 9
affiliation or contractual relationship with an alcohol company, any of its subsidiaries, parent
company, any other organizations funded by alcohol companies, or accept funds from
organizations providing funding directly related to the sale or promotion of alcohol products
during the term of the subgrant from Region 6 Behavioral Healthcare Behavioral Healthcare.
I, the official named below, hereby swear that I am duly authorized legally to bind the contractor
or subgrant recipient to the above described certification. I am fully aware that this certification,
executed on the date below, is made under penalty of perjury under the laws of the State of
Nebraska.
Ce ificatjon of hpTirector of Agency or Person with Signatory uthority:
igrjaturt , f ) _24
Pri ted Name
q ---3 o -- 7. 0 'oc' -_---ChAv, ,,,> ---6J1 ,42, 0
Date Title
For College or University Applicants
College or University Name:
The Principal Investigator for the proposed project in the College or University listed above
hereby certifies that he/she will not accept funding nor have an affiliation or contractual
relationship with an alcohol company, any of its subsidiaries, parent company, any other
organizations funded by alcohol companies, or accept funds from organizations providing
funding directly related to the sale or promotion of alcohol products during the term of the
subgrant from Region 6 Behavioral Healthcare Behavioral Healthcare.
I, the Principal Investigator named below, am fully aware that this certification, executed on the
date below, is made under penalty of perjury under the laws of the State of Nebraska.
Certification of the Principal Investigator:
Signature Printed Name
Date Title
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
30
005
31
tation is available, and an individual elects to travel by personal
automobile, reimbursement will be limited to the appropriate air fare, or the mileage
reimbursement, whichever is less.
This summary of expense policies is intended to be a guide dealing with the most common
types of expense items. If there are unusual circumstances, or if there is any question
whatsoever concerning anticipated expenses, please contact a Health and Human Services
Region representative for clarification prior to incurring the expense.
•
e 41e1 �tiT �� l� i4L YOv
•
Organization Name
n� . krVi371) 1.e *Ps (A-10/itlam) 2n
•
. Na @ nd i I o fficial Signing for Signature of OffiI
Organizatio
•
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
34
ed. Employees leaving for overnight travel on or before
6:00 p.m. may be reimbursed for evening meal expenses. Noon meals may be reimbursed if -
the employee leaves on or before 11:00 a.m. (for overnight travel), or returns on or after 2:00
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
35
ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
•
CERTIFICATION REGARDING LOBBYING
The undersigned certifies, to the best of his or her knowledge and belief that:
1. No federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of any agency, a member of local government, an officer or employee of
local government, or an employee of a member of local government in connection
with the awarding of any federal contract, the making of any federal subgrant, the
making of any federal loan, the entering into of any cooperative agreement and the
extension, continuation, renewal, amendment, or modification of any federal contract,
subgrant, loan, or cooperative agreement.
2. If any funds of than federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any
agency. A member of local government, an officer or employee of local government,
or an employee of a member of local government in connection with this federal
contract, subgrant, loan, or cooperative agreement, the undersigned shall complete
and submit Standard Form—LLL, Disclosure Form to Report Lobbying in accordance
with its instructions.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for
making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any
person who fails to file the required certification shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure:
) 2vgture\of 4Iff lal signing on atebehalf of apporganization
Named titled official signing for the organization
l
Organization name
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
of the State of Nebraska.
Certification of the Principal Investigator:
Signature Printed Name
Date Title
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
30
005
31
tation is available, and an individual elects to travel by personal
automobile, reimbursement will be limited to the appropriate air fare, or the mileage
reimbursement, whichever is less.
This summary of expense policies is intended to be a guide dealing with the most common
types of expense items. If there are unusual circumstances, or if there is any question
whatsoever concerning anticipated expenses, please contact a Health and Human Services
Region representative for clarification prior to incurring the expense.
•
e 41e1 �tiT �� l� i4L YOv
•
Organization Name
n� . krVi371) 1.e *Ps (A-10/itlam) 2n
•
. Na @ nd i I o fficial Signing for Signature of OffiI
Organizatio
•
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
34
ed. Employees leaving for overnight travel on or before
6:00 p.m. may be reimbursed for evening meal expenses. Noon meals may be reimbursed if -
the employee leaves on or before 11:00 a.m. (for overnight travel), or returns on or after 2:00
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
35
ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
FISCAL REPORTING REQUIREMENTS
A. The Fiscal Agent and/or all direct Subrecipients shall submit billings for reimbursement for
actual, allowable and reasonable expenditures in accordance with the Fiscal Agent and/or
all direct Subrecipients approved project budget. The Region will make reimbursement,
subject to the following conditions:
1. The financial reimbursement request for services shall be reported on forms
specified by the Region. A financial statement of monthly revenues and expenses
shall be provided as supporting documentation with the reimbursement request.
Supporting documentation shall be defined as:
• a copy of a third party invoice (Examples of third party invoices would
include itemized billings from a supplier, or a copy of an itemized cash
register tape)
• a report from a third party provider (An example of a third party invoice
would be a departmental report for salaries and benefits provided by a
third party provider[ADP or Pay Flex])
• a report from a system independent of the general ledger (An example
on a report from a system independent of the general ledger would be a
payroll report which is processed by the payroll department)
• or an internally prepared form which is approved by a supervisor (An
example of an internally prepared form which is approved by a Supervisor
is a mileage and employee reimbursement form)
2. Government funds to support this project remain available. In the event funds cease
to be available, this subgrant shall be terminated, or the activities shall be suspended
until such funds become available. The determination of availability of governmental
funds is at the sole discretion of the Region and/or the primary funding source.
3. Reimbursement requests shall be submitted at least monthly and within the month
immediately following the month in which the service was delivered. The Region
shall have fifteen (15) working days to review and approve reimbursement
documentation.
4. Subrecipient shall submit the monthly reimbursement requests to person and
address provided by the Region.
5. Suspension or termination for cause or convenience as described in the federal
grants administration regulations applicable to the Subrecipient.
B. The Region shall pay the Subrecipient upon (1) receipt of the reimbursement request; and
required supporting documentation and (2) Region 6 Behavioral Healthcare approval of the
reimbursement request and supporting documentation.
C. Prospective Payment
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
`4V
tative for clarification prior to incurring the expense.
•
e 41e1 �tiT �� l� i4L YOv
•
Organization Name
n� . krVi371) 1.e *Ps (A-10/itlam) 2n
•
. Na @ nd i I o fficial Signing for Signature of OffiI
Organizatio
•
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
34
ed. Employees leaving for overnight travel on or before
6:00 p.m. may be reimbursed for evening meal expenses. Noon meals may be reimbursed if -
the employee leaves on or before 11:00 a.m. (for overnight travel), or returns on or after 2:00
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
35
ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
1. The Subrecipient may submit a written request for a prospective payment. The j
prospective payment or advance request shall not exceed 20% of the total funds
under this subgrant for start up activities. Such prospective payment shall provide
justification as to why such funds are required.
2. Prospective payment request must be received in the Region prior to the first
reimbursement request.
D. The Region will delay, reduce, withhold, or require repayment of funds paid to the
Subrecipient under the following conditions:
1. The Subrecipient fails to meet reasonable deadlines and/or file reports on a timely
basis.
•
2. Region,6 Behavioral Healthcare or approved Subrecipient financial reports and/or
audits reveal insufficient documentation, as prescribed by the Region's audit policies.
3. Reviews conducted by the Region indicate the funds under the contract have been
used to pay for any purposes not authorized by the subgrant.
r oa-og
Si net e o uthon z, o 'al signing igning on Date
behalf o a cant •‘.•;. ization
Kt .,,,.. 1 t (tc,:,i,( ,J
pvifo
Namelnd.(le of 6 igning for the organization
C E�� 0 e C roil F/1 14 ) ( ,,r,,,} 1,,,' i , UJ�, �\
Organization name
I
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
41
vent funds cease
to be available, this subgrant shall be terminated, or the activities shall be suspended
until such funds become available. The determination of availability of governmental
funds is at the sole discretion of the Region and/or the primary funding source.
3. Reimbursement requests shall be submitted at least monthly and within the month
immediately following the month in which the service was delivered. The Region
shall have fifteen (15) working days to review and approve reimbursement
documentation.
4. Subrecipient shall submit the monthly reimbursement requests to person and
address provided by the Region.
5. Suspension or termination for cause or convenience as described in the federal
grants administration regulations applicable to the Subrecipient.
B. The Region shall pay the Subrecipient upon (1) receipt of the reimbursement request; and
required supporting documentation and (2) Region 6 Behavioral Healthcare approval of the
reimbursement request and supporting documentation.
C. Prospective Payment
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
`4V
tative for clarification prior to incurring the expense.
•
e 41e1 �tiT �� l� i4L YOv
•
Organization Name
n� . krVi371) 1.e *Ps (A-10/itlam) 2n
•
. Na @ nd i I o fficial Signing for Signature of OffiI
Organizatio
•
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
34
ed. Employees leaving for overnight travel on or before
6:00 p.m. may be reimbursed for evening meal expenses. Noon meals may be reimbursed if -
the employee leaves on or before 11:00 a.m. (for overnight travel), or returns on or after 2:00
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
35
ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
RECORDS AND REPORTING REQUIRMENTS
A. Financial Records
1. The Fiscal Agent and/or direct Subrecipients agree to maintain complete and
accurate records regarding the expenditures of funds provided by the Region under
this subgrant.
a. The Fiscal Agent and/or all direct Subrecipients agree to be accountable to
the Region for all sources and expenditures of funds.
b. The Fiscal Agent and/or all direct Subrecipients agree to keep separate
accounting for Region 6 Behavioral Healthcare funds from any other funds
received by the Fiscal Agent and/or Subrecipient.
c. The Fiscal Agent and/or all direct Subrecipients agree to submit monthly
expenses and revenue balance sheets with the monthly reimbursement
requests.
2. Independent Annual Fiscal Audits or Financial Accounting
a. The Fiscal Agent and/or all direct Subrecipients agree to provide Region 6
Behavioral Healthcare with two copies of a fiscal audit or year end financial
statement of all expense and revenues completed by a Certified Public
Accountant during this contract period.
b. The Fiscal Agent and/or all direct Subrecipients agree to provide a copy of -
this contract to the auditor
c. The fiscal audit is due no later than 120 days following the end of the
subgrant fiscal year.
B. Program Reports
1. The Fiscal Agent and/or all direct Subrecipients agree to submit program reports
within the timeframes outlined by the Region describing progress made toward
completing activities, problems encountered, resources expended, and activities
planned for the next reporting period.
2. Any deviation from subgrant conditions, or failure to meet objectives stated in a
previous report shall be justified in writing from the Subrecipient.
3. The timeframes will be established through the Region and will be patterned after the
timeframes established by the primary funding source. Therefore, schedules may
vary as the Region will require time to collect, compile and analyze reports prior to
submission with most grants.
C. Annual Report/Subgrant Close-Out Report. The Subrecipient agrees to submit to the
Region an annual or final Subgrant Close-Out report no later than 15 days after the end of
the award period, which is due in the Region by the date established by the Region. The
final report shall include a summary of all of the previous quarterly reports, a discussion of
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
'T�
orting documentation.
C. Prospective Payment
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
`4V
tative for clarification prior to incurring the expense.
•
e 41e1 �tiT �� l� i4L YOv
•
Organization Name
n� . krVi371) 1.e *Ps (A-10/itlam) 2n
•
. Na @ nd i I o fficial Signing for Signature of OffiI
Organizatio
•
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
34
ed. Employees leaving for overnight travel on or before
6:00 p.m. may be reimbursed for evening meal expenses. Noon meals may be reimbursed if -
the employee leaves on or before 11:00 a.m. (for overnight travel), or returns on or after 2:00
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
35
ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
any deviations from subgrant requirements, Fiscal Agent/Subrecipient duties, report of
significant findings, and recommendations drawn from evaluation efforts.
• D. The Region may extend the due date for any report, upon request.
E. Close out of this subgrant shall not affect the retention period for Subrecipient records, or
Region, State, and Federal rights of access to Fiscal Agent and/or all direct Subrecipients
• records, nor shall Close out of this subgrant affect the Fiscal Agent and/or all direct
Subrecipients responsibilities regarding property, or with respect to any program income for
which the Subrecipient is still accountable under this subgrant.
F. The Fiscal Agent and/or all direct Subrecipients agree to reductions in the current Region 6
Behavioral Healthcare payment based upon any failure to comply with the subgrant
conditions, as determined by any program or financial review, conducted under this
subgrant, and/or any review conducted by the Region under its rules and regulations.
G. The Fiscal Agent and/or all direct Subrecipients shall provide the Region access to the
Fiscal Agent and/or all direct Subrecipients' financial records upon request. If after
examining the Fiscal Agent and/or all direct Subrecipients'financial records, the Region has
reasonable cause to believe that funds under the subgrant may have been used for .
purposes not specified in the subgrant, the Region may request an additional in-depth audit.
Should a more in-depth audit be required, the Region may name its representatives to
conduct an additional audit at the Subrecipient's expense.
H. The Region will offset current payments to the Fiscal Agent and/or all direct Subrecipients or
require repayment by the Fiscal Agent or Subrecipient of the amount any audit or review has
shown the Subrecipient has been overpaid or inappropriately paid by the Region.
tir4 ,
C/, {��. )
Signre f au ze official signing on Date
behalf of pli O anization
Log c,
„.,, ,
Name a� title of icial signing for the organization .i►�-1,e1'r j`J)�(1p�� L q,t, S0 �,�oU
,,
C.,qN.c,,kt5A -c) 1,,,,,k4 1.414,-,(-4vN CD\vl tr,A.-- h t 6---)1 0.-kk,'141.\ dik
Organization name }
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
43
ly reports, a discussion of
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
'T�
orting documentation.
C. Prospective Payment
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
`4V
tative for clarification prior to incurring the expense.
•
e 41e1 �tiT �� l� i4L YOv
•
Organization Name
n� . krVi371) 1.e *Ps (A-10/itlam) 2n
•
. Na @ nd i I o fficial Signing for Signature of OffiI
Organizatio
•
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
34
ed. Employees leaving for overnight travel on or before
6:00 p.m. may be reimbursed for evening meal expenses. Noon meals may be reimbursed if -
the employee leaves on or before 11:00 a.m. (for overnight travel), or returns on or after 2:00
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
35
ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
PREVENTION SYSTEM COORDINATION, PLANNING AND SERVICES
PREVENTION PROVIDERS
A. A Prevention Service Provider is defined as a for-profit entity, non-profit entity, or community
coalition whose primary activity is to provide direct services and/or education designed to
specifically reduce or delay the onset of substance abuse in accordance with grant specific
•
guidelines. Federal funds cannot be contracted with a for-profit entity.
B. Fiscal Agent is designed as the entity having responsibility for overseeing funding issued to
a coalition through Region 6 Behavioral Healthcare Prevention Block Grant Dollars.A Fiscal
Agent may be a non-profit entity selected by the coalition or a coalition that has been
incorporated as a non-profit entity and serves as the signing authority for this grant. The
Fiscal Agent shall issue Terms and Assurances to Prevention Service Providers under this
contract that are reflective of the assurances contained herein.
C. Service Provider of substance abuse prevention services funded through the Federal Block
Grant set aside must have the demonstrated ability to provide these services as set by
federal block grant requirements.
D. Each Service Provider must meet the following criteria to be an approved behavioral health
prevention provider, to be eligible for funds from the Fiscal Agent through Region 6
Behavioral Healthcare (hereinafter referred to as the Region) and the Nebraska Department
of Health and Human Services (hereinafter referred to as Department). The Fiscal Agent
shall ensure that:
1. Service Provider must be enrolled, and a member in good standing in the behavioral
health provider network in the region in which the provider will be providing services for
the Region. Based upon minimum standards set by the Department and Network
Management Team, enrollment in the network shall be determined by the Region.
2. Provide network enrollment documentation for the Region. The documentation of a
provider in good standing in one region may be accepted for the provider to be enrolled
in another region. Regions shall review and analyze all such documentation for
appropriateness and completeness. Any noted deficiency shall be corrected with the
provider. All enrollment documentation shall be available to the Department upon
request.
3. Service Provider must agree to a routine•verification of the prevention services delivered,
program fidelity and federal block grant requirements. Network Management and/or the
Department will complete verification.
4. Service Provider must agree to ensure continuity and comprehensiveness of services by
operating collaboratively with other community behavioral health prevention services and
providers. This shall include coordinating services with the Regional Prevention System
Coordination Office, other providers, the State BH Prevention Manager, and the
Department.
5. Service Provider must agree to comply with information reporting (including the
Prevention Data Set) required to maximize all federal funding.
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
?4
on or before
6:00 p.m. may be reimbursed for evening meal expenses. Noon meals may be reimbursed if -
the employee leaves on or before 11:00 a.m. (for overnight travel), or returns on or after 2:00
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
35
ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
1
,6. Service Provider shall comply with federal and state required standards of confidentiality
• and shall collaborate as a member of the regional provider network to develop regional
confidentiality protocols to ensure continuity of care with all providers in the Network.
D. Prevention Services Plan. The Fiscal Agent shall ensure that all Service Providers will
participate in the development of a comprehensive plan of direct prevention services
designed to promote mental health and prevent the abuse of substances.
1. The Prevention Services Plan is defined as a comprehensive plan based upon identified
regional needs which ensure that effective prevention services are available for both
general and high risk populations.
2. Individual providers under contract to each Region will develop goals and objectives for
Prevention Strategies approved by the Region and the Department if the agency .
receives state or federal funding for the prevention services.
0 f"-- 3-3-\--.
ignatu e uth� ,Lk
official signing on Date
behalf of applicant's ' -nization
s (1) -
3 OW
ame and 'tie of official signing for the organization
6_—_,r2-: A-7/ -tZ 0 tryA AA \:61:,\\A-k_ C__0),NrY'XN-C1 i'\11\45,A41,1, 00----)7-\
Organization name
c)
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
k i3 .
man Services (hereinafter referred to as Department). The Fiscal Agent
shall ensure that:
1. Service Provider must be enrolled, and a member in good standing in the behavioral
health provider network in the region in which the provider will be providing services for
the Region. Based upon minimum standards set by the Department and Network
Management Team, enrollment in the network shall be determined by the Region.
2. Provide network enrollment documentation for the Region. The documentation of a
provider in good standing in one region may be accepted for the provider to be enrolled
in another region. Regions shall review and analyze all such documentation for
appropriateness and completeness. Any noted deficiency shall be corrected with the
provider. All enrollment documentation shall be available to the Department upon
request.
3. Service Provider must agree to a routine•verification of the prevention services delivered,
program fidelity and federal block grant requirements. Network Management and/or the
Department will complete verification.
4. Service Provider must agree to ensure continuity and comprehensiveness of services by
operating collaboratively with other community behavioral health prevention services and
providers. This shall include coordinating services with the Regional Prevention System
Coordination Office, other providers, the State BH Prevention Manager, and the
Department.
5. Service Provider must agree to comply with information reporting (including the
Prevention Data Set) required to maximize all federal funding.
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
?4
on or before
6:00 p.m. may be reimbursed for evening meal expenses. Noon meals may be reimbursed if -
the employee leaves on or before 11:00 a.m. (for overnight travel), or returns on or after 2:00
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
35
ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
C-25A CITY OF OMAHA
• LEGISLATIVE CHAMBER
Omaha,Nebraska
RESOLVED BY THE CITY COUNCIL OF THE CITY OF OMAHA:
WHEREAS, the City of Omaha has made an application to the Nebraska
Department of Health and Human Services, Region 6 Behavioral Health Care to fund the Greater
Omaha Healthy Communities/Healthy Youth Coalitions, which will provide speakers and other
resources to promote positive, responsible behavior for all the youth in the Grater Omaha area,
while protecting them from the harmful effects of alcohol,tobacco and other drug usage; and,
WHEREAS, the Nebraska Department of Health and Human Services, Region 6
Behavioral Health Care awarded the grant to the Greater Omaha Healthy Communities/Healthy
Youth Coalition in the amount of$60,634.00 without a match requirement, the grant project and
budget period is July 1, 2008 to June 1, 2009; and,
WHEREAS, it is in the best interest of the City of Omaha and the residents
thereof to accept this grant award.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF OMAHA:
THAT, this Council does hereby approve the application for and the acceptance
of the award from the Nebraska Department of Health and Human Services, Region 6 Behavioral
Health Care, to the Greater Omaha Healthy Communities/Healthy Youth Coalition in the amount
of $60,634.00 with no match requirement to provide speakers and other resources to promote
positive, responsible behavior for all the youth in the Greater Omaha area, while protecting them
from the harmful effects of alcohol, tobacco and other drug usage, the project and budget period
is from July 1, 2008 to June 1, 2009.
APPROVED AS TO FORM:
a, c,„
D TY CITY ATTORNEY DATE
By /`+J,Iax
Councilmember
Adopted SEP " 008 7-O
0/1)04_, _
City Clerly
ble€4%
O
Approved '
Mayor
of a
provider in good standing in one region may be accepted for the provider to be enrolled
in another region. Regions shall review and analyze all such documentation for
appropriateness and completeness. Any noted deficiency shall be corrected with the
provider. All enrollment documentation shall be available to the Department upon
request.
3. Service Provider must agree to a routine•verification of the prevention services delivered,
program fidelity and federal block grant requirements. Network Management and/or the
Department will complete verification.
4. Service Provider must agree to ensure continuity and comprehensiveness of services by
operating collaboratively with other community behavioral health prevention services and
providers. This shall include coordinating services with the Regional Prevention System
Coordination Office, other providers, the State BH Prevention Manager, and the
Department.
5. Service Provider must agree to comply with information reporting (including the
Prevention Data Set) required to maximize all federal funding.
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
?4
on or before
6:00 p.m. may be reimbursed for evening meal expenses. Noon meals may be reimbursed if -
the employee leaves on or before 11:00 a.m. (for overnight travel), or returns on or after 2:00
Adapted from the Nebraska Department of Health and Human Services System Documents in 2005
35
ei+
Page 2 of 4
A licant's Name.
recipient agrees to teach only the
certified standard G.R.E.A.T.curricula,and agrees to use the approved free student workbooks and approved free
graduation certificates. The grant recipient agrees not to reproduce,in whole or in part,in any format,the student
workbooks without prior BJA approval. Order forms are available at http://www.great-online.org/.
1f1^
OJP FORM 4000/2(REV.4.88
rr�- MM h.-r
a. r. ° CCD j CCDD K 2 2 .'3' 2Ns CD
to
ri ! Ui
�• 0 r :;
•
ti �. A) � ° E � ° � x z
co
�,; -0 P CD CD •6 r' o r) " 0
(( cc
7 rti N (� N N A� O o—h En p N En CI., !A
`� o O• W ¢ci> O CD n 0
° 0 °CDOo ° N v, w / ,up ,,� \
Cr'n G ° `
• p cor
p0cr0cr ° g ,< 0O g ° `C3
CAD O 5 CCDD 0. O 0- CT O, CD CDCD
N
750 3,000
Commercial Transportation(2009-10) 4 750 3,000
Vehicle Mileage 2,500 .505 1,263
Total 9,363
Rev.4/97
Analyst
& It:?/u/a1Approve