Section 975.223  Grant Application

a)         Once the applicant fulfills the requirements of Sections 975.221 and 975.222, a grant application can be submitted.  The application shall include the following:

1)         The legal name of the applicant;

2)         The name and title of the applicant's chief officers and key managers;

3)         The applicant's address;

4)         A general description of the applicant, including its business and business experience;

5)         The applicant's telephone number and fax number;

6)         The applicant's FEIN;

7)         The applicant's Illinois Department of Human Rights number;

8)         The applicant's DUNS number;

9)         The project director's name and e-mail address;

10)         A detailed description of the project for which grant funding is requested.  This will include a summary of the applicant's plan of action to address the goals of either:

A)        Establishing a new CHC site to provide primary health care services to medically underserved populations or areas or to provide primary health care services to the uninsured population of Illinois; or

B)        Expanding the services of an existing CHC site to provide primary health care services to medically underserved populations or areas or primary health care services to the uninsured population of Illinois. (Section 10(a) of the Act)

11)         A project narrative that includes the following:

A)        The proposed service area, including a map depicting the boundaries of the service area and the identification of other FQHCs, FQHC Look-Alikes, local health departments and hospitals within the service area;

B)        A statement of need for the project, including a brief description of the project and its needs and expected accomplishments.  The narrative shall also provide a brief description of the financial and facility resources for the project;

C)        The project objectives, documenting the measurable objectives that the project will accomplish, including appropriate measuring metrics;

D)        A plan of operation describing the implementation plan for the objectives and a timetable for their achievement;

E)        A plan describing how the project will be evaluated to ascertain if the objectives have been achieved, including documenting the project's progress in meeting the particular needs of the project's service area; and

F)         A budget listing the total dollar amount needed for the project, including the amount to be provided by the applicant and other funding sources and the amount of funding requested through the grant.  The applicant shall identify all revenue sources and amounts and provide budget estimates, including expenditures for the duration of the project.  The project's budget shall include the following costs (if applicable):

i)          Personal services, including salaries and hourly compensation for officers, directors, and key employees;

ii)         Benefits;

iii)        Travel;

iv)        Commodities/supplies;

v)         Equipment;

vi)        Facility construction/renovation;

vii)       Contractual;

viii)      Printing;

ix)        Telecommunications;

x)         Patient/client care; and

xi)        Administrative costs.

b)         Flood Plain and Historic Preservation Requirements.  For construction or modernization projects, the applicant must document:

1)         Whether the project is or is not in a flood plain and that the location of the project complies with Executive Order #5 (2006):  Construction Activities in Special Flood Hazard Areas and the requirements of the Illinois Department of Natural Resources regarding construction in floodways (Construction in Floodways of Rivers, Lakes and Streams; and

2)         That the Illinois Historic Preservation Agency has determined that the project does not affect historic resources.  Information on preservation requirements is at:  www.illinoishistory.gov/ps/index.htm.

c)         When the Department receives a grant application, the following process will occur:

1)         The Department will determine whether the applicant is eligible to apply in accordance with the requirements of the Act and Section 975.220.  If the applicant is ineligible to apply, the Department will contact the applicant in writing with the determination.

2)         If the applicant is eligible to apply, the Department will determine whether the application is complete.  A review will determine whether all applicable criteria have been addressed and whether all required materials and documentation have been submitted.  The Department will also determine whether the applicant has fulfilled the requirements of Sections 975.221and 975.222.

A)        If the application is deemed complete, the Department will proceed with the application evaluation process (see Section 975.250).

B)        If the application is deemed incomplete, the Department will notify the applicant via certified mail.  An applicant has 30 calendar days from the date of receipt of the certified letter to address the issues that the Department has identified and submit a revised application.  If the applicant does not respond to the Department's determination within the prescribed time frame or if a revised application fails to address the issues identified by the Department, the application will be deemed null and void.

(Source:  Added at 35 Ill. Reg. 14202, effective August 4, 2011)