§596.50. Grant Application

The application requirements of this Section are applicable to the grants referenced in Subparts B, C and D of this Part.

 

a)         Applications shall be developed and distributed by the Department for eligible applicants.

 

b)         Applications submitted to the Department shall describe the applicant's proposed methods to achieve the goals specified in the Department's request for proposals.

 

c)         Projects that do not develop clinics or provide for direct provision of health care services can apply for and be awarded up to four years of funding.  Projects that develop clinics or provide for direct provision of health care services can apply for and be awarded up to six years of funding.

 

d)         Applications shall include, but not be limited to:

 

1)         The legal name of the applicant;

 

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

 

3)         The applicant's legal 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 (Data Universal Numbering System) number;

 

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

 

10)         A description of the project, including a summary statement of the applicant's plan to address the goals described in the Department's request for proposal;

 

11)         A description of the service area or special population group to be served by the project, a statement of the special needs of the service area or special population group and a thorough explanation of the manner in which the project would meet those needs;

 

12)         A list of objectives the applicant proposes and a time table for their achievement.  These objectives must be specific, measurable and relevant to the Department's request for proposal;

 

13)         A process that will allow for an objective evaluation of the project's progress in meeting the needs of the service area or special population group described in subsection (d)(11), including appropriate measuring metrics;

 

14)         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 could include the following costs (if applicable):

 

A)        Personal services;

 

B)        Benefits;

 

C)        Travel;

 

D)        Commodities/supplies;

 

E)        Equipment;

 

F)         Facility construction/renovation;

 

G)        Contractual;

 

H)        Printing;

 

I)         Telecommunications;

 

J)         Patient/client care; and

 

K)        Administrative costs.

 

15)       A plan and timetable for development of the project's self-sufficiency.

 

e)         In addition to the requirement of subsection (d), applications for projects that will develop or enhance a clinic shall include the following:

 

1)         Staffing plan for the clinic;

 

2)         Referral arrangements for services not available at the clinic;

 

3)         A plan for quality assurance and continuing professional education for clinic staff; and

 

4)         A plan for after-hours coverage.

 

f)        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.

 

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

 

(Source:  Added at 35 Ill. Reg. 14147, effective August 4, 2011)