STATE INFORMATION ON THE INDEPENDENT LIVING PROGRAM STATE
The State information provided below will be considered permanent and will remain in effect unless rescinded by the State, after notification in writing to the Commissioner, ACYF.
Name of Agency Administering the ILP: ____________________________________________
Employer Identification Number (EIN): _____________________________________________
ADMINISTRATION OF STATE State Administered ________ County Administered _________
* If county administered, please describe the following:
- The precise legal relationship between the State and the counties with regard to the ILP and the expenditure of funds.
- How does the State enter into agreements with the counties’
- Does the State delegate responsibility to the counties’
- Are there written agreements’
- Are there provisions for such agreements in State law or in the State plan’
STATE MATCHING INFORMATION
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The State will apply for and match the additional funds over the $45 million basic amount.
Yes ____________* No _____________
If yes, All ______________________ or $________________________
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If funds become available-through reallotment, the state will apply for and match these funds.
Yes ____________* No _____________
If yes, All ______________________ or $________________________
If yes to either item, indicate "ALL" or specify the amount of additional and the amount of reallotted funds the State will apply for and match (dollar-for-dollar).
ELIGIBLE POPULATION
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The State elects to serve non-IV-E eligible youth.
Yes __________ No _________
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The State elects to serve former foster care youth.
Yes __________ No _________
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The State elects to serve youth up to age 21.
Yes __________ No _________
If yes to any of the above, describe how the State will integrate the additional client population into planning for and implementation of the ILP.
TRUST FUNDS
The State elects to establish trust funds for youth leaving foster care.
Yes __________ No _________
If yes, please describe:
- How will the trust funds be financed’
- How will the trust funds be integrated into the overall individual independent living plan’
- What are the rules that will govern the use of and disbursement from such trust funds’
- What safeguards will be employed to ensure that no Federal ILP funds contributed to the trust fund are later used for the provision of room and board’
________________________________________________________
Signature Title
________________________________________________________
Agency/Organization
Date Definitions
(From 45 CFR Part 76, Government wide Debarment and Suspension (Nonprocurement)
Covered transaction. For purposes of these regulations, a covered transaction is a primary covered transaction or a lower tier covered transaction. Covered transactions at any tier need not involve the transfer of Federal funds.
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Primary covered transaction. Except as noted in paragraph (a) (2) of this section, a primary covered transaction is any nonprocurement transaction between an agency and a person, regardless of type, including: grants, cooperative agreements, scholarships, fellowships, contracts of assistance, loans, loan guarantees, subsidies, insurance, payments for specified use, donation agreements and any other nonprocurement transactions between a Federal agency and a person.Primary covered transactions also include those transactions specially designated by the U.S. Department of Housing and Urban Development in such agency's regulations governing debarment and suspension.
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Lower tier covered transaction. A lower tier covered transaction is:
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Any transaction between a participant and a person other than a procurement contract for goods or services, regardless of type, under a primary covered transaction.
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Any procurement contract for goods or services between a participant and a person, regardless of type, expected to equal or exceed the Federal procurement small purchase threshold fixed at 10 U.S.C. Section 2304 (g) and 41 U.S.C. Section 253 (g) (currently $25,000) under a primary covered transaction.
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Any procurement contract for goods or services between a participant and a person under a covered transaction, regardless of amount, under which that person will have a critical influence on or substantive control over that covered transaction.
Such persons are:
- Principal investigators.
- Providers of federally-required audit services.
- Researchers.
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7. The prospective primary participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions," provided by HHS, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.
8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List (of excluded parties).
9. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by as prudent person in the ordinary course of business dealings.
10. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, HHS may terminate this transaction for cause or default.
Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions
- The prospective primary participant certifies to the best of
its knowledge and beliefs, that it and its principals:
- are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;
- have not within a three-year period preceding this proposal been convicted of or had a civil Judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under public transaction; violation of Federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;
- are not presently indicted for otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification; and
- have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default.
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Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.
Grant No. ________________________________________________
Signature _______________________ Date ________________
Attachments:
Attachment A: P.L. 103-66, Section 13714 of
Subchapter C - Human Resources and Income Security Amendments
Attachment
B: FY 1994 Independent Living Program
Allotments
Attachment
D: Certifications
Attachment
E: List of Regional Administrators, ACF
