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DAAA Request Proposal Continuation Fund Form

*REQUIRED

Providers are required to prepare proposals in accordance with the following instructions:
 

A.         Proposal Cover Sheet
 

Complete the posted Proposal Cover Sheet (Attachment A) in its entirety. All requested information is required. The indicated space on the cover sheet must be signed by a person authorized to commit the agency to any eventual Service Agreement. Electronic signature is acceptable on the online version of the proposal submission; however, the hardcopy proposal submission must include an original signature. Unsigned proposals will be returned to the applicant agency. 


B.         Proposal Submission Checklist
 

Submit all sections of the proposal in the order listed in this section of the RFP and on the Proposal Submission Checklist (Attachment B).  Check the space to the left of each section listed on the Proposal Submission Checklist to indicate inclusion of that section in the proposal submission. 


C.         Program Narrative

           
1.     Project Overview


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(1,500 character limit, text)
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(500 character limit, text)
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(1,000 character limit, text)

d. Note that there are specific project expectations listed on the Scope of Services for each service. Provide an overview of how each of these expectations will be addressed in the upcoming fiscal year. Enter your responses on the relevant Scope(s) posted with this RFP, and submit separately through the submit function at the bottom of each Scope.
e. Provide fill out service projections from the document below.

f. Describe outreach strategies you will use to reach eligible individuals and inform them of the proposed services.  Outreach strategies may include: publications; organized word-of-mouth; mailings; media plans; presentations about your service; information tables; and, other overall concepts of how you will reach eligible individuals.
*REQUIRED

g.  Utilizing Attachment C, Outreach Plan, provide details on specific outreach activities you will conduct and timelines for completion.  Your plan must include specialized outreach activities targeted to reach older individuals with: the greatest economic need, especially low-income minorities; the greatest social need; severe disabilities; and limited English proficiency.


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(1,000 character limit, text)

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2. Agency & Staff Capability

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(1,000 character limit, text)

(Upload of their agency org chart)

(Upload of their program org chart)

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(1,000 character limit, text)

(500 character limit, text)

f.  By checking this box, your organization agrees to require all authorized SAMS users to complete mandatory training sessions as instructed by the DAAA Data Services Manager and/or assigned Contract Services representative, and to inform the DAAA Data Services Manager or any changes, planned or unforeseen, prior to or during the fiscal year.
*REQUIRED

g. Do any potential conflicts of interest that exist for your organization to enter into contract with the Dallas Area Agency on Aging.  

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h.  If yes, include the person for whom the potential conflict exists as well as the nature of the potential conflict of interest and the relationship to any current or former board member, current or former aging advisory committee member, or current or former employee.
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(1000 text character limit)

D. Budget Information

Proposal Budgets should be prepared using the reduced Title III planning allocation shown in the notification letter sent to you on: July 27, 2015.

Each proposed service must have its own budget workbook completed. Only Cost Reimbursement Budgets should be uploaded into the proposal submission. Fixed Unit Rate Budgets have been previously submitted to DAAA. The Cost Areas and Cost Categories overview provides narrative outlining allowable line item budget costs (Appendix A). It is not all-inclusive of allowable/disallowable costs, but addresses commonly questioned costs.  

Cost Reimbursement Budgets (Attachment D) include:
(Caregiver Information Service; Information, Referral and Assistance; Instruction and Training; Ombudsman; Senior Center Operations)

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Cost reimbursement Appendix A


· Project Staff Allocation: This worksheet should be completed first to determine total proposed Personnel expenses for the program for FY 2016. List each staff member necessary to providing the proposed service and the percentage of time they will be allocated to the project. This form self calculates the total personnel cost to the project. Total Personnel expense on the Cost Reimbursement Budget must not exceed the total allocated cost on this form.

Not Applicable

· Cost Reimbursement Budget: These worksheets are to be used to breakdown total budget cost areas to specific allowable expense categories.

· Expense Category Explanation: This worksheet must be used to provide explanations to justify all expenses allocated to Title III, Local Cash, and Other Resources, noting all sources of match and/or in-kind. The Budget Amount column will self-populate from amounts entered into the Cost Reimbursement Budget worksheets (CR Budget 1-4).

· Cost Reimbursement Budget Summary: This worksheet self populates from Cost Reimbursement Budget worksheets 1-4

· In-Kind Forms (if applicable): This workbook is available upon request to those entities planning to utilize the value of in-kind items/services to offset local cash match requirements.

Not Applicable

Fixed Unit Rate Budgets:

 

(Congregate Meals; Home Delivered Meals; Transportation)

·       FY 2016 Rate Setting workbooks for Title III funding requests for unit rate funded services have been previously submitted to DAAA.  A final copy of the workbook, signed by a person authorized to commit the agency to any eventual Service Contract must be on-file with the DAAA.  If a fully-signed, original copy of the Rate Setting workbook has not been filed, it must be submitted with the FY 2016 written proposal to be considered for funding. 


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