STATE OF ARIZONA SOCIAL SERVICES BLOCK GRANT PLAN 2012-2013 THE ARIZONA DEPARTMENT OF ECONOMIC SECURITY August 15, 2012 AZ 2012-2013 SSBG PLAN Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Title II of the Genetic Information Nondiscrimination Act (GINA) of 2008; the Department prohibits discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, disability, genetics and retaliation. The Department must make a reasonable accommodation to allow a person with a disability to take part in a program, service or activity. For example, this means if necessary, the Department must provide sign language interpreters for people who are deaf, a wheelchair accessible location, or enlarged print materials. It also means that the Department will take any other reasonable action that allows you to take part in and understand a program or activity, including making reasonable changes to an activity. If you believe that you will not be able to understand or take part in a program or activity because of your disability, please let us know of your disability needs in advance if at all possible. To request this document in alternative format or for further information about this policy, contact your local office; TTY/TDD Services: 7-1-1. • Free language assistance for DES services is available upon request. • Ayuda gratuita con traducciones relacionadas con los servicios del DES está disponible a solicitud del cliente. August 15, 2012 - ii - AZ 2012-2013 SSBG PLAN TABLE OF CONTENTS SUBJECT PAGE List of Figures ................................................................................................................... iv Appendices ........................................................................................................................ iv Introduction ....................................................................................................................... 1 SSBG Planning Level........................................................................................................ 1 TANF Block Grant Funds Transferred to the SSBG .................................................... 1 SSBG Service Goals .......................................................................................................... 2 Evaluation .......................................................................................................................... 2 Reporting on Activities Funded ....................................................................................... 2 SSBG Planning Process .................................................................................................... 2 State Planned Services ...................................................................................................... 3 Locally Planned Services .................................................................................................. 3 Arizona Tribal Entities ..................................................................................................... 4 Geographic Areas.............................................................................................................. 5 Financial Operations System ........................................................................................... 5 Proof of Audit .................................................................................................................... 5 Public Comment and Review ........................................................................................... 5 Plan Amendment ............................................................................................................... 8 Catalog of Services ............................................................................................................ 8 Federal Uniform Definitions of Services Titles .............................................................. 8 Arizona Dictionary and Taxonomy of Human Services ................................................ 9 Crosswalk for Federal SSBG Services to Arizona Taxonomy .................................... 20 Service Availability ......................................................................................................... 24 Local and State Planned Levels ..................................................................................... 25 Target Group Definitions ............................................................................................... 25 Planned Expenditures – SFY 2013 ................................................................................ 26 August 15, 2012 - iii - AZ 2012-2013 SSBG PLAN LIST OF FIGURES SUBJECT PAGE Figure 1: SSBG Geographic Areas (State Map) ............................................................ 6 Figure 2: DES Organization Chart ................................................................................. 7 APPENDICES SUBJECT PAGE Appendix A. Public Notice ............................................................................................ 59 Public Notice .............................................................................................................. 60 Appendix B. Certifications ............................................................................................ 61 Certification Regarding Lobbying .......................................................................... 62 Certification Regarding Drug-Free Workplace Requirements ............................ 63 Certification Regarding Debarment, Suspension And Other Responsibility Matters .............................................................................................. 66 Certification Regarding Environmental Tobacco Smoke .................................... 69 August 15, 2012 - iv - AZ 2012-2013 SSBG PLAN STATE OF ARIZONA Title XX Social Services Block Grant Plan July 1, 2012 – June 30, 2013 Introduction This document provides information on the types of activities supported and the categories or characteristics of individuals served under the provisions of the Omnibus Budget Reconciliation Act of 1981, Public Law 97-35, Subtitle C - Block Grants for Social Services, which amends Title XX of the Social Security Act. The Arizona Department of Economic Security (DES) under the statutory provisions of the law administers the Arizona Social Services Block Grant (SSBG) Plan (the Plan). The program period covered corresponds to the State Fiscal Year 2013 (SFY 2013), which begins on July 1, 2012, and ends June 30, 2013. SFY 2013 overlaps portions of Federal Fiscal Year 2012 (FFY 2012) and FFY 2013, which run from October 1 through September 30. SSBG Planning Level The specific formula used to estimate the amount of federal SSBG funds that are available for funding the planned services during Arizona’s SFY 2013 is calculated from one-fourth of Arizona’s FFY 2012 allocation and three-fourths of Arizona’s estimated FFY 2013 allocation. Since the actual allotment available to Arizona is determined pursuant to Congressional and Presidential approval, the services and planning levels identified are estimates. An amount of $19,992,342 TANF Block Grant funds projected to be transferred to the SFY 2013 SSBG is included in the Plan in addition to the SFY 2013 estimated SSBG funding level of $34,998,781 for a total combined planning level of $54,991,123. The Plan spreadsheets immediately follow the narrative portion of the Plan. There are Plan spreadsheets for each of the DES Administrations/Divisions that plan to use SSBG funding for SFY 2013. The spreadsheets show the Services, Target Group(s), Status Eligibility, and Funding for each of the Locally Planned and State Planned SSBG services. This format allows the DES, local entities, and the U.S. Department of Health and Human Services (DHHS) to see the planned uses for SSBG funds. TANF Block Grant Funds Transferred to the SSBG Laws 2012, Chapter 24 allows up to ten percent of Temporary Assistance to Needy Families (TANF) Block Grant funds to be transferred to the SSBG for Children Services funding. The Department is estimating a transfer of $19,992,342 of TANF funds for Children’s Services which is below ten percent of TANF Block Grant funds in accordance with the Arizona statute. August 15, 2012 -1- AZ 2012-2013 SSBG PLAN SSBG Service Goals The mission of the Arizona Department of Economic Security is to promote the safety, well-being, and self-sufficiency of children, adults, and families. Arizona’s SSBG-funded services will be directed toward one or more of the following federal goals: I. II. III. IV. V. Achieve or maintain economic self-support to prevent, reduce, or eliminate dependency. Achieve or maintain self-sufficiency, including reduction or prevention of dependency. Prevent or remedy neglect, abuse, or exploitation of children and adults unable to protect their own interests or preserving, rehabilitating, or reunifying families. Prevent or reduce inappropriate institutional care by providing for community-based care, home-based care, or other forms of less intensive care. Secure referral or admission for institutional care when other forms of care are not appropriate or providing services to individuals in institutions. The goals of DES and the five federal SSBG goals are very much aligned particularly in the areas of achieving or maintaining economic self-support to prevent, reduce, or eliminate dependency. The goals of DES are to: Strengthen individuals and families; Increase self-sufficiency; Collaborate with communities to increase capacity; and Increase efficiency and effectiveness through innovation and accountability. DES facilitates the efficient delivery of a broad array of services aimed at helping individuals and families make effective decisions to increase their safety, stability, and selfsufficiency. Evaluation The appropriate administrations within DES contracting for services funded by the SSBG have the responsibility of monitoring and evaluating the social service programs funded by the SSBG. Reporting on Activities Funded DES will prepare a report on activities carried out with funds allocated in the Plan. The report may be used to determine the extent to which funds were spent in a manner consistent with the Plan. The Annual Report of Services Funded by the Social Services Block Grant for Fiscal Year 2013 will be available to the public after January 1, 2014. To obtain copies of this report, direct your request to the contact person at the telephone number or mailing address listed on page 5 of this Plan. SSBG Planning Process DES is responsible for planning and developing the Plan. This includes acquiring input from planning regions and local planning bodies and tribal entities for locally planned SSBG services. Planning for the use of the balance of available SSBG funds is accomplished as a part of the Department’s annual budget development process. August 15, 2012 -2- AZ 2012-2013 SSBG PLAN State Planned Services The DES Administrations/Divisions participating in Arizona’s SSBG planning and reporting process are:         Administration for Children, Youth and Families (ACYF) Child Care Administration (CCA) Division of Benefits and Medical Eligibility (DBME) Division of Aging and Adult Services (DAAS) Division of Business and Finance (DBF) – Policy and Planning Administration (PPA) Division of Developmental Disabilities (DDD) Employment Administration (EA) Rehabilitation Services Administration (RSA) These Administrations/Divisions within DES perform statewide planning activities by coordinating with similar and related programs of other state and local agencies, producing planning documents, fulfilling all federal statutory responsibilities accompanying the administration of programs, and involving local planning agencies in the development of a coordinated planning effort and review of local priorities for incorporation into statewide planning products. Locally Planned Services A significant amount of SSBG services are provided primarily through local service-delivery systems contracted by DES to augment state services and to respond to local needs. Arizona's six Councils of Governments (COGs) are invited to act as a conduit for local input into this portion of the SSBG service-delivery system. The method for obtaining local input varies by COG region and typically includes using broad-based planning committee(s) to identify regional priorities for the use of locally planned funds. The following chart indicates the distribution of the allocation for locally planned services by COG region. COUNCILS OF GOVERNMENTS (COGs) Maricopa Association of Governments Pima Association of Governments Northern Arizona Council of Governments Western Arizona Council of Governments Central Arizona Association of Governments Southeastern Arizona Governments Organization TOTAL August 15, 2012 LOCAL PLANNED SERVICES ALLOCATION $3,700,944 1,450,893 375,589 443,396 414,270 387,269 $6,772,361 -3- AZ 2012-2013 SSBG PLAN Arizona Tribal Entities Tribal Nations within Arizona have been established as separate SSBG Planning and Services areas. Technical assistance is provided to tribes, upon request, by DES. Each participating tribal entity is allocated a share of the state's SSBG allocation that is based on each tribe's Arizona population. The chart below indicates the allocations, planned target group and services for each tribal services area. NAME of TRIBE Ak-Chin Indian Community Cocopah Tribe Colorado River Indian Tribes Fort McDowell Yavapai Nation Fort Mojave Tribe Gila River Indian Community Havasupai Tribe Hopi Tribe Hualapai Tribe Kaibab-Paiute Tribe Pascua Yaqui Tribe Quechan Tribe Salt River Pima-Maricopa Indian Community San Carlos Apache Tribe San Juan Southern Paiute Tribe Tonto Apache Tribe White Mountain Apache Tribe Yavapai-Apache Nation Total (Aging and Adult Home-Based Services) Tohono O'Odham (Child Day Care Services) Navajo Nation (Child Home-Based Services) Gila River Indian Community (Child Home-Based Services) TOTALS ALLOCATION $ 15,089 16,420 25,148 15,666 18,482 91,956 15,855 93,375 24,451 13,236 24,676 22,994 29,626 89,227 11,647 12,725 111,372 20,619 $ 652,564 116,258 1,197,707 17,747 $1,984,276 Tribal planned services may be contracted with each tribal government for the amount shown. Specific services and eligibility criteria are determined during the contracting process and are not designated in this Plan. August 15, 2012 -4- AZ 2012-2013 SSBG PLAN Geographic Areas The regional areas for which services are planned are identified on the map on page 6. The Plan spreadsheets further delineate many services to the county level. Financial Operations System Arizona uses a federally approved cost allocation plan. DES is responsible for administering a wide variety and large quantity of grants and therefore utilizes multiple methods to assign costs. Indirect costs are typically assigned using modified total direct cost methodology. Other methods of assigning costs include Random Moment Samples, caseload counts, population factors, square footage, and time studies. Proof of Audit In accordance with 42 U.S.C. 1397e, the Single Audit Report for year ending June 30, 2011 was performed by the State of Arizona, Office of the Auditor General and submitted to the Arizona State Legislature March 30, 2012. Public Comment and Review The proposed Arizona State Fiscal Year 2013 SSBG Plan was made available to the public, local planning agencies and tribal entities for review and comment. A public notice was posted on the Department’s Internet website on June 1, 2012 requesting public comment. Please refer to Appendix A for a copy of the public notice. All interested persons were afforded an opportunity to provide written comments on the proposed plan to the SSBG Coordinator by close of business on June 25, 2012 at the addresses listed below: Arizona Department of Economic Security Rod Huenemann, SSBG Coordinator Policy and Planning Administration 1789 West Jefferson Street - Mail Site Code 837A Phoenix, Arizona 85007 Telephone: (602) 542-3882 E-mail: SSBGInput@azdes.gov August 15, 2012 -5- AZ 2012-2013 SSBG PLAN Figure 1: Geographic Planning Areas (State Map) August 15, 2012 -6- AZ 2012-2013 SSBG PLAN Figure 2: DES Organization Chart Arizona Department of Economic Security Office of the Attorney General Nicole Davis Governor Janice K. Brewer Economic Security Advisory Council Office of Equal Opportunity (Morris Greenidge) Office of Ombudsman (Ezra Loring) Legislative Services (Kathy Ber) Strategic Partnership Director (Cheryl Holliday) Governor's Advisory Councils Director Clarence H. Carter Governor's Advisory Council on Aging (Cathy De Lisa, Executive Director) Developmental Disabilities Planning Council (Larry Clausen, Executive Director) Faith-Based & Community Initiatives Chuck Fitzgerald  Arizona Early Intervention Program Molly D. Bright Deputy Director of Programs Sharon E. Sergent Office of Accountability Marcus Hambrick     Division of Child Support Enforcement Veronica Hart Ragland     Systems & Automation Finance Policy & Resources Legal Services Division of Employment & Rehabilitation Services James Apperson Division of Benefits & Medical Eligibility Leona Hodges     Disability Determination Family Assistance Program Evaluation Coordinated Hunger Program     Child Care Employment Rehabilitation Services Unemployment Insurance Division of Developmental Disabilities Sherry M. Klein (Acting)       Business Operations Managed Care Program Operations ATPC Clinical Quality Division of Aging & Adult Services Melanie Starns          August 15, 2012 Finance & Business Operations Adult Protective Services Refugee Resettlement Elder Rights & Benefits Independent Living Support Domestic Violence Intervention Coordinated Homeless Program Community Action Programs Tribal Relations Liaison    Finance & Business Operations Administration Program Improvement Administration Comprehensive Medical & Dental Program Child Welfare Program Department of Administration Training Development Administration Correspondence Control Office Leticia Morales Financial Services Administration Michael Wisehart Division of Business & Finance Todd Bright        -7- Human Resources Administration Fred Burk  Appellate Services Audit & Management Services Licensing, Certification & Regulations Special Investigations Division of Children, Youth & Families Veronica Bossack  Deputy Director of Operations & Special Projects Jim Hillyard Volunteer Services Accounting Business System Facilities Management Accounts Receivables & Collections Procurement Policy & Planning Operations Support Services Division of Technology Services Michael Dellner          Systems & Programming Data Center Technical Support Customer Service Support Center IT Support Services Information Security Server Database Integrated Systems AZ 2012-2013 SSBG PLAN Office of Communications Tasya Peterson Plan Amendment The Plan may be revised throughout the year as necessary to reflect substantial changes in the activities provided that affect the overall intent of the Plan. Any substantive revisions will be made available for public review and comment from interested persons and federal and public agencies. Service needs and program decisions may make it necessary to add services or make changes in eligibility, geographic and service availability, or the target group to which the service may be directed. These changes may be made in the Department's contracting process or direct servicedelivery process without modifying the Plan. Catalog of Services This section identifies the services that may be funded under terms of the SSBG. The services are defined as follows: The Federal Uniform Definitions of Services is a listing of the 29 titles of services that are required to be used for the purpose of reporting SSBG expenditures annually to the Federal Government. These services are defined in Title 45, Part 96, Appendix A of the Code of Federal Regulations. The 29 titles are listed below.  Services listed in the Arizona Dictionary and Taxonomy of Human Services are provided by DES or through purchase-of-service agreements with local community service providers.  The Crosswalk for Federal SSBG Services to the Arizona Dictionary and Taxonomy for Human Services provides a listing of the Federal Service Titles and the corresponding Arizona Taxonomy Service Titles. Federal Uniform Definitions of Services Titles 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. Adoption Services Case Management Services Congregate Meals Counseling Services Day Care Services - Adults Day Care Services - Children Education and Training Services Employment Services Family Planning Services Foster Care Services for Adults Foster Care Services for Children Health Related and Home Health Services Home Based Services Home Delivered Meals Housing Services Independent and Transitional Living Services August 15, 2012 -8- 17. Information and Referral 18. Legal Services 19. Pregnancy and Parenting Services for Young Parents 20. Prevention and Intervention Services 21. Protective Services for Adults 22. Protective Services for Children 23. Recreational Services 24. Residential Treatment Services 25. Special Services for Persons with Developmental or Physical Disabilities 26. Special Services for Youth Involved In or At Risk of Involvement With Criminal Activity 27. Substance Abuse Services 28. Transportation Services 29. Other Services AZ 2012-2013 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services  Adaptive Aids and Devices A service that provides or fabricates specialized equipment that will assist persons in performing normal living skills, and any necessary installation, fitting, adjustment, and training.  Adaptive Aids and Devices – Repair/Modification A service that repairs or modifies aids and devices that assist persons in performing normal living skills.  Administrative Services Services that enable the effective administration and receipt of services.  Adoption A service that provides for the certification of a family, support services to the family after a child is placed and supervision of the family until the child’s adoption is finalized.  Adoption Services Services that provide for the selection of a family, placement and supervision of a child until an adoption is finalized.  Adoption Subsidy A service that provides payments for special services and/or maintenance for children who might otherwise not be adopted.  Adult Day Care/Adult Day Health Care A service that provides supervised planned care and health-related services to adults in a group setting during a portion of a 24-hour day.  Adult Foster Care A service that provides residential care and supervision of one to four adults in a family setting.  Advocacy Services that take action to protect the rights of individuals and ensure they receive appropriate services and benefits or to seek needed changes in the law and/or administrative rules to protect the rights of individuals and ensure adequate service levels.  Alternative Communication Training A service that provides for a specific curriculum that creates an opportunity for competency in recognized and accepted non-verbal medium.  Alternative Residential Services An alternative setting to an individual’s own home that is licensed or certified to provide one or more of the following: room and board, health care, health related services, behavioral health services, and/or habilitation for residents on a continuing basis. The setting is not a licensed nursing care institution. August 15, 2012 -9- AZ 2012-2013 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services  Assessment/Evaluation Services that provide an evaluation to identify and analyze problems, needs and/or assets and may recommend corrective action and/or treatment.  Attendant Care/Personal Assistance A service that provides a qualified individual to supply needed services in order for an individual to remain in his/her home and/or participate in work/community activities.  Basic Education A service that provides instruction in educational areas necessary for an individual to function effectively.  Behavioral Therapeutic Activities A service that provides therapeutic activities to persons and/or their families in a home, school, preschool, after school, nursery/day care, or other residential or non-office setting. (The Department of Health Services presently calls this service In Home and Community.)  Case Management A service or process that establishes a relationship with an individual or family in order to enhance their functioning and/or integration into the community. Appropriate services and/or benefits are identified, planned, obtained, provided, recorded, monitored, modified when necessary and/or terminated. This may include: assessment to determine their needs and eligibility when applying for/receiving services, assistance in finding necessary resources in addition to covered services to meet basic needs, assistance in obtaining entitlements, communication and coordination of care as well as follow-up of crisis contacts or missed appointments.  Child Care A service that provides supervised planned care for children during a portion of a 24-hour day.  Child Foster Care A service that provides family home care and supervision to child(ren) on a 24-hour day basis.  Child Support Services that locate absent parents, establish paternity, establish child support obligation, and collect and distribute child/spousal support.  Chore A service that provides for heavy indoor cleaning and may include designated outdoor tasks.  Client Access, Education and Information A service that provides education, information and assistance to individuals and groups regarding the availability of, and accessibility to, human services. August 15, 2012 - 10 - AZ 2012-2013 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services  Community Education and Information A service that provides information on, and/or instructions in, various subjects through public contact and/or meetings, printed materials and media presentations focused on a particular subject, field of interest, agency or service(s).  Community Services Services that provide a range of activities that have a measurable and major impact on causes of poverty.  Companion Services A service that provides companions and supportive services to individuals with special needs.  Comprehensive Disability Related Services Services that provide two or more of the following services that assist individuals in achieving their vocational or independent living goals. The services include but are not limited to: adaptive aids and devices, assistive technology training, independent living skills, orientation and adjustment to disability training, orientation and mobility training, and work adjustment training.  Comprehensive Service Delivery Services that provide two or more of the following services that assist individuals in accessing or receiving services: protective services, counseling, home care, home management training, reassurance, home repair/adaptation/renovation, transportation, parent aide service and case management.  Comprehensive Youth Development A service that mobilizes volunteers who are adults to carry out programs that develop the personal fitness and character of youth.  Congregate Meals A service that provides for a nutritious meal containing at least 1/3 of the Recommended Dietary Allowance for an individual in a congregate setting.  Consultation A service that provides professional information and advice to assist in planning, developing, implementing and evaluating individual and service programs and in providing coordination with the professional community.  Coordination A service that promotes efficiency through the cooperation and collaboration of multiple entities concerned with the same issue or need.  Counseling/Intervention Services that provide for a wide range of personal, interpersonal, situational, and functional guidance. August 15, 2012 - 11 - AZ 2012-2013 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services  Crisis Shelter Services Services that provide assistance to abused individuals or families. Services include, but are not limited to both the shelter and counseling.  Day Care Services that provide for, and support the provision of, supervised planned care during a portion of a 24-hour day.  Day Treatment and Training Services that provide training, supervision, therapeutic activities and as appropriate, counseling, to promote skill development in independent living, self care, communication, and social relationships.  Developmental Day Training A service that provides specialized sensor motor, cognitive, communicative, social, interaction, and behavioral training for some portion of a 24-hour day.  Developmental Disability Day Care A service that provides supervised planned care, daily living skills training, and habilitation services in a group setting during a portion of a 24-hour day.  Drug Abuse Counseling A service that provides an individual an opportunity to learn the effects of drug abuse and counsels the person on alternative life style habits.  Eligibility Determination A service that provides a decision that an individual or household is or is not qualified for services or benefits.  Emergency Human Services Services that respond to crises-related situations where there is an inability to provide for the basic needs. Services may include, but are not limited to: case management, financial and referral.  Emergency Shelter A service that provides immediate shelter to persons who are without shelter or a fixed place of residence. Emergency shelter may usually be provided for a period of up to 120 days.  Employment Related Services Services that provide outreach, intake, eligibility, placement and follow-up activities in support of obtaining employment. Services may include, but are not limited to: occupational/vocational education, assessment, basic education, work experience, counseling, case management, job development and placement, work adjustment training, supported employment, supported employment extended, work exploration, and prevocational training. August 15, 2012 - 12 - AZ 2012-2013 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services  Employment Services Services that provide activities and assistance in support of finding, entering or retaining a job for individuals or groups.  Exemplary Youth Work Program Services that provide various employment-related training activities for youth. Services may include, but are not limited to: occupational/vocational education, assessment, basic education, work experience, counseling, case management, and job placement.  Family Planning A service that provides assistance to individuals to voluntarily implement plans to determine the number and spacing of children.  Food Administration A service that provides for the storage, handling, and distribution of food products.  General Transportation A service that provides or assists in obtaining various types of transportation for specific needs.  Group Home Care A licensed facility for the 24-hour care and supervision of individuals.  Habilitation Services Services that provide a variety of interventions designed to maximize the functioning of persons with developmental disabilities. Services may include, but are not limited to: habilitative therapies, special developmental skills, behavior intervention, and sensorimotor development.  Home Care Services that provide individuals who are at risk of institutionalization with coordinated inhome support needed to remain at home. Services may include, but are not limited to: attendant care/personal assistance, housekeeping/homemaker, chore, home health aid, personal care, respite, and nursing services.  Home Delivered Meals A service that provides for a nutritious meal containing at least 1/3 of the Recommended Dietary Allowance for an individual, delivered to his/her place of residence.  Home Health Aid A service that provides intermittent health maintenance continued treatment or monitoring of a health condition and supportive care for activities of daily living at the individual’s place of residence.  Home Management Skills Training A service that provides training in activities related to routine household maintenance. August 15, 2012 - 13 - AZ 2012-2013 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services  Home Recruitment and Study A service that identifies families for either permanent placements or to provide child care services, conducts training to families and prepares the home study for licensure/certification.  Home Repair/Renovation A service that provides for safety and/or structural repairs to the home.  Hospice A service that provides health care and emotional support to terminally ill individuals and their families/caregivers during the final stages of life.  Housekeeping/Homemaker A service that provides assistance in the performance of routine household activities at an individual’s place of residence.  Housing Search and Relocation A service that provides assistance toward locating suitable housing.  Housing Support Services Services that focus on providing the necessary supports to locate and maintain a home.  Independent Living A service that provides for individuals living independently and possessing the skills necessary to function at a minimum level of self-sufficiency.  Independent Living Skills A service that provides interpersonal and daily living skills training and counseling to prepare individuals for independent living.  Information and Referral A service that provides or arranges for assistance to individuals to enable them to gain access to services through the provision of accurate and current information and referral to appropriate resources. Referral may involve short-term supportive assistance and followup.  In-Home Family Support Services that provide coordinated support services that will assist the family to remain intact or an individual to remain in his/her home.  Intensive Family Preservation and Reunification Services Services that provide intensive crisis-oriented activities to families whose children are at significant risk of out-of-home placement due to abuse and/or neglect in order to allow those children to safely remain in their own home. Services may include, but are not limited to: counseling, communication and negotiation skills, parenting skills training, home management skills, job readiness training, case management, and development of linkages to community resources. August 15, 2012 - 14 - AZ 2012-2013 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services  Interpreter A service that provides a person or equipment to facilitate communication.  Job Development and Placement A service that provides assistance in obtaining employment for job-ready individuals.  Job Training A service that develops specific vocational skills.  Legal Assistance A service that provides consultation and representation of civil and legal matters.  Legal Services Services that provide for consultation and information based on law.  Long-Term Care Advocacy A service that is to investigate and resolve complaints relating to administrative action that may adversely affect the health, safety, welfare and rights of individuals who are residents of long term care facilities.  Medical Alert System Services provide access to emergency assistance by means of an electronic alert system for vulnerable individuals who live alone or are left alone for an extended period.  Mental Health Education A service that provides instruction utilizing a positive life style as the medium of instruction.  Monitoring A service that checks and keeps track of contractor compliance with state, federal and contractual regulations, rules and conditions.  Nursing A service that provides nursing intervention that may include patient care, coordination facilitation and education.  Nutrition Education A service that provides individual or group instruction about food to maintain or improve development.  Occupational Therapy A service that directs the individual’s participation in selected activities to restore, maintain or improve functional skills.  Occupational/Vocational Education A service that provides instruction and/or skills training in technical, business and other trade areas. Training may be provided in a classroom or actual job setting. August 15, 2012 - 15 - AZ 2012-2013 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services  Orientation and Mobility Training A service that provides skills training that assists a person in safely navigating an identified environment.  Outreach A service that provides a systematic method to identify and directly contact persons in need of services.  Parent Aide Service A service that provides a range of support services instruction and assistance to parents or caregivers to improve their skills and ability to fulfill parenting roles and responsibilities.  Parenting Skills Training A service that provides training that promotes specific parent or caregiver skills.  Peer Counseling A service that provides self-help opportunities.  Personal Care A service that provides assistance with personal physical needs.  Personal Escort A service that provides an escort who transports and assists an individual to perform necessary errands away from the residence.  Personal Living Skills Training A service that provides training that promotes specific self-care skills.  Physical Therapy A service that provides treatment to restore, maintain or improve a physical function.  Planning A service that identifies and analyzes priority needs, explores options, establishes goals, and develops a course of action that will bring about a desired condition or event at some specific time in the future.  Prevention Services that provide for planned efforts to prevent specific conditions, illnesses, injuries or environmental hazards that could place an individual, group or community at risk for a negative social, physical, behavioral or health outcome.  Prevocational Training A service that provides sensorimotor, cognitive, communicative, social interaction and behavioral training necessary for vocational activities. August 15, 2012 - 16 - AZ 2012-2013 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services  Professional Family Foster Care Services that provide in a family-based home, care and supervision of a child on a 24-hour basis and include specialized care and support services, which are the responsibility of the licensee who serves as the foster parent. ● Professional Specialty A service that allows for the provision of services not otherwise identified separately in this Arizona Dictionary and Taxonomy of Human Services that requires special expertise, knowledge or credentials in a given area.  Program Administration A service that distributes and administers funds received for programs.  Program Development A service that researches and/or establishes a new service(s); improves, expands, or integrates an existing service(s).  Program Evaluation A service that assesses systematically the impact and/or efficiency of programs.  Protective Services Services that provide support to individuals who are in abusive, self-neglect, or vulnerable situations. Services may include, but are not restricted to: financial, shelter, legal, counseling, information and referral and follow-up.  Reassurance A service that provides a regular contact system for individuals restricted to their place of residence.  Rehabilitation Instructional Services Services that provide training in community living skills and activities directed toward personal and social adjustment.  Relinquishment and Severance A service that assists biological and/or legal parents in the decision and/or process of relinquishment or termination of their rights as parents.  Research A service that entails gathering information on specific topics.  Residential Living and Development Services that provide for varying degrees of residential care, supervision, counseling, and training in activities of daily living.  Respiratory Therapy A service that provides treatment to restore, maintain, or improve breathing. August 15, 2012 - 17 - AZ 2012-2013 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services  Respite Services that provide different types of respite.  Respite Care A service that provides short-term care and supervision consistent with the health needs of the person to supplement care to provide a safe living environment and/or to support or relieve caregivers for the benefit of the person.  Self-Help Group A service that provides peer intervention in a group setting.  Shelter Services that provide for care, refuge, and protection.  Sheltered Employment A service that provides a controlled and protected work environment, additional supervision, and other supports for individuals engaged in remunerative work either in a sheltered workshop or in the community.  Social Adjustment A service that instructs multiple domains of a person’s life for improved functioning.  Social Development Services that provide structure and instruction, designed to promote improved social functioning.  Socialization and Recreation A service that promotes mentally and emotionally healthy interaction between participants and that may be organized around leisure activities.  Speech Therapy A service that provides evaluations, program recommendations, and/or treatment/training in receptive and expressive language, voice, articulation, and fluency.  Staff Development and Training A service that provides an organized method of improving needed staff skills.  Substance Abuse Assessment A service that provides for the assessment of an individual to determine substance abuse and dependence and recommend interventions and treatment.  Substance Abuse Screening A service that provides for the screening of an individual to determine the presence of alcohol or drug abuse. (Note: For testing, reference Clinical Laboratory Service.) August 15, 2012 - 18 - AZ 2012-2013 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services  Supervised Employment Services that provide for training in an area of employment under guidance of a trained supervisor.  Supported Employment A service that provides job development, assistance in matching the individual with an integrated competitive job, and intensive time-limited supports to an employed individual once placed.  Supported Employment, Extended A service that provides long-term, on-going support services for an employed individual.  Supportive Intervention/Guidance Counseling A service that provides supportive intervention and/or guidance.  Transitional Housing A service that provides long-term shelter for a period of up to two years to homeless persons, who are sufficiently stabilized to pursue some level of self-sufficiency, but may require additional supportive services. The goal of this service is to facilitate movement to permanent housing.  Transitional Shelter A service that provides short-term care.  Transportation Services that promote or provide mobility.  Unaccompanied Minors Service A service that provides foster care provisions for refugee minors who are in the United States without a qualified parent or legal guardian.  Utility Assistance A service that provides financial and/or non-financial aid to meet residential public service needs.  Volunteer Services A service that provides coordination of volunteer activities.  Work Adjustment Training A service that provides training in the meaning, value and demands of work and in the development of positive attitudes toward work.  Work Experience A service that provides work situations and support services to foster and promote the transition to employment. August 15, 2012 - 19 - AZ 2012-2013 SSBG PLAN Crosswalk for Federal SSBG Services to the Arizona Dictionary and Taxonomy of Human Services SSBG Services for Federal Reporting Requirements Arizona Taxonomy Services Approved for SSBG Funding 1. Adoption Services  Adoption  Adoption Services  Adoption Subsidy  Relinquishment and Severance 2. Case Management Services  Case Management  Coordination  Eligibility Determination  Emergency Human Services 3. Congregate Meals  Congregate Meals 4. Counseling Services  Assessment/Evaluation  Counseling/Intervention  Professional Specialty  Supportive Intervention/Guidance Counseling 5. Day Care Services-Adults  Adult Day Care/Adult Day Health Care  Companion Services  Day Treatment and Training  Developmental Day Training  Monitoring 6. Day Care Services-Children  Child Care  Day Treatment and Training  Developmental Day Training  Home Recruitment and Study  Monitoring 7. Education and Training Services  Alternative Communication Training  Basic Education  Interpreter 8. Employment Services  Adaptive Aids and Devices  Adaptive Aids and Devices – Repair/Modification  Assessment /Evaluation  Employment Related Services  Exemplary Youth Work Program  Job Development and Placement  Job Training  Mature Worker Program August 15, 2012 - 20 - AZ 2012-2013 SSBG PLAN Crosswalk for Federal SSBG Services to the Arizona Dictionary and Taxonomy of Human Services 8. Employment Services (Continued)  Occupational/Vocational Education  Prevocational Training  Sheltered Employment  Supported Employment  Supported Employment, Extended  Work Adjustment Training  Work Experience 9.  Family Planning Family Planning Services 10. Foster Care Services for Adults  Adult Foster Care  Home Recruitment and Study 11. Foster Care Services for Children  Child Foster Care  Home Recruitment and Study  Monitoring  Professional Family Foster Care 12. Health Related and Home Health Services  Disease Prevention and Health Promotion  Home Health Aid  Hospice  Medical Alert System 13. Home Based Services  Administrative Services  Attendant Care/Personal Assistance  Community Services  Home Care  Housekeeping /Homemaker  Orientation and Mobility Training  Parent Aid Service  Personal Care  Personal Living Skills Training  Program Development  Reassurance  Rehabilitation Instructional Services  Respite 14. Home Delivered Meals  Home Delivered Meals 15. Housing Services  Emergency Shelter  Home Repair/Renovation  Housing Search and Relocation  Housing Support Services  Planning  Shelter  Transitional Housing August 15, 2012 - 21 - AZ 2012-2013 SSBG PLAN Crosswalk for Federal SSBG Services to the Arizona Dictionary and Taxonomy of Human Services 16. Independent and Transitional Living Services  Independent Living Skills  Unaccompanied Minors Service 17. Information and Referral  Client Access, Education and Information  Community Education and Information  Coordination  Information and Referral  Outreach  Volunteer Services 18. Legal Services  Legal Assistance 19. Pregnancy and Parenting Services For Young Parents  Community Education and Information  Parenting Skills Training 20. Prevention and Intervention Services  Advocacy  Behavioral Therapeutic Activities  Comprehensive Service Delivery  Comprehensive Youth Development  Counseling/Intervention  Crisis Shelter Services  Emergency Shelter  In-Home Family Support  Intensive Family Preservation and Reunification Services  Long-Term Care Advocacy  Parent Aide Service  Peer Counseling  Supportive Intervention/Guidance Counseling  Transitional Shelter 21. Protective Services for Adults  Emergency Human Services  Protective Services 22. Protective Services for Children  Emergency Human Services  Protective Services 23. Recreational Services  Comprehensive Youth Development  Social Adjustment  Socialization and Recreation 24. Residential Treatment Services  (Not a DES service) August 15, 2012 - 22 - AZ 2012-2013 SSBG PLAN Crosswalk for Federal SSBG Services to the Arizona Dictionary and Taxonomy of Human Services 25. Special Services for Persons With Developmental or Physical Disabilities  Adaptive Aids and Devices  Adaptive Aids and Devices – Repair/Modification  Alternative Communication Training  Attendant Care/Personal Assistance  Day Treatment and Training  Developmental Day Training  Developmental Disability Day Care  Comprehensive Disability Related Services  Employment Services  Employment Related Services  Habilitation Services  Home Management Skills Training  Housekeeping/Homemaker  Independent Living  Interpreter  Job Training  Occupational Therapy  Personal Living Skills Training  Physical Therapy  Rehabilitation Instructional Services  Respite  Sheltered Employment  Socialization and Recreation  Speech Therapy  Supported Employment  Supported Employment, Extended  Transportation 26. Special Services For Youth Involved in or at Risk of Involvement with Criminal Activity  Prevention 27. Substance Abuse Services  Assessment/Evaluation  Case Management 28. Transportation Services  Personal Escort  Transportation 29. Other Services  Program Administration  Program Occupancy  Research  Coordination August 15, 2012 - 23 - AZ 2012-2013 SSBG PLAN SSBG funds may not be used for direct monetary payments to SSBG clients, purchase of land, build buildings, public school system, and professional medical care. However, there are exceptions that allow the use of SSBG funds for some of these items under certain circumstances. Service Availability The Services, Target Group Eligibility and Status Eligibility sections are identified below and provide the primary basis for determining eligibility for service. In addition to these areas, service availability will be determined on the basis of programmatic need for service. More specific service availability criteria may be specified in the purchase-of-service contracts with provider agencies. An individual who is determined to be eligible under the above criteria shall not be denied access to services because of any other condition, although providers may use waiting lists and/or set priorities for services based on level of need for the service. A. Services This column lists the services available in the geographic area. Eligibility for service may vary from one geographic area to another, and services may only be available in certain areas of the state. Some services may be identified as being available on a statewide basis. B. Target Group Eligibility This column identifies the types of individuals eligible for service. The most common target groups identified are adults, children, elderly, persons with disabilities, developmentally disabled, and adults/families/children. The definitions of these target groups are identified on page 25. Combinations of target groups may be identified (e.g., elderly persons with disabilities would be designated as "ELD/PWD"). Also, there may be characteristics added to the target groups (e.g., ELD/PWD/Blind) that further clarify availability of service. C. Status Eligibility This column identifies the financial category for which individuals must qualify in order to be eligible for service. Arizona does not require a means test for SSBG-funded services. Children and their families who receive services that are funded with TANF funds transferred to the SSBG must have incomes less than 200 percent of the federal poverty level. 1. Income Eligibility TANF/SSBG Funds - Services funded by TANF are restricted, transferred funds to SSBG as required by 42 U.S.C. Part A, Title IV, Sec. 404, (d) (3) (B), which reads: EXCEPTION RELATING TO TITLE XX PROGRAMS. All amounts paid to a State under this part that are used to carry out State programs pursuant to Title XX shall be used only to carry out programs and services to children and their families whose income is less than 200 percent of the income official poverty line (as defined by the Office of Management and Budget, revised annually…Act of 1981) applicable to a family of the size involved. 2. Income Eligibility Child Care - The Child Care Administration provides child care assistance to support working families with incomes at or below 165 percent of the federal poverty level. Working families whose incomes are at or below 100 percent of the federal poverty level and working families that are transitioning off of cash assistance with incomes at or below 165 percent of the federal poverty level receive priority status for services. Families referred by Child Protective Services (CPS), August 15, 2012 - 24 - AZ 2012-2013 SSBG PLAN children receiving CPS foster care, and families who are receiving cash assistance and are participating in the Employment Administration-Jobs program and/or who are employed receive services without regard to income. 3. Group - All individuals within a specific target group are financially eligible. 4. Homeless - Individuals who have been evicted from a residence, who are residing in an emergency shelter, or who are without a regular nighttime residence and who are without family or friends that are able or willing to share their residence. Local and State-Planned Levels These columns represent estimates of the federal dollars that may be utilized for the delivery of the services. Target Group Definitions 1. Adults (AD) - Any individual 18 years of age or older. 2. Children (CH) - Any individual under the age of 18. 3. Developmentally Disabled Individuals (DD) - Any individual having a severe, chronic disability attributable to a cognitive disability, cerebral palsy, epilepsy or autism, and which manifested itself before age 18, is likely to continue indefinitely and results in substantial functional limitations in three or more areas of the major life activities; and reflects the need for a combination and sequence of special, interdisciplinary or generic care, treatment, or other services, which are of lifelong or extended duration and are individually planned or coordinated.  "Major life activities" for the purpose of this definition are: (1) self-care; (2) receptive and expressive language; (3) learning; (4) mobility; (5) self-direction; (6) capacity for independent living; and (7) economic self-sufficiency. 4. Elderly (ELD) - Any individual 60 years of age or older. 5. Persons with Disabilities (PWD) - Any individual who has a physical or mental impairment that substantially limits one or more major life activities and has a diagnosis of such impairment.  "Physical or Mental Impairment" includes physiological conditions, cosmetic disfigurements, anatomical losses or mental disorders.  "Diagnosis" means diagnosed or classified as having a physical or mental impairment by a doctor of medicine, a doctor of osteopathy or a psychologist certified by either the Arizona State Board of Psychologist Examiners or the Department of Education.  "Major life activities" for the purpose of this definition are: (1) self-care; (2) receptive and expressive language; (3) learning; (4) mobility; (5) self-direction; (6) capacity for independent living; and (7) economic self-sufficiency. 6. Adults/Families/Children (AFC) - Any individual or family. August 15, 2012 - 25 - AZ 2012-2013 SSBG PLAN DIVISION OF CHILDREN, YOUTH, AND FAMILIES (DCYF) SFY 2013 DISTRICT I (MARICOPA COUNTY) SERVICES TARGET GROUP STATUS ELIG. LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL $ 37,375 Case Management CH (Pregnant/ Parenting Youth) Group $ 37,375 $ - Counseling/Intervention AFC Group $ - $ 183,484 $ 183,484 Supportive Intervention/Guidance Counseling CH Group $ 47,578 $ - $ 47,578 Crisis Shelter Services DISTRICT I TOTALS CH Group $ $ 73,391 158,344 $ $ 8,916 192,400 $ $ 82,307 350,744 DISTRICT II (PIMA COUNTY) SERVICES TARGET GROUP STATUS ELIG. LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL Supportive Intervention/Guidance Counseling AD/CH (DV Offenders) Group $ 44,307 $ - $ 44,307 Supportive Intervention/Guidance Counseling AD/CH (Rural DV Offenders) Group $ 44,307 $ - $ 44,307 Supportive Intervention/Guidance Counseling AFC Group $ 93,031 $ - $ 93,031 Supportive Intervention/Guidance Counseling AFC (Rural) Group $ 93,031 $ - $ 93,031 Behavioral Therapeutic Activities CH Group $ 69,551 $ - $ 69,551 Counseling/Intervention DISTRICT II TOTALS AFC Group $ $ 344,227 $ $ 33,568 33,568 $ $ 33,568 377,795 August 15, 2012 -26- AZ 2012-2013 SSBG PLAN DIVISION OF CHILDREN, YOUTH, AND FAMILIES (DCYF) SFY 2013 DISTRICT III (APACHE, COCONINO, NAVAJO, YAVAPAI COUNTIES) SERVICES TARGET STATUS GROUP ELIG. COCONINO COUNTY Supportive Intervention/Guidance Counseling COCONINO TOTALS AFC YAVAPAI COUNTY Community Education & Information CH Supportive Intervention/Guidance Counseling YAVAPAI TOTALS DISTRICT WIDE Counseling/Intervention DISTRICT WIDE TOTALS DISTRICT III TOTALS AFC Children Group LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL $ 28,920 $ - $ 28,920 $ 28,920 $ - $ 28,920 Group $ 11,644 $ - $ 11,644 Group $ 11,644 $ - $ 11,644 $ 23,288 $ - $ 23,288 $ $ $ 52,208 $ $ $ 18,650 18,650 18,650 $ $ $ 18,650 18,650 70,858 Group DISTRICT IV (LA PAZ, MOHAVE, YUMA COUNTIES) SERVICES DISTRICT WIDE Counseling/Intervention TARGET GROUP AFC STATUS ELIG. Group DISTRICT WIDE TOTALS DISTRICT IV TOTALS August 15, 2012 -27- LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL $ - $ 33,571 $ 33,571 $ $ - $ $ 33,571 33,571 $ $ 33,571 33,571 AZ 2012-2013 SSBG PLAN DIVISION OF CHILDREN, YOUTH, AND FAMILIES (DCYF) SFY 2013 DISTRICT V (GILA, PINAL COUNTIES) SERVICES GILA COUNTY Prevention Supportive Intervention/Guidance Counseling GILA TOTALS PINAL COUNTY Prevention Supportive Intervention/Guidance Counseling PINAL TOTALS DISTRICT WIDE Counseling/Intervention DISTRICT WIDE TOTALS DISTRICT V TOTALS TARGET GROUP STATUS ELIG. GRAHAM COUNTY Prevention GRAHAM TOTALS DISTRICT WIDE Supportive Intervention/Guidance Counseling DISTRICT WIDE TOTALS DISTRICT VI TOTALS August 15, 2012 STATE PLANNED LOCAL & STATE TOTAL AFC Group $ 4,664 $ - $ 4,664 AFC Group $ 8,292 $ - $ 8,292 $ 12,956 $ - $ 12,956 AFC Group $ 11,402 $ - $ 11,402 AFC Group $ 27,470 $ - $ 27,470 $ 38,872 $ - $ 38,872 $ $ $ 51,828 $ $ $ 15,212 15,212 15,212 $ $ $ 15,212 15,212 67,040 AFC Group DISTRICT VI (COCHISE, GREENLEE, GRAHAM, SANTA CRUZ COUNTIES) SERVICES TARGET STATUS GROUP ELIG. GREENLEE COUNTY Supportive Intervention/Guidance Counseling GREENLEE TOTALS LOCAL PLANNED AFC Group LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL $ 7,874 $ - $ 7,874 $ 7,874 $ - $ 7,874 AFC Group $ $ 25,758 25,758 $ $ - $ $ 25,758 25,758 AFC Group $ 4,818 $ 15,212 $ 20,030 $ $ 4,818 38,450 $ $ 15,212 15,212 $ $ 20,030 53,662 -28- AZ 2012-2013 SSBG PLAN DIVISION OF CHILDREN, YOUTH, AND FAMILIES (DCYF) SFY 2013 TRIBAL AND STATEWIDE SERVICES TARGET GROUP STATUS ELIG. TRIBAL ACYF/ITCA Tribal Consultation LOCAL PLANNED $ STATE PLANNED LOCAL & STATE TOTAL - $ 31,642 $ 31,642 Navajo Home Based Services CH (Tribal Allocation, chart on page 4 of this Plan) Group $ 1,197,707 $ - $ 1,197,707 Gila Home Based Services (Tribal Allocation, chart on page 4 of this Plan) TRIBAL TOTALS Group $ 17,747 $ - $ $ 1,215,454 $ 31,642 680,213 CH 17,747 $ 1,247,096 ADMINISTRATION/OTHER In-Home Family Support AFC Group $ - $ Foster Care Services for Children CH Group $ - $ 7,581,567 $ 7,581,567 Group $ - $ $ $ - $ 19,992,342 $ 19,992,342 Protective Services for Children AFC (Caseload Growth CPS In & Out-ofHome) TANF/SSBG Funds Children's Services (Laws 2012, Chapter 294) 286,301 $ 680,213 286,301 Case Management AFC Group $ - $ 1,379,457 $ 1,379,457 Home Recruitment and Study AFC Group $ - $ $ ADMIN / OTHER TOTALS TRIBAL AND STATEWIDE SERVICES 38,920 38,920 $ $ 1,215,454 $ 29,958,800 $ 29,990,442 $ 29,958,800 $ 31,205,896 LOCAL PLANNED STATE PLANNED $ 1,860,511 $ 30,299,055 LOCAL & STATE TOTAL $ 32,159,566 NOTE: TANF Funds Transferred to SSBG Federal Restrictions: TANF/SSBG funds are restricted for use per 42 U.S.C. Part A, Title IV, Sec. 404, (d) (3) (B), which reads: "EXCEPTION RELATING TO TITLE XX PROGRAMS. All amounts paid to a State under this part that are used to carry out State programs pursuant to Title XX shall be used only to carry out programs and services to children and their families whose income is less than 200 percent of the income official poverty line (as defined by the Office of Management and Budget, revised annually… Act of 1981) applicable to a family of the size involved." ALL ACYF SERVICES ACYF TOTALS August 15, 2012 -29- AZ 2012-2013 SSBG PLAN CHILD CARE ADMINISTRATION (CCA) SFY 2013 STATEWIDE SERVICES TARGET GROUP STATUS ELIG. Tribal Allocation (Tohono O'odham Nation for Day Care Services Children) (Tribal Allocation, chart on page 4 of this Plan) CH Group Day Care Services - Children Group CH STATEWIDE TOTALS LOCAL PLANNED $ 116,258 STATE PLANNED $ - LOCAL & STATE $ 116,258 $ - $ 163,432 $ 163,432 $ 116,258 $ 163,432 $ 279,690 ALL CCA SERVICES LOCAL PLANNED $ 116,258 CCA TOTALS August 15, 2012 -30- STATE PLANNED $ 163,432 LOCAL & STATE $ 279,690 AZ 2012-2013 SSBG PLAN Division of Benefits and Medical Eligibility (DBME) SFY 2013 District II (Pima County) SERVICES Congregate Meals TARGET GROUP Children STATUS ELIG. Group District II (Pima County) LOCAL PLANNED $ 31,563 STATE PLANNED $ - LOCAL & STATE $ 31,563 $ $ $ 31,563 - 31,563 STATEWIDE SERVICES Coordination: Food Bank TARGET GROUP AFC STATUS ELIG. Group STATEWIDE LOCAL PLANNED $ - STATE PLANNED $ 261,150 LOCAL & STATE $ 261,150 $ $ $ - 261,150 261,150 ALL DBME SERVICES LOCAL PLANNED $ 31,563 DBME TOTALS August 15, 2012 -31- STATE PLANNED $ 261,150 LOCAL & STATE $ 292,713 AZ 2012-2013 SSBG PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2013 DISTRICT I (MARICOPA COUNTY) SERVICES TARGET GROUP STATUS ELIG. LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL Adult Day Care/Adult Day Health Care ELD Group $ 195,930 $ 23,376 $ 219,306 Adult Day Care/Adult Day Health Care PWD Group $ 10,260 $ - $ 10,260 Adult Protective Services ELD/PWD Group $ - $ 62,235 $ 62,235 Congregate Meals PWD Group $ 11,144 $ 1,473 $ 12,617 Supportive Intervention/Guidance Counseling ELD Group $ - $ 43,450 $ 43,450 Home Delivered Meals ELD Group $ 452,468 $ - $ 452,468 Home Delivered Meals PWD Group $ 19,049 $ - $ 19,049 Transportation ELD Group $ - $ 7,008 $ 7,008 Home Care ELD Group $ 341,621 $ 2,025,718 $ 2,367,339 Home Care PWD Group $ 29,301 $ - $ 29,301 Administrative Services ELD/PWD Group $ - $ 424,319 $ 424,319 Respite ELD/PWD Group $ - $ 192,826 $ 192,826 Case Management ELD/PWD Group $ - $ 362,715 $ 362,715 Coordination ELD Group $ - $ 18,221 $ 18,221 Volunteer Services PWD Group $ - $ 1,400 $ 1,400 Legal Assistance ELD Group $ - $ 18,888 $ 18,888 Emergency Shelter AFC (Victims of Domestic Violence) Group $ 352,943 $ - $ 352,943 Supportive Intervention/Guidance Counseling AFC (Domestic Violence) Group $ 34,979 $ - $ 34,979 Emergency Shelter AFC (Homeless Families & Individuals) Group $ 290,862 $ 122,900 $ 413,762 Transitional Housing ELD/DD (Homeless) Group $ 98,669 $ - $ 98,669 August 15, 2012 -32- AZ 2012-2013 SSBG PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2013 Transitional Housing AFC Group $ 69,354 $ - $ 69,354 Case Management (Basic Needs) AFC Group $ 1,031,644 $ - $ 1,031,644 Housing Support Services AFC (Homeless) Not Ap. $ - $ 31,614 $ 31,614 Transitional Housing AFC (Homeless) Not Ap. $ - $ 72,864 $ 72,864 Research AFC (Homeless) Not Ap. $ - $ 3,605 $ 3,605 $ 3,412,612 $ 6,350,836 DISTRICT I TOTALS August 15, 2012 $ 2,938,224 -33- AZ 2012-2013 SSBG PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2013 DISTRICT II (PIMA COUNTY) SERVICES TARGET GROUP STATUS ELIG. LOCAL PLANNED STATE PLANNED Home Care (Personal Care, Housekeeping & Home Health) ELD or PWD Group $ 356,760 Medical Alert System ELD or PWD Group $ Adult Day Care ELD or PWD Group Case Management ELD or PWD Case Management - Intake LOCAL & STATE TOTAL $ 1,055,709 $ 1,412,469 - $ 12,200 $ 12,200 $ - $ 3,231 $ 3,231 Group $ 352,770 $ - $ 352,770 ELD or PWD Group $ - $ 133,918 $ 133,918 Home Repair/Renovation ELD or PWD Group $ - $ 28,002 $ 28,002 Home Delivered Meals ELD or PWD Group $ 82,719 $ - $ 82,719 Administrative Services ELD or PWD Group $ - $ 199,154 $ 199,154 Advocacy ELD or PWD Not Ap. $ - $ 21,116 $ 21,116 Supportive Intervention/Guidance Counseling AD/CH (Domestic Violence Victims) Group $ 24,083 $ - $ 24,083 Crisis Intervention Shelter Services AD (Domestic Violence Victims) Group $ 31,789 $ 8,207 $ 39,996 Case Management Group $ 18,389 $ - $ 18,389 Legal Assistance (Civil:Various for AFC families in need of food stamp (Low Income assistance) Residents) Group $ 19,266 $ - $ 19,266 Legal Assistance (Civil:Various for AFC families facing eviction or needing (Low Income landlord tenant mitigation) Residents) Group $ 19,266 $ - $ 19,266 Legal Assistance (Civil:Various for AFC domestic violence victims) (Domestic Violence Victims) Group $ 28,899 $ - $ 28,899 Case Management AFC (Homeless) Group $ - $ 2,272 $ 2,272 Emergency Shelter AD/CH (Adults and Youth Homeless) Group $ 24,083 $ 4,382 $ 28,465 August 15, 2012 AD (Domestic Violence Victims) -34- AZ 2012-2013 SSBG PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2013 Housing Support Services AFC (Homeless) Not Ap. Transitional Housing AD/CH (Adults Group and Children DISTRICT II TOTALS August 15, 2012 -35- $ - $ 12,500 $ 12,500 $ 28,899 $ 15,122 $ 44,021 $ 986,923 $ 1,495,813 $ 2,482,736 AZ 2012-2013 SSBG PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2013 DISTRICT III (APACHE, COCONINO, NAVAJO, YAVAPAI COUNTIES) SERVICES TARGET STATUS GROUP ELIG. LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL APACHE COUNTY Case Management ELD or PWD Group $ 2,383 $ 4,471 $ 6,854 Administrative Services ELD or PWD Group $ - $ 3,022 $ 3,022 Home Delivered Meals ELD or PWD or AD Group $ 24,334 $ 2,911 $ 27,245 Transportation ELD or PWD or AD Group $ 10,841 $ - $ 10,841 Respite ELD or PWD Group $ - $ 853 $ 853 Community Education & Information ELD or PWD Group $ $ 1,925 $ 1,925 Program Development ELD or PWD Group $ - $ 1,322 $ 1,322 Legal Assistance ELD or PWD Group $ - $ 766 $ 766 Congregate Meals ELD or PWD Group $ - $ 1,539 $ 1,539 Public Health - Disease Prevention ELD or PWD & Health Promotion Group $ $ 1,508 $ 1,508 Long-Term Care Advocacy ELD or PWD Group $ - $ 1,282 $ 1,282 Information & Referral (IR2) ELD or PWD Group $ - $ 281 $ 281 Information & Referral (IR1) ELD or PWD Group $ - $ 133 $ 133 Job Development & Placement Mature Worker Program ELD or PWD $ - $ 154 $ 154 Home Care ELD or PWD Group $ - $ 6,552 $ 6,552 AFC (Homeless) Not Ap. $ - $ 5,960 $ 5,960 Transitonal Housing $ 37,558 $ 32,679 $ 70,237 APACHE TOTALS COCONINO COUNTY Home Delivered Meals ELD or PWD Group $ 14,455 $ - $ 14,455 Respite ELD or PWD Group $ 9,636 $ - $ 9,636 Administrative Services ELD or PWD Group $ - $ 10,358 $ 10,358 Adult Day Care ELD or PWD Group $ - $ 17,272 $ 17,272 Case Management ELD or PWD Group $ 3,854 $ 19,991 $ 23,845 August 15, 2012 -36- AZ 2012-2013 SSBG PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2013 Home Care ELD or PWD Group $ 1,927 $ 20,932 $ 22,859 Transportation ELD or PWD Group $ 11,560 $ 12,739 $ 24,299 Emergency Shelter AFC - Crisis Intervention Group $ 6,745 $ - $ 6,745 Supportive Intervention/Guidance Counseling AFC Domestic Group Violence $ 6,745 $ - $ 6,745 Case Management AFC - Crisis Intervention $ 6,745 $ - $ 6,745 Community Ed. & Information ELD or PWD Group $ - $ 6,736 $ 6,736 Program Development ELD or PWD Group $ - $ 4,626 $ 4,626 Legal Assistance ELD or PWD Group $ - $ 2,679 $ 2,679 Congregate Meals ELD or PWD Group $ - $ 5,384 $ 5,384 Public Health - Disease Prevention ELD or PWD & Health Promotion Group $ - $ 5,278 $ 5,278 Long-Term Care Advocacy ELD or PWD Group $ - $ 4,488 $ 4,488 Information & Referral (IR2) ELD or PWD Group $ - $ 982 $ 982 Information & Referral (IR1) ELD or PWD Group $ - $ 462 $ 462 Job Development & Placement Mature Worker Program ELD or PWD Group $ - $ 538 $ 538 $ 61,667 $ 112,465 $ 174,132 Group COCONINO TOTALS August 15, 2012 -37- AZ 2012-2013 SSBG PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2013 NAVAJO COUNTY Administrative Services ELD or PWD Group $ - $ 10,407 $ 10,407 Transportation ELD or PWD or AD Group $ 10,002 $ - $ 10,002 Case Management ELD or PWD Group $ 4,007 $ 19,984 $ 23,991 Home Delivered Meals ELD or PWD Group $ 10,008 $ 184 $ 10,192 Respite ELD or PWD Group $ - $ 2,982 $ 2,982 Emergency Shelter AFC - Crisis Intervention, Domestic Violence Group $ 9,015 $ - $ 9,015 Case Management AFC Group $ 15,460 $ - $ 15,460 Transportation AFC Group $ 4,548 $ - $ 4,548 Community Ed. & Information ELD or PWD Group $ - $ 6,736 $ 6,736 Program Development ELD or PWD Group $ - $ 4,626 $ 4,626 Legal Assistance ELD or PWD Group $ - $ 2,679 $ 2,679 Congregate Meals ELD or PWD Group $ - $ 5,384 $ 5,384 Public Health - Disease Prevention ELD or PWD & Health Promotion Group $ - $ 5,278 $ 5,278 Long-Term Care Advocacy ELD or PWD Group $ - $ 4,488 $ 4,488 Information & Referral (IR2) ELD or PWD Group $ - $ 982 $ 982 Information & Referral (IR1) ELD or PWD Group $ - $ 462 $ 462 Job Development & Placement Mature Worker Program ELD or PWD Group $ - $ 538 $ 538 Home Care ELD or PWD Group $ - $ 22,932 $ 22,932 $ 53,040 $ 87,662 $ 140,702 NAVAJO TOTALS YAVAPAI COUNTY Administrative Services ELD or PWD Group $ - $ 50,549 $ 50,549 Case Management ELD or PWD Group $ 5,821 $ 105,487 $ 111,308 Home Delivered Meals ELD or PWD or AD Group $ 8,150 $ 41,046 $ 49,196 Respite ELD or PWD Group $ - $ 14,486 $ 14,486 August 15, 2012 -38- AZ 2012-2013 SSBG PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2013 Adult Day Care/Adult Day Health Care ELD or PWD Group $ 9,316 $ 27,037 $ 36,353 Case Management Assistance for Eviction Prevention AFC - Crisis Intervention Group $ 5,821 $ - $ 5,821 Emergency Shelter AFC - Crisis Intervention Group $ 11,644 $ - $ 11,644 Case Management AFC - Crisis Intervention Group $ 11,644 $ - $ 11,644 Transportation AFC Group $ 29,108 $ - $ 29,108 Transportation ELD or PWD Group $ - $ 63,789 $ 63,789 Community Ed. & Information ELD or PWD Group $ - $ 33,843 $ 33,843 Program Development ELD or PWD Group $ - $ 22,471 $ 22,471 Legal Assistance ELD or PWD Group $ - $ 13,015 $ 13,015 Congregate Meals ELD or PWD Group $ - $ 21,904 $ 21,904 Public Health - Disease Prevention ELD or PWD & Health Promotion Group $ - $ 25,637 $ 25,637 Long-Term Care Advocacy ELD or PWD Group $ - $ 21,800 $ 21,800 Information & Referral (IR2) ELD or PWD Group $ - $ 4,772 $ 4,772 Information & Referral (IR1) ELD or PWD Group $ - $ 2,246 $ 2,246 Job Development & Placement Mature Worker Program ELD or PWD Group $ - $ 2,614 $ 2,614 Home Care ELD or PWD Group $ - $ 111,382 $ 111,382 $ $ 81,504 233,769 $ $ 562,078 794,884 $ $ 643,582 1,028,653 YAVAPAI TOTALS DISTRICT III TOTALS August 15, 2012 -39- AZ 2012-2013 SSBG PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2013 DISTRICT IV (LA PAZ, MOHAVE, YUMA COUNTIES) SERVICES TARGET GROUP STATUS ELIG. LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL LA PAZ COUNTY Home Care ELD or PWD Group $ 3,193 $ 49,171 $ 52,364 Administrative Services ELD or PWD Group $ - $ 17,036 $ 17,036 Case Management ELD or PWD Group $ 5,321 $ 74,152 $ 79,473 Home Delivered Meals ELD or PWD Group $ 13,125 $ - $ 13,125 Transportation LA PAZ TOTALS AFC Group $ $ 13,834 35,473 $ $ 140,359 $ $ 13,834 175,832 MOHAVE COUNTY Home Care ELD or PWD Group $ 41,813 $ 63,909 $ 105,722 Case Management ELD or PWD Group $ 43,630 $ 156,139 $ 199,769 Administrative Services ELD or PWD Group $ - $ 32,875 $ 32,875 Home Delivered Meals ELD/AD/PWD Group $ 41,813 $ - $ 41,813 Emergency Shelter Domestic Violence $ 54,537 $ - $ 54,537 $ 181,793 $ 252,923 $ 434,716 Group MOHAVE TOTALS YUMA COUNTY Home Care ELD/PWD Group $ 29,398 $ 17,341 $ 46,739 Case Management ELD or PWD Group $ 20,351 $ 164,381 $ 184,732 Administrative Services ELD or PWD Group $ - $ 30,765 $ 30,765 Adult Day Care/Adult Day Health Care ELD or PWD Group $ 15,829 $ - $ 15,829 Home Delivered Meals ELD or PWD Group $ 27,135 $ - $ 27,135 Transportation AFC Group $ 40,703 $ - $ 40,703 Respite AFC Group $ 4,523 $ - $ 4,523 Emergency Shelter AFC Group $ 27,136 $ - $ 27,136 $ $ 165,075 382,341 $ $ 212,487 605,769 $ $ 377,562 988,110 YUMA TOTALS DISTRICT IV TOTALS August 15, 2012 -40- AZ 2012-2013 SSBG PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2013 DISTRICT V (GILA, PINAL COUNTIES) SERVICES TARGET GROUP STATUS ELIG. LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL GILA COUNTY Home Care ELD or PWD Group $ 18,579 $ 90,754 $ 109,333 Program Development ELD or PWD Group $ - $ 1,245 $ 1,245 Home Delivered Meals ELD or PWD Group $ 19,845 $ 16,752 $ 36,597 Home Repair/Renovation ELD or PWD Group $ 6,242 $ - $ 6,242 Case Management ELD or PWD Group $ 26,228 $ 39,033 $ 65,261 Respite ELD or PWD Group $ - $ 6,340 $ 6,340 Administrative Services ELD or PWD Group $ - $ 23,074 $ 23,074 Emergency Shelter Domestic Violence Group $ 25,652 $ - $ 25,652 Case Management GILA COUNTY TOTALS PINAL COUNTY Home Care AFC Group $ $ 8,048 104,594 $ $ 177,198 $ $ 8,048 281,792 ELD/PWD Group $ 8,486 $ 179,246 $ 187,732 Program Development ELD or PWD Group $ - $ 2,106 $ 2,106 Administrative Services ELD or PWD Group $ - $ 38,340 $ 38,340 Home Delivered Meals ELD or PWD Group $ 23,819 $ 28,157 $ 51,976 Home Repair/Renovation ELD or PWD Group $ 7,623 $ - $ 7,623 Case Management ELD or PWD Group $ 30,120 $ 64,483 $ 94,603 Respite ELD or PWD Group $ - $ 8,048 $ 8,048 Emergency Shelter Domestic Violence Group $ 50,802 $ - $ 50,802 Case Management AFC Group $ 16,096 $ - $ 16,096 $ $ 136,946 241,540 $ $ 320,380 497,578 $ $ 457,326 739,118 PINAL COUNTY TOTALS DISTRICT V TOTALS August 15, 2012 -41- AZ 2012-2013 SSBG PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2013 DISTRICT VI (COCHISE, GRAHAM, GREENLEE, SANTA CRUZ COUNTIES) SERVICES TARGET STATUS GROUP ELIG. LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL COCHISE COUNTY Congregate Meals ELD or PWD Group $ - $ 31,427 $ 31,427 Administrative Services ELD or PWD Group $ - $ 36,966 $ 36,966 Respite ELD or PWD Group $ - $ 8,727 $ 8,727 Home Care ELD or PWD Group $ 22,280 $ 97,228 $ 119,508 Home Delivered Meals ELD or PWD Group $ 54,539 $ 25,345 $ 79,884 Case Management ELD or PWD Group $ 7,073 $ 114,570 $ 121,643 Long-Term Care Advocacy ELD or PWD Group $ - $ 7,000 $ 7,000 Transportation ELD or PWD Group $ - $ 8,005 $ 8,005 Case Management Domestic Violence Group $ 32,128 $ - $ 32,128 Emergency Shelter Domestic Violence Group $ - $ 39,000 $ 39,000 $ 116,020 $ 368,268 $ 484,288 COCHISE TOTALS GRAHAM COUNTY Home Care ELD or PWD Group $ 9,251 $ 17,172 $ 26,423 Administrative Services ELD or PWD Group $ - $ 9,680 $ 9,680 Home Delivered Meals ELD or PWD Group $ 23,465 $ 12,351 $ 35,816 Respite ELD or PWD Group $ 4,259 $ 1,745 $ 6,004 Case Management ELD or PWD Group $ - $ 36,463 $ 36,463 Transportation GRAHAM TOTALS GREENLEE COUNTY ELD or PWD Group $ $ 36,975 $ $ 3,860 81,271 $ $ 3,860 118,246 Home Care ELD or PWD Group $ 15,929 $ 3,498 $ 19,427 Administrative Services ELD or PWD Group $ - $ 5,078 $ 5,078 Home Delivered Meals ELD or PWD Group $ 19,610 $ 5,409 $ 25,019 Respite ELD or PWD Group $ 646 $ 646 Transportation ELD or PWD Group $ 2,313 $ 911 $ 3,224 Case Management GREENLEE TOTALS ELD or PWD Group $ $ 37,852 $ $ 15,817 31,359 $ $ 15,817 69,211 August 15, 2012 -42- AZ 2012-2013 SSBG PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2013 SANTA CRUZ COUNTY Congregate Meals ELD or PWD Group $ - $ 1,648 $ 1,648 Home Care ELD or PWD Group $ 10,793 $ 27,186 $ 37,979 Administrative Services ELD or PWD Group $ - $ 10,521 $ 10,521 Home Delivered Meals ELD or PWD Group $ 22,887 $ - $ 22,887 Case Management ELD or PWD Group $ - $ 51,521 $ 51,521 $ $ 33,680 224,527 $ $ 90,876 571,774 $ $ 124,556 796,301 SANTA CRUZ TOTALS DISTRICT VI TOTALS STATEWIDE SERVICES TARGET GROUP STATUS ELIG. LOCAL PLANNED STATE PLANNED Protective Services for Adults AD Group $ - Tribal Entities Home Based Services (Tribal Allocations Chart on page 4 of this Plan) ELD or PWD Group $ DAAS Administrative Services AD Group Coordination AFC Homeless Coordination AFC Domestic Violence LOCAL & STATE TOTAL $ 1,192,632 $ 1,192,632 652,563 $ - $ 652,563 $ - $ 812,205 $ 812,205 Group $ - $ 12,000 $ 12,000 Group $ - $ 21,960 $ 21,960 $ 652,563 $ 2,038,797 $ 2,691,360 STATEWIDE TOTALS ALL DAAS SERVICES DAAS TOTALS August 15, 2012 -43- LOCAL PLANNED STATE PLANNED $ 5,659,887 $ 9,417,227 LOCAL & STATE TOTAL $ 15,077,114 AZ 2012-2013 SSBG PLAN DIVISION OF DEVELOPMENTAL DISABILITIES (DDD) SFY 2013 DISTRICT I (MARICOPA COUNTY) SERVICES TARGET GROUP STATUS ELIG. Employment Related Services DD Group (Special Employment Opportunities ) $ 285,686 $ - LOCAL & STATE TOTAL $ 285,686 Employment Related Services DD Group (In Family Home Needs Community or Specialized Employment) $ 55,855 $ - $ 55,855 Habilitation Services DD (Not Eligible for ALTCS) Group $ 18,951 $ - $ 18,951 Attendant Care/Personal Assistance DD (Not Eligible for ALTCS) Group $ 18,770 $ - $ 18,770 Respite Caregivers for PWDD Not IDEA Part H Group $ 29,693 $ - $ 29,693 $ 408,955 $ - $ 408,955 DISTRICT I TOTALS LOCAL PLANNED STATE PLANNED DISTRICT 2 (PIMA COUNTY) SERVICES Home Care TARGET GROUP DD STATUS ELIG. Group DISTRICT 2 TOTALS August 15, 2012 -44- LOCAL PLANNED $ 7,729 STATE PLANNED $ - LOCAL & STATE $ 7,729 $ $ $ 7,729 - 7,729 AZ 2012-2013 SSBG PLAN DIVISION OF DEVELOPMENTAL DISABILITIES (DDD) SFY 2013 DISTRICT III (APACHE, COCONINO, NAVAJO, YAVAPAI COUNTIES) SERVICES TARGET STATUS GROUP ELIG. COCONINO COUNTY Supported Employment COCONINO TOTALS YAVAPAI COUNTY Supported Employment YAVAPAI TOTALS DISTRICT III TOTALS LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL DD Adults Group $ $ 49,141 49,141 $ $ - $ $ 49,141 49,141 DD Adults Group $ $ $ 5,821 5,821 54,962 $ $ $ - $ $ $ 5,821 5,821 54,962 DISTRICT V (GILA, PINAL COUNTIES) SERVICES TARGET GROUP STATUS ELIG. LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL GILA COUNTY Employment Related Services GILA TOTALS DD Group $ $ 29,016 29,016 $ $ - $ $ 29,016 29,016 PINAL COUNTY Employment Related Services PINAL TOTALS DD Group $ $ 58,032 58,032 $ $ - $ $ 58,032 58,032 $ 87,048 $ - $ 87,048 DISTRICT V TOTALS August 15, 2012 -45- AZ 2012-2013 SSBG PLAN DIVISION OF DEVELOPMENTAL DISABILITIES (DDD) SFY 2013 DISTRICT VI (COCHISE, GRAHAM, GREENLEE, SANTA CRUZ COUNTIES) SERVICES TARGET STATUS GROUP ELIG. LOCAL PLANNED STATE PLANNED LOCAL & STATE COCHISE COUNTY Employment Related Services COCHISE TOTALS AD-DD Group $ $ 42,882 42,882 $ $ - $ $ 42,882 42,882 GRAHAM COUNTY Employment Related Services GRAHAM TOTALS AD-DD Group $ $ 29,007 29,007 $ $ - $ $ 29,007 29,007 GREENLEE COUNTY Developmental Disability Day Care GREENLEE TOTALS CH-DD Group $ $ 5,878 5,878 $ $ - $ $ 5,878 5,878 AD-DD Group $ $ $ 46,525 46,525 124,292 $ $ $ - $ $ $ 46,525 46,525 124,292 SANTA CRUZ COUNTY Employment Related Services SANTA CRUZ TOTALS DISTRICT VI TOTALS STATEWIDE SERVICES TARGET GROUP STATUS ELIG. LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL Employment Related Services (DD Target Group) $ - $ - $ - Case Management (DD Target Group) $ - $ - $ - Counseling/Intervention (DD Target Group) $ - $ - $ - Case Management $ - $ - $ - STATEWIDE TOTALS $ - $ - $ - ALL DDD SERVICES LOCAL PLANNED $ 682,986 DDD TOTALS August 15, 2012 -46- STATE PLANNED $ - LOCAL & STATE $ 682,986 AZ 2012-2013 SSBG PLAN EMPLOYMENT ADMINISTRATION (EA) SFY 2013 DISTRICT II (PIMA COUNTY) SERVICES Employment Related Services TARGET GROUP AD STATUS ELIG. Group DISTRICT II TOTALS LOCAL PLANNED STATE PLANNED $ 41,993 $ - LOCAL & STATE TOTAL $ 41,993 $ 41,993 $ - $ 41,993 DISTRICT IV (YUMA COUNTY) SERVICES Employment Related Services TARGET GROUP AD STATUS ELIG. Group DISTRICT II TOTALS LOCAL PLANNED STATE PLANNED $ 54,271 $ - LOCAL & STATE TOTAL $ 54,271 $ 54,271 $ - $ 54,271 ALL EA SERVICES LOCAL PLANNED $ 96,264 EA TOTALS August 15, 2012 -47- STATE PLANNED $ - LOCAL & STATE TOTAL $ 96,264 AZ 2012-2013 SSBG PLAN REHABILITATION SERVICES ADMINISTRATION (RSA) SFY 2013 DISTRICT I (MARICOPA COUNTY) SERVICES TARGET GROUP STATUS ELIG. Adaptive Aids and Devices PWD Group $ 9,513 $ - LOCAL & STATE TOTAL $ 9,513 Supportive Intervention/Guidance Counseling PWD Group Employment $ 13,306 $ - $ 13,306 Supported Employment, Extended PWD Group $ 162,666 $ - $ 162,666 Rehabilitation Instructional Services PWD Group $ 9,936 $ - $ 9,936 $ 195,421 $ - $ 195,421 DISTRICT I TOTALS LOCAL PLANNED STATE PLANNED DISTRICT II (PIMA COUNTY) SERVICES TARGET GROUP STATUS ELIG. Interpreter PWD (Deaf) Group Adults $ 3,939 $ - LOCAL & STATE TOTAL $ 3,939 Supportive Intervention/Guidance Counseling PWD Hearing Impaired $ 34,519 $ - $ 34,519 $ 38,458 $ - $ 38,458 Group DISTRICT II TOTALS DISTRICT III (APACHE, COCONINO, NAVAJO, YAVAPAI COUNTIES) SERVICES TARGET STATUS GROUP ELIG. LOCAL PLANNED LOCAL PLANNED STATE PLANNED STATE PLANNED LOCAL & STATE TOTAL COCONINO COUNTY Extended Supported Employment COCONINO TOTALS PWD Adults Group $ $ 10,506 10,506 $ $ - $ $ 10,506 10,506 NAVAJO COUNTY Job Training NAVAJO TOTALS PWD Adults Group $ $ 18,323 18,323 $ $ - $ $ 18,323 18,323 PWD Adults Group $ $ $ 5,821 5,821 34,650 $ $ $ - $ $ $ 5,821 5,821 34,650 YAVAPAI COUNTY Extended Supported Employment YAVAPAI TOTALS DISTRICT III TOTALS August 15, 2012 -48- AZ 2012-2013 SSBG PLAN REHABILITATION SERVICES ADMINISTRATION (RSA) SFY 2013 DISTRICT IV (LA PAZ, MOHAVE, YUMA COUNTIES) SERVICES YUMA COUNTY Extended Supported Employment YUMA TOTALS DISTRICT IV TOTALS TARGET GROUP PWD STATUS ELIG. Group LOCAL PLANNED $ $ $ 6,784 6,784 6,784 STATE PLANNED $ $ $ LOCAL & STATE TOTAL - $ $ $ 6,784 6,784 6,784 DISTRICT V (GILA, PINAL COUNTIES) SERVICES TARGET GROUP STATUS ELIG. LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL GILA COUNTY Extended Supported Employment GILA TOTALS PWD Group $ $ 15,717 15,717 $ $ - $ $ 15,717 15,717 PINAL COUNTY Extended Supported Employment PINAL TOTALS PWD Group $ $ 18,137 18,137 $ $ - $ $ 18,137 18,137 $ 33,854 $ - $ 33,854 DISTRICT V TOTALS August 15, 2012 -49- AZ 2012-2013 SSBG PLAN REHABILITATION SERVICES ADMINISTRATION (RSA) SFY 2013 STATEWIDE SERVICES TARGET GROUP STATUS ELIG. Sheltered Employment PWD Group Supported Employment, Extended PWD Group Independent Living PWD Group STATEWIDE TOTALS LOCAL PLANNED $ STATE PLANNED - $ - LOCAL & STATE TOTAL $ 18,043 $ 18,043 $ 36,788 $ 36,788 $ 500,000 $ 500,000 $ 554,831 $ 554,831 ALL RSA SERVICES LOCAL PLANNED RSA TOTALS $ STATE PLANNED 309,167 $ 554,831 LOCAL & STATE TOTAL $ 863,998 CROSS-PROGRAM SFY 2013 STATEWIDE SERVICES Case Management $ - $ 251,916 LOCAL & STATE TOTAL $ 251,916 STATEWIDE TOTALS $ - $ 251,916 $ August 15, 2012 TARGET GROUP STATUS ELIG. -50- LOCAL PLANNED STATE PLANNED 251,916 AZ 2012-2013 SSBG PLAN PLANNED SFY 2013 SSBG SERVICE ALLOCATIONS LISTED BY FEDERAL SSBG SERVICE DEFINITIONS NUMBERS 1-29 INDICATING THE RESPONSIBLE DES DIVISION/ADMINISTRATION THAT PROVIDES OR CONTRACTS FOR THE SERVICE SVC CODE SERVICE (SVC) TITLE ADMIN 1. Adoption Services DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 2. Case Management Services DAAS RSA EA CCA DDD DBME DCYF CROSS-PROGRAM $ $ $ $ $ $ $ $ TOTAL $ 3,049,490 37,375 251,916 3,338,781 3. Congregate Meals DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 79,903 31,563 111,466 4. Counseling Services DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 269,273 269,273 -51- ALLOCATION - AZ 2012-2013 SSBG PLAN PLANNED SFY 2013 SSBG SERVICE ALLOCATIONS LISTED BY FEDERAL SSBG SERVICE DEFINITIONS NUMBERS 1-29 INDICATING THE RESPONSIBLE DES DIVISION/ADMINISTRATION THAT PROVIDES OR CONTRACTS FOR THE SERVICE SVC CODE SERVICE (SVC) TITLE ADMIN 5. Day Care Services--Adults DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 302,251 302,251 6. Day Care Services--Children DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 279,690 279,690 7. Education and Training Services DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ - 8. Employment Services DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 3,306 96,264 99,570 -52- ALLOCATION AZ 2012-2013 SSBG PLAN PLANNED SFY 2013 SSBG SERVICE ALLOCATIONS LISTED BY FEDERAL SSBG SERVICE DEFINITIONS NUMBERS 1-29 INDICATING THE RESPONSIBLE DES DIVISION/ADMINISTRATION THAT PROVIDES OR CONTRACTS FOR THE SERVICE SVC CODE SERVICE (SVC) TITLE ADMIN 9. Family Planning Services DAAS RSA EA CCA DDD DBME ACYF $ $ $ $ $ $ $ TOTAL $ - 10. Foster Care Services for Adults DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ - 11. Foster Care Services for Children DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 27,612,829 27,612,829 12. Health Related and Home Health Services DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 49,901 49,901 -53- ALLOCATION AZ 2012-2013 SSBG PLAN PLANNED SFY 2013 SSBG SERVICE ALLOCATIONS LISTED BY FEDERAL SSBG SERVICE DEFINITIONS NUMBERS 1-29 INDICATING THE RESPONSIBLE DES DIVISION/ADMINISTRATION THAT PROVIDES OR CONTRACTS FOR THE SERVICE SVC CODE SERVICE (SVC) TITLE ADMIN 13. Home Based Services DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 6,524,235 1,215,454 7,739,689 14. Home Delivered Meals DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 989,576 989,576 15. Housing Services DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 819,076 819,076 16. Independent and Transitional Living Services DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ -54- ALLOCATION - AZ 2012-2013 SSBG PLAN PLANNED SFY 2013 SSBG SERVICE ALLOCATIONS LISTED BY FEDERAL SSBG SERVICE DEFINITIONS NUMBERS 1-29 INDICATING THE RESPONSIBLE DES DIVISION/ADMINISTRATION THAT PROVIDES OR CONTRACTS FOR THE SERVICE SVC CODE SERVICE (SVC) TITLE ADMIN 17. Information and Referral DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 60,960 60,960 18. Legal Services DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 105,996 105,996 19. Pregnancy and Parenting Services for Young Parents DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 11,644 11,644 20. Prevention and Intervention Services DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 1,580,767 47,825 2,633,194 4,261,786 -55- ALLOCATION AZ 2012-2013 SSBG PLAN PLANNED SFY 2013 SSBG SERVICE ALLOCATIONS LISTED BY FEDERAL SSBG SERVICE DEFINITIONS NUMBERS 1-29 INDICATING THE RESPONSIBLE DES DIVISION/ADMINISTRATION THAT PROVIDES OR CONTRACTS FOR THE SERVICE SVC CODE SERVICE (SVC) TITLE ADMIN 21. Protective Services for Adults DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 1,254,867 1,254,867 22. Protective Services for Children DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 286,301 286,301 23. Recreational Services DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ - 24. Residential Treatment Services DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ - -56- ALLOCATION AZ 2012-2013 SSBG PLAN PLANNED SFY 2013 SSBG SERVICE ALLOCATIONS LISTED BY FEDERAL SSBG SERVICE DEFINITIONS NUMBERS 1-29 INDICATING THE RESPONSIBLE DES DIVISION/ADMINISTRATION THAT PROVIDES OR CONTRACTS FOR THE SERVICE SVC CODE ALLOCATION SERVICE (SVC) TITLE ADMIN 25. Special Services for Persons with Developmental or Physical Disabilities DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 816,173 682,986 1,499,159 26. Special Services for Youth Involved in or at Risk of Involvement with Criminal Activity DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 61,854 61,854 27. Substance Abuse Services DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ - 28. Transportation Services DAAS RSA EA CCA DDD DBME DCYF $ $ $ $ $ $ $ TOTAL $ 219,221 219,221 29. Other Services DAAS RSA EA CCA DDD DBME DCYF Program Occupancy $ $ $ $ $ $ $ $ TOTAL $ 37,565 261,150 31,642 550,300 880,657 (DES Training, Consultation, Research, Coordination, Program Occupancy) -57- AZ 2012-2013 SSBG PLAN PLANNED SFY 2013 SSBG SERVICE ALLOCATIONS LISTED BY FEDERAL SSBG SERVICE DEFINITIONS NUMBERS 1-29 INDICATING THE RESPONSIBLE DES DIVISION/ADMINISTRATION THAT PROVIDES OR CONTRACTS FOR THE SERVICE SVC CODE 30. 31. SERVICE (SVC) TITLE ALLOCATION ADMIN Total of the SFY 2012 Planned SSBG Funding Allocations Listed Above for Federal Service Definitions Numbers 1 Through 29 TOTAL $ 50,254,547 $ 4,736,576 TOTAL $ 4,736,576 Administrative Costs Department All SFY 2011 State and Locally Planned SSBG Funding Allocations Listed by the Administration/Division Responsible for Providing or Contracting for the Services DCYF DDD RSA CCA EA DBME DAAS Case Management Program Occupancy Administrative Costs -58- $ $ $ $ $ $ $ $ $ $ 32,159,566 682,986 863,998 279,690 96,264 292,713 15,077,114 251,916 550,300 4,736,576 TOTAL $ 54,991,123 AZ 2012-2013 SSBG PLAN APPENDIX A PUBLIC NOTICE August 15, 2012 -59- AZ 2012-2013 SSBG PLAN PUBLIC NOTICE Issue Date: June 1, 2012 ARIZONA DEPARTMENT OF ECONOMIC SECURITY PUBLIC COMMENT ON THE STATE OF ARIZONA SOCIAL SERVICES BLOCK GRANT (SSBG) PLAN JULY 1, 2012 – JUNE 30, 2013 The Department of Economic Security (DES) requests public comment on the abovereferenced plan. A copy of the proposed plan is available for public inspection on the DES Internet website at the link below. https://www.azdes.gov/ssbginput2013/ The Department will accept written comments on the plan sent any of the following addresses: E-mail: ssbginput@azdes.gov Fax: (602) 542-6000 Mail: Department of Economic Security ATTN: Rod Huenemann P.O. Box 6123, Site Code 837A Phoenix, Arizona 85005 Written comments should be sent so that the Department will receive them before 5:00 PM, Monday, June 25, 2012, and should include contact information for the person providing comments, as well as the name of any organization that person represents. Questions may be directed to Rod Huenemann at (602) 542-3882. THIS DOCUMENT IS AVAILABLE IN ALTERNATIVE FORMAT BY CONTACTING ROD HUENEMANN AT (602) 542-3882 OR AT THE ADDRESS SPECIFIED ABOVE. REQUESTS SHOULD BE MADE AS EARLY AS POSSIBLE TO ALLOW TIME TO ARRANGE THE ACCOMMODATION. August 15, 2012 -60- AZ 2012-2013 SSBG PLAN APPENDIX B CERTIFICATIONS 1. Certification Regarding Lobbying 2. Certification Regarding Drug-Free Workplace Requirements 3. Certification Regarding Debarment, Suspension and Other Responsibility Matters 4. Certification Regarding Environmental Tobacco Smoke August 15, 2012 -61- AZ 2012-2013 SSBG PLAN CERTIFICATION REGARDING LOBBYING Certification for Contracts, Grants, Loans, and Cooperative Agreements 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 an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, 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, grant, loan, or cooperative agreement. (2) If any funds other 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 Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, ``Disclosure Form to Report Lobbying,'' in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. 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. Statement for Loan Guarantees and Loan Insurance The undersigned states, to the best of his or her knowledge and belief, that: If any 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 Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, ``Disclosure Form to Report Lobbying,'' in accordance with its instructions. Submission of this statement 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 statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Signature Director Title Arizona Department of Economic Security Organization August 15, 2012 -62- AZ 2012-2013 SSBG PLAN CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS This certification is required by the regulations implementing the Drug-Free Workplace Act of 1988: 45 CFR Part 76, Subpart, F. Sections 76.630(c) and (d)(2) and 76.645(a)(1) and (b) provide that a Federal agency may designate a central receipt point for STATE-WIDE AND STATE AGENCY-WIDE certifications, and for notification of criminal drug convictions. For the Department of Health and Human Services, the central pint is: Division of Grants Management and Oversight, Office of Management and Acquisition, Department of Health and Human Services, Room 517-D, 200 Independence Avenue, SW Washington, DC 20201. Certification Regarding Drug-Free Workplace Requirements (Instructions for Certification) 1. By signing and/or submitting this application or grant agreement, the grantee is providing the certification set out below. 2. The certification set out below is a material representation of fact upon which reliance is placed when the agency awards the grant. If it is later determined that the grantee knowingly rendered a false certification, or otherwise violates the requirements of the Drug-Free Workplace Act, the agency, in addition to any other remedies available to the Federal Government, may take action authorized under the Drug-Free Workplace Act. 3. For grantees other than individuals, Alternate I applies. 4. For grantees who are individuals, Alternate II applies. 5. Workplaces under grants, for grantees other than individuals, need not be identified on the certification. If known, they may be identified in the grant application. If the grantee does not identify the workplaces at the time of application, or upon award, if there is no application, the grantee must keep the identity of the workplace(s) on file in its office and make the information available for Federal inspection. Failure to identify all known workplaces constitutes a violation of the grantee's drug-free workplace requirements. 6. Workplace identifications must include the actual address of buildings (or parts of buildings) or other sites where work under the grant takes place. Categorical descriptions may be used (e.g., all vehicles of a mass transit authority or State highway department while in operation, State employees in each local unemployment office, performers in concert halls or radio studios). 7. If the workplace identified to the agency changes during the performance of the grant, the grantee shall inform the agency of the change(s), if it previously identified the workplaces in question (see paragraph five). 8. Definitions of terms in the Nonprocurement Suspension and Debarment common rule and Drug-Free Workplace common rule apply to this certification. Grantees' attention is called, in particular, to the following definitions from these rules: Controlled substance means a controlled substance in Schedules I through V of the Controlled Substances Act (21 U.S.C. 812) and as further defined by regulation (21 CFR 1308.11 through 1308.15); Conviction means a finding of guilt (including a plea of nolo contendere) or imposition of sentence, or both, by any judicial body charged with the responsibility to determine violations of the Federal or State criminal drug statutes; August 15, 2012 -63- AZ 2012-2013 SSBG PLAN Criminal drug statute means a Federal or non-Federal criminal statute involving the manufacture, distribution, dispensing, use, or possession of any controlled substance; Employee means the employee of a grantee directly engaged in the performance of work under a grant, including: (i) All direct charge employees; (ii) All indirect charge employees unless their impact or involvement is insignificant to the performance of the grant; and, (iii) Temporary personnel and consultants who are directly engaged in the performance of work under the grant and who are on the grantee's payroll. This definition does not include workers not on the payroll of the grantee (e.g., volunteers, even if used to meet a matching requirement; consultants or independent contractors not on the grantee's payroll; or employees of subrecipients or subcontractors in covered workplaces). Certification Regarding Drug-Free Workplace Requirements Alternate I. (Grantees Other Than Individuals) The grantee certifies that it will or will continue to provide a drug-free workplace by: (a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition; (b) Establishing an ongoing drug-free awareness program to inform employees about -(1)The dangers of drug abuse in the workplace; (2) The grantee's policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a); (d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will -(1) Abide by the terms of the statement; and (2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction; (e) Notifying the agency in writing, within ten calendar days after receiving notice under paragraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to every grant officer or other designee on whose grant activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification number(s) of each affected grant; (f) Taking one of the following actions, within 30 calendar days of receiving notice under paragraph (d)(2), with respect to any employee who is so convicted -(1) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; (g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f). (B) The grantee may insert in the space provided below the site(s) for the performance of work done in connection with the specific grant: August 15, 2012 -64- AZ 2012-2013 SSBG PLAN Place of Performance (Street address, city, county, state, zip code) Check if there are workplaces on file that are not identified here. Alternate II. (Grantees Who Are Individuals) (a) The grantee certifies that, as a condition of the grant, he or she will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the grant; (b) If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any grant activity, he or she will report the conviction, in writing, within 10 calendar days of the conviction, to every grant officer or other designee, unless the Federal agency designates a central point for the receipt of such notices. When notice is made to such a central point, it shall include the identification number(s) of each affected grant. [55 FR 21690, 21702, May 25, 1990] Signature Director Title Arizona Department of Economic Security Organization August 15, 2012 -65- AZ 2012-2013 SSBG PLAN CERTIFICATION REGARDING RESPONSIBILITY MATTERS DEBARMENT, SUSPENSION AND OTHER Certification Regarding Debarment, Suspension, and Other Responsibility Matters--Primary Covered Transactions Instructions for Certification 1. By signing and submitting this proposal, the prospective primary participant is providing the certification set out below. 2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction. 3. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default. 4. The prospective primary participant shall provide immediate written notice to the department or agency to which this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 5. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations. 6. The prospective primary participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction. 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 ExclusionLower Tier Covered Transaction,'' provided by the department or agency entering into this covered transaction, 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 proposed for debarment under 48 CFR part 9, subpart 9.4, 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 List of Parties Excluded from Federal Procurement and Nonprocurement Programs. 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 a prudent person in the ordinary course of business dealings. August 15, 2012 -66- AZ 2012-2013 SSBG PLAN 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 proposed for debarment under 48 CFR part 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default. Certification Regarding Debarment, Suspension, and Other Responsibility Matters--Primary Covered Transactions (1) The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or agency; (b) 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 a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted for or 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 (d) 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. (2) 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. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--Lower Tier Covered Transactions Instructions for Certification 1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out below. 2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. 3. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or had become erroneous by reason of changed circumstances. 4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meaning set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. 5. The prospective lower tier participant agrees by submitting this proposal that, [[Page 33043]] should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. 6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary ExclusionLower Tier Covered Transaction,” without modification, in all lower tier covered transactions and in all August 15, 2012 -67- AZ 2012-2013 SSBG PLAN solicitations for lower tier covered transactions. 7. 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 proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, ineligible, or voluntarily excluded from covered transactions, 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 List of Parties Excluded from Federal Procurement and Nonprocurement Programs. 8. 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 a prudent person in the ordinary course of business dealings. 9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under 48 CFR part 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. Certification Regarding Debarment, Suspension, Ineligibility an Voluntary Exclusion--Lower Tier Covered Transactions (1) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. (2) Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Signature Director Title Arizona Department of Economic Security Organization August 15, 2012 -68- AZ 2012-2013 SSBG PLAN CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE Public Law 103227, Part C Environmental Tobacco Smoke, also known as the Pro Children Act of 1994, requires that smoking not be permitted in any portion of any indoor routinely owned or leased or contracted for by an entity and used routinely or regularly for provision of health, day care, 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 does not apply to children's services provided in private residences, facilities funded solely by Medicare or Medicaid funds, and portions of facilities used for inpatient drug or alcohol treatment. Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1000 per day and/or the imposition of an administrative compliance order on the responsible entity by signing and submitting this application the applicant/grantee certifies that it will comply with the requirements of the Act. The applicant/grantee further agrees that it will require the language of this certification be included in any subawards which contain provisions for the children's services and that all subgrantees shall certify accordingly. Signature Director Title Arizona Department of Economic Security Organization August 15, 2012 -69- AZ 2012-2013 SSBG PLAN