STATE OF ARIZONA SOCIAL SERVICES BLOCK GRANT PLAN 2017-2018 THE ARIZONA DEPARTMENT OF ECONOMIC SECURITY May 15, 2017 AZ 2017-2018 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. May 15, 2017 - ii - AZ 2017-2018 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...................................................................................... 3 SSBG Planning Process .................................................................................................. 3 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 .................................. 21 Service Availability ......................................................................................................... 26 Local and State Planned Levels.................................................................................... 29 Planned Service Allocations Listed by Federal Service Definitions ........................ 52 May 15, 2017 - iii - AZ 2017-2018 SSBG PLAN LIST OF FIGURES SUBJECT PAGE Figure 1: Geographic Planning Areas (State Map)....................................................... 6 Figure 2: DES Organization Chart................................................................................... 7 APPENDICES SUBJECT PAGE Appendix A. Public Notice ............................................................................................ 60 Public Notice ............................................................................................................. 61 Appendix B. Certifications............................................................................................ 62 Certification Regarding Lobbying........................................................................... 63 Certification Regarding Drug-Free Workplace Requirements ............................ 64 Certification Regarding Debarment, Suspension And Other Responsibility Matters ............................................................................................. 67 Certification Regarding Environmental Tobacco Smoke ................................... 70 Appendix C. Pre-Expenditure Report Form….............................................................................................................................71 May 15, 2017 - iv - AZ 2017-2018 SSBG PLAN STATE OF ARIZONA Title XX Social Services Block Grant Plan July 1, 2017 – June 30, 2018 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 (SFY) 2018, which begins on July 1, 2017, and ends June 30, 2018. SFY 2018 overlaps portions of Federal Fiscal Year (FFY) 2017 and FFY 2018, 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 2018 is calculated from one-fourth of Arizona’s FFY 2017 estimated allocation and three-fourths of Arizona’s estimated FFY 2018 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 $20,014,130 Temporary Assistance to Needy Families (TANF) Block Grant funds projected to be transferred to the SFY 2018 SSBG is included in the Plan in addition to the SFY 2017 estimated SSBG funding level of $32,749,900 for a total combined planning level of $52,764,030. The planned SFY 2018 expenditures are detailed on spreadsheets that begin on page 29 of the Plan. Spreadsheets are displayed for the Arizona Department of Child Safety (DCS) and each of the DES Administrations/Divisions that plan to use SSBG funding for SFY 2018. 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 DES, the Department of Child Safety (DCS), 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 2016, Chapter 117, Section 24 allows up to ten percent of TANF Block Grant funds to be transferred to SSBG for Children Services funding. The Department is estimating a transfer of $20,014,130 of TANF funds for Children’s Services which is below ten percent of TANF Block Grant funds in accordance with the Arizona statute. May 15, 2017 -1- AZ 2017-2018 SSBG PLAN SSBG Service Goals The mission of DES is to make Arizona stronger by helping Arizonans reach their potential through temporary assistance for those in need, and care for the vulnerable. The DES vision is opportunity, assistance and care for Arizonans in need. The goals of DES are to: serve Arizonans with integrity, humility and kindness; support Arizonans to reach their potential through social services that train, rehabilitate, and connect them with job creators; provide temporary assistance to Arizonans in need while they work toward greater self-sufficiency; provide children with food, health care, and parental financial support; provide services to individuals with disabilities; and protect the vulnerable by investigating allegations of abuse, neglect and exploitation. With the implementation of SSBG, DES was designated by the Governor as the administering agency. Among the programs funded by SSBG are services to children. These services are provided both by private agencies under contract and directly by the State. On May 29, 2014, A.R.S. § 8-451 established DCS with the primary purpose of protecting children. DCS is comprised of the State Child Welfare Program previously administered by DES, including Child Protective Services, Foster Care, Adoption, the Comprehensive Medical and Dental Program, and the Office of Child Welfare Investigations. Recognizing each Department's desire to do comprehensive planning for its populations, DES and DCS developed and signed an agreement governing the administration of the Social Services Block Grant. 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 communitybased care, home-based care, or other forms of less intensive care; and 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, the purpose of DCS, 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 and preventing and remedying neglect, abuse, or exploitation of children and adults unable to protect their own interests or preserving, rehabilitating, or reunifying families. Evaluation The appropriate administrations within DES and DCS contracting for services funded by the SSBG have the responsibility of monitoring and evaluating the social service programs funded by the SSBG. May 15, 2017 -2- AZ 2017-2018 SSBG PLAN 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 2018 will be available to the public after January 1, 2019. To obtain copies of this report, direct your request to the contact person at the telephone number or mailing address listed on page five of this Plan. SSBG Planning Process DES is responsible for planning and developing the Plan. This includes acquiring input from local planning bodies and tribal entities for locally planned SSBG services. Planning for the use of the available SSBG funds is accomplished as a part of the DES and DCS annual budget development process. State Planned Services The state level entities participating in Arizona’s SSBG planning and reporting process are: • • • • • • • DCS DES Child Care Administration (CCA) DES Division of Aging and Adult Services (DAAS) DES Division of Business and Finance (DBF) DES Division of Developmental Disabilities (DDD) DES Workforce Administration (WA) DES Rehabilitation Services Administration (RSA) These entities 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 and DCS 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. May 15, 2017 -3- AZ 2017-2018 SSBG PLAN LOCAL PLANNED SERVICES ALLOCATION COUNCILS OF GOVERNMENTS 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 $3,456,125 1,363,299 347,580 414,813 381,369 355,487 TOTAL $6,318,673 Arizona Tribal Entities Tribal nations within Arizona have been established as separate SSBG Planning and Services areas. Technical assistance is provided to tribal nations, upon request, by DES. Each participating tribal nation provides a recommendation for the use of a portion of the state’s SSBG allocation within their tribal area. The chart below indicates the planned allocations, target group and services for each tribal services area. NAME OF TRIBE ALLOCATION 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 Nation (Child Day Care Services) Navajo Nation (Child Home-Based Services) Gila River Indian Community (Intensive Family Preservation and Reunification Services) TOTALS May 15, 2017 -4- $14,303 $15,564 $23,838 $14,850 $17,519 $87,164 $15,029 $88,509 $23,177 $12,546 $23,390 $21,796 $28,082 $84,576 $11,040 $12,062 $105,568 $19,545 $618,557 $99,612 $1,135,293 $16,822 $1,870,284 AZ 2017-2018 SSBG PLAN 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. Geographic Areas The regional areas for which services are planned are identified on the map on page six. 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 of grants and therefore utilizes multiple methods to assign costs. Indirect costs are typically assigned using Modified Total Direct Costs methodology. Other methods of assigning costs include Random Moment Samples, caseload counts, square footage, number of Full Time Equivalent Employees, and machine hours for client and administrative systems. Proof of Audit In accordance with 42 U.S.C. § 1397(e), the Single Audit Report for year ending June 30, 2015, was performed by the State of Arizona, Office of the Auditor General and submitted to the Arizona State Legislature June 6, 2016. Public Comment and Review The proposed Arizona State Fiscal Year 2018 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 DES Internet website on March 15, 2017, 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 April 5, 2017, at the addresses listed below: Arizona Department of Economic Security Rod Huenemann, SSBG Coordinator Policy and Planning Administration 1789 West Jefferson Street - Mail Drop 1292 Phoenix, Arizona 85007 Telephone: (602) 542-3882 E-mail: SSBGInput@azdes.gov May 15, 2017 -5- AZ 2017-2018 SSBG PLAN •Page e Fredonia • Littlefield • • Teec Nos Pos Kayenta • Tuba City III IV Whippo ~rfill • Spnngs • Chinle • Window Rock Kykotsmovi ePolacca FLAGS TAFF • • Lower Greasewood eDilkon Winslo w• • Holbrook • Sanders Cottonwood • St. Johns • Prescott Valley • Prescott •• Show L~w Springerville Lakesi de• - - - - - , Whiteriver • Quartzsite San Carlos •Apache • ~ - - - Jct. Kearn Y'1 • Bylas Safford • Coolidge • Mamm0th Casa Grande • • e e Eloy e Ajo •Mara na II • TUCSO N • Sells • Willcox Benson • VI • • Bisbee Sierra . - - - - , Vista Figure 1: Geographic Planning Areas (State Map) May 15, 2017 -6- AZ 2017-2018 SSBG PLAN Figure 2: DES Organization Chart ona Department of Economic Security Governor Doug Ducey I Interi m Director Henry Darwin I I I nt erim Deputy Direct or of Programs Sean Price Division of Agi ng & Ad ult Services Rhonda Coat es (Int erim) I -I - I I Legisl ative Director Kat hy Ber Communicat i on s Di rect or Tasya Pet erson Clark Pr incell Conni e Weber Deputy Di rect or of Operations Jim Hillya rd Int erim Offi ce of Inspect or Gen eral Dennis Young Sherry Klein Divi sion of Benefit s & M edical Eligibility Bryon Wi nst on (Act ing) Division of Bu sin ess & Finance Deb ra Pet erson A nna Hunt er Scott Carson I- - Division of Technology Services Lori Cunningh am {Int eri m) Jeffrey Raynor Allen Platt cass Taylor Ryan Riach Division for Child & Family Engagement Maureen Casey (In t erim) -- Divisi on of Child Support Services Heat h er Noble (Int erim) Department of Admi nist rat ion Office of Equal I Division of Develop mental Disabi lit i es Dr. Laura Love Lisa Cavazos-Barrett Pearlette Ra mos May 15, 2017 -- Division of Empl oyment & Rehabilitat ion Services M ichael Wi sehart Opportunity Vacant }-- r Huma n Resources Admi nist rat ion Signa Moore Lynn Larson Federico Murillo Fallas Martha Sesmas Office of Cont inuous Improvement Lel a W endell M olly Bright -- Office of Com munity Engagement Leah Land rum Tayl or -- Office of Professi onal Devel opment Adele Cook Cindy Treadwell - 7- AZ 2017-2018 SSBG PLAN 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 DES’ contracting process or direct service-delivery process without modifying the Plan. Catalog of Services This section identifies the services that may be funded under terms of 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 45 CFR, 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, DCS 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. Adoption Services 2. Case Management Services 3. Congregate Meals 4. Counseling Services 5. Day Care Services - Adults 6. Day Care Services - Children 7. Education and Training Services 8. Employment Services 9. Family Planning Services 10. Foster Care Services for Adults 11. Foster Care Services for Children 12. Health Related and Home Health Services 13. Home Based Services 14. Home Delivered Meals 15. Housing Services 16. Independent and Transitional Living Services Ma y 15, 2017 -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 2017-2018 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. Ma y 15, 2017 -9- AZ 2017-2018 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. Ma y 15, 2017 - 10 - AZ 2017-2018 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services • 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. • 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 Ma y 15, 2017 - 11 - AZ 2017-2018 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services • Counseling/Intervention Services that provide for a wide range of personal, interpersonal, situational, and functional guidance. • Crisis Shelter Services Services that provide assistance to abused individuals or families. include, but are not limited to both the shelter and counseling. Services • 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. • Domestic Violence Services provide assistance to an abused individual or families. Services available include: shelter, supportive, prevention strategies, training, victim’s rights and victim’s compensation, coordination, crisis counseling, case management, advocacy, planning, program development, program evaluation, supported employment, life skills training, law enforcement and prosecution. • 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. Ma y 15, 2017 - 12 - AZ 2017-2018 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services • 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 pre-vocational training. • 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. Ma y 15, 2017 - 13 - AZ 2017-2018 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services • Home Care Services that provide individuals who are at risk of institutionalization with coordinated in-home 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. • 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. Ma y 15, 2017 - 14 - AZ 2017-2018 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services • 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 follow-up. • 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. • 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. Ma y 15, 2017 - 15 - AZ 2017-2018 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services • 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. • 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 Escort A service that provides an escort who transports and assists an individual to perform necessary errands away from the residence. Ma y 15, 2017 - 16 - AZ 2017-2018 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services • 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. • 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. Ma y 15, 2017 - 17 - AZ 2017-2018 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services • 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. • 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. Ma y 15, 2017 - 18 - AZ 2017-2018 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services • 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. • 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 selfsufficiency, 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. Ma y 15, 2017 - 19 - AZ 2017-2018 SSBG PLAN Arizona Dictionary and Taxonomy of Human Services • 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. Ma y 15, 2017 - 20 - AZ 2017-2018 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 • • • Ma y 15, 2017 - 21 - AZ 2017-2018 SSBG PLAN Crosswalk for Federal SSBG Services to the Arizona Dictionary and Taxonomy of Human Services • • • • • • • • • Job Development and Placement Job Training Mature Worker Program Prevocational Training Sheltered Employment Supported Employment Supported Employment, Extended Work Adjustment Training Work Experience Family Planning Services • Family Planning 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 8. 9. Employment Services (Continued) Ma y 15, 2017 - 22 - AZ 2017-2018 SSBG PLAN Crosswalk for Federal SSBG Services to the Arizona Dictionary and Taxonomy of Human Services 15. Housing Services • • • • • • • Emergency Shelter Home Repair/Renovation Housing Search and Relocation Housing Support Services Planning Shelter Transitional Housing 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 Legal Services 19. Pregnancy and Parenting Services For Young Parents • Community Education and Information • Parenting Skills Training • • • • • • • • • • Advocacy Behavioral Therapeutic Activities Comprehensive Service Delivery Comprehensive Youth Development Counseling/Intervention Crisis Shelter Services Domestic Violence Housing Support Services 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 20. Prevention and Intervention Services • • • • • • Ma y 15, 2017 - 23 - AZ 2017-2018 SSBG PLAN Crosswalk for Federal SSBG Services to the Arizona Dictionary and Taxonomy of Human Services 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) 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 • • • • • • • • • • • • • • • • • • • • • • • • • Ma y 15, 2017 - 24 - AZ 2017-2018 SSBG PLAN Crosswalk for Federal SSBG Services to the Arizona Dictionary and Taxonomy of Human Services 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 • • Coordination Consultation Ma y 15, 2017 - 25 - AZ 2017-2018 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 27. 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. Except as noted below, 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 (FPL). Families receiving child care assistance must meet income requirements specified. 1. Income Eligibility TANF/SSBG Funds - Services funded by TANF funds transferred to SSBG are delivered in accordance with the requirements of 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 for programs and services to children or their families whose income is less than 200 percent of the income official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved. Ma y 15, 2017 - 26 - AZ 2017-2018 SSBG PLAN 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 FPL at the time of application determination. Once determined eligible, the families can remain eligible until the next redetermination takes place as long as all other eligibility criteria are met, unless the income exceeds 85 percent of State Median Income. Families referred by DCS, children receiving DCS foster care, and families who are receiving cash assistance and are participating in the Workforce Administration-Jobs program and/or who are employed receive services without regard to income and are not subject to a waiting list. Families transitioning off of the TANF cash assistance program must have incomes at or below 165 percent of the FPL; however, these families are not subject to a waiting list. Another group of families who are not subject to a waiting list are those who are residing in a homeless/domestic violence shelter. When a waiting list is in place, working families, whose incomes are at or below 100 percent of the FPL, are given priority for any subsequent releases of families into service. 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. D. Local and State-Planned Levels These columns represent estimates of the federal dollars that may be utilized for the delivery of the services. E. 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) selfdirection; (6) capacity for independent living; and (7) economic selfsufficiency. 4. Elderly (ELD) - Any individual 60 years of age or older. Ma y 15, 2017 - 27 - AZ 2017-2018 SSBG PLAN 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) selfdirection; (6) capacity for independent living; and (7) economic selfsufficiency. 6. Adults/Families/Children (AFC) - Any individual or family. Ma y 15, 2017 - 28 - AZ 2017-2018 SSBG PLAN DEPARTMENT OF CHILD SAFETY (DCS) SFY 2018 DISTRICT I (MARICOPA COUNTY) SERVICES TARGET GROUP STATUS ELIG. LOCAL PLANNED STATE PLANNED Case Management CH (Pregnant/ Parenting Youth) Group $ 36,866 $ - LOCAL & STATE TOTAL $ 36,866 Supportive Intervention/Guidance Counseling CH Group $ 41,716 $ - $ 41,716 Crisis Shelter Services DISTRICT I TOTALS CH Group $ $ 95,654 174,236 $ - $ $ 95,654 174,236 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 $ 33,107 $ - $ 33,107 Supportive Intervention/Guidance Counseling AFC Group $ 172,318 $ - $ 172,318 Behavioral Therapeutic Activities CH Group $ 64,412 $ - $ 64,412 $ 269,837 $ - $ 269,837 DISTRICT II TOTALS May 15, 2017 -29- AZ 2017-2018 SSBG PLAN DEPARTMENT OF CHILD SAFETY (DCS) SFY 2018 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 III TOTALS May 15, 2017 AFC 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 52,208 $ $ - $ $ 23,288 52,208 -30- AZ 2017-2018 SSBG PLAN DEPARTMENT OF CHILD SAFETY (DCS) SFY 2018 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 V TOTALS TARGET GROUP STATUS ELIG. Supportive Intervention/Guidance Counseling GREENLEE TOTALS GRAHAM COUNTY Prevention GRAHAM TOTALS DISTRICT WIDE Supportive Intervention/Guidance Counseling DISTRICT WIDE TOTALS DISTRICT VI TOTALS May 15, 2017 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 51,828 $ $ - $ $ 38,872 51,828 DISTRICT VI (COCHISE, GREENLEE, GRAHAM, SANTA CRUZ COUNTIES) SERVICES TARGET STATUS GROUP ELIG. GREENLEE COUNTY Prevention LOCAL PLANNED LOCAL PLANNED STATE PLANNED AFC Group $ 5,000 AFC Group $ 2,874 $ $ 7,874 AFC Group $ $ 25,758 25,758 AFC Group $ 4,818 $ $ 4,818 38,450 -31- LOCAL & STATE TOTAL $ 5,000 - $ 2,874 $ - $ 7,874 $ $ - $ $ 25,758 25,758 $ 4,818 $ $ 4,818 38,450 $ $ - AZ 2017-2018 SSBG PLAN DEPARTMENT OF CHILD SAFETY (DCS) SFY 2018 TRIBAL AND STATEWIDE SERVICES TARGET GROUP STATUS ELIG. TRIBAL ACYF/ITCA Tribal Consultation LOCAL PLANNED $ STATE PLANNED LOCAL & STATE TOTAL - $ 29,993 $ 29,993 Navajo Home Based Services CH (Tribal Allocation Chart on Page 4 of this Plan) Group $ 1,135,293 $ - $ 1,135,293 Gila Home Based Services (Tribal Allocation Chart on Page 4 of this Plan) TRIBAL TOTALS Group $ 16,822 $ - $ $ 1,152,115 $ 29,993 292,531 CH 16,822 $ 1,182,108 STATEWIDE SERVICES Counseling/Intervention AFC Group $ Legal Services AFC Group $ 1,423,764 $ 1,423,764 Foster Care Services for Children CH Group TANF Transferred to SSBG (Children's Services) Case Management AFC Group STATEWIDE SERVICE TOTALS TRIBAL AND STATEWIDE SERVICES $ 292,531 $ - $ 5,849,500 $ 5,849,500 $ - $ 20,014,130 $ 20,014,130 $ - $ 5,463,243 $ 5,463,243 $ - $33,043,168 $33,043,168 $ 1,152,115 $33,073,161 $34,225,276 LOCAL PLANNED STATE PLANNED $ 1,738,674 $33,073,161 LOCAL & STATE TOTAL $34,811,835 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 DCS SERVICES DCS TOTALS May 15, 2017 -32- AZ 2017-2018 SSBG PLAN CHILD CARE ADMINISTRATION (CCA) SFY 2018 TRIBAL AND STATEWIDE SERVICES TARGET GROUP STATUS ELIG. Tohono O'odham Nation Day Care Services (Tribal Allocation Chart on Page 4 of this Plan) CH Group Day Care Services - Children CH Group TRIBAL AND STATEWIDE TOTALS LOCAL PLANNED $ 99,612 STATE PLANNED $ - LOCAL & STATE $ 99,612 $ $ $ $ $ $ 99,612 154,915 154,915 154,915 254,527 ALL CCA SERVICES LOCAL PLANNED $ 99,612 CCA TOTALS May 15, 2017 -33- STATE PLANNED $ 154,915 LOCAL & STATE $ 254,527 AZ 2017-2018 SSBG PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2018 DISTRICT I (MARICOPA COUNTY) SERVICES TARGET GROUP STATUS ELIG. LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL Adult Day Care/Adult Day Health Care ELD or PWD Group $ 198,072 $ 17,061 $ 215,133 Emergency Human Services ELD or PWD Group $ - $ 45,425 $ 45,425 Supportive Intervention/Guidance Counseling ELD or PWD Group $ - $ 31,713 $ 31,713 Congregate Meals ELD or PWD Group $ - $ 2,875 $ 2,875 Home Delivered Meals ELD Group $ 511,695 $ - $ 511,695 Transportation ELD or PWD Group $ - $ 5,115 $ 5,115 Home Care ELD or PWD Group $ 357,749 $ 1,397,276 $ 1,755,025 Administrative Services ELD or PWD Group $ - $ 342,476 $ 342,476 Respite ELD or PWD Group $ - $ 146,737 $ 146,737 Case Management ELD or PWD Group $ - $ 338,134 $ 338,134 Volunteer Services ELD or PWD Group $ - $ 14,321 $ 14,321 Legal Assistance ELD or PWD Group $ - $ 13,818 $ 13,818 Emergency Shelter AFC (Victims of Domestic Violence) Group $ 428,116 $ - $ 428,116 Supportive Intervention/Guidance Counseling AFC (Domestic Violence) Group $ 34,503 $ - $ 34,503 Emergency Shelter AFC (Homeless Families & Individuals) Group $ 340,287 $ 340,287 Housing Support Services ELD/DD (Homeless) Group $ 96,669 $ 96,669 May 15, 2017 -34- $ - AZ 2017-2018 STATE PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2018 Housing Support Services AFC Group $ 79,665 $ - $ 79,665 Case Management (Basic Needs) AFC Group $ 1,189,386 $ - $ 1,189,386 Housing Support Services AFC (Homeless) Group $ - $ 252,407 $ 252,407 $ 2,607,358 $ 5,843,500 DISTRICT I TOTALS May 15, 2017 $ 3,236,142 -35- AZ 2017-2018 STATE PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2018 DISTRICT II (PIMA COUNTY) SERVICES TARGET GROUP STATUS ELIG. LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL Home Care (Personal Care, Housekeeping & Home Health) ELD or PWD Group $ 330,424 $ 757,200 $ 1,087,624 Medical Alert System ELD or PWD Group $ - $ 9,061 $ 9,061 Adult Day Care/Adult Day Health Care ELD or PWD Group $ - $ 2,400 $ 2,400 Case Management ELD or PWD Group $ 326,729 $ - $ 326,729 Case Management - Intake ELD or PWD Group $ - $ 99,461 $ 99,461 Home Repair/Renovation ELD or PWD Group $ - $ 20,797 $ 20,797 Home Delivered Meals ELD or PWD Group $ 76,606 $ - $ 76,606 Administrative Services ELD or PWD Group $ - $ 186,796 $ 186,796 Supportive Intervention/Guidance Counseling AD/CH (Domestic Violence Victims) Group $ 22,294 $ - $ 22,294 Crisis Intervention Shelter Services AD (Domestic Group Violence Victims) $ 60,000 $ - $ 60,000 Domestic Violence AD (Domestic Violence Victims) Group $ - $ 8,207 $ 8,207 Case Management AD (Domestic Violence Victims) Group $ 35,000 $ - $ 35,000 Legal Assistance (Civil:Various for AFC families in need of food stamp (Low Income assistance) Residents) Group $ 17,831 $ - $ 17,831 Legal Assistance (Civil:Various for AFC families facing eviction or needing (Low Income Residents) landlord tenant mitigation) Group $ 17,831 $ - $ 17,831 Legal Assistance (Civil:Various for AFC domestic violence victims) (Domestic Violence Victims) Group $ 26,747 $ - $ 26,747 May 15, 2017 -36- AZ 2017-2018 STATE PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2018 Emergency Shelter AD/CH (Adults and Youth ­ Homeless) Group $ 50,000 $ - $ 50,000 Housing Support Services AD/CH (Adults Group and Children $ 40,000 $ - $ 40,000 $ 1,083,922 $ 2,087,384 DISTRICT II TOTALS May 15, 2017 $ 1,003,462 -37- AZ 2017-2018 STATE PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2018 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 $ - $ 4,393 $ 4,393 Administrative Services ELD or PWD Group $ - $ 2,910 $ 2,910 Home Delivered Meals ELD or PWD or AD Group $ 24,334 $ - $ 24,334 Transportation ELD or PWD or AD Group $ 13,224 $ - $ 13,224 Community Education & Information ELD or PWD Group $ $ 1,977 $ 1,977 Program Development ELD or PWD Group $ - $ 1,319 $ 1,319 Legal Assistance ELD or PWD Group $ - $ 1,448 $ 1,448 Long-Term Care Advocacy ELD or PWD Group $ - $ 1,357 $ 1,357 Information & Referral ELD or PWD Group $ - $ 917 $ 917 Home Care ELD or PWD Group $ - $ 5,524 $ 5,524 $ 37,558 $ 19,845 $ 57,403 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 $ - $ 10,024 $ 10,024 Case Management ELD or PWD Group $ 3,854 $ 25,846 $ 29,700 Home Care ELD or PWD Group $ 1,927 $ 17,850 $ 19,777 Transportation ELD or PWD Group $ 11,560 $ 1,973 $ 13,533 Emergency Shelter AFC - Crisis Intervention, Domestic Violence 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 May 15, 2017 Group -38- AZ 2017-2018 STATE PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2018 Community Ed. & Information ELD or PWD Group $ - $ 6,917 $ 6,917 Program Development ELD or PWD Group $ - $ 4,616 $ 4,616 Legal Assistance ELD or PWD Group $ - $ 5,067 $ 5,067 Long-Term Care Advocacy ELD or PWD Group $ - $ 4,750 $ 4,750 Information & Referral ELD or PWD Group $ - $ 6,485 $ 6,485 $ 61,667 $ 83,528 $ 145,195 COCONINO TOTALS May 15, 2017 -39- AZ 2017-2018 STATE PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2018 NAVAJO COUNTY Administrative Services ELD or PWD Group $ - $ 10,060 $ 10,060 Transportation ELD or PWD or AD Group $ 10,002 $ - $ 10,002 Case Management ELD or PWD Group $ 4,007 $ 14,842 $ 18,849 Home Delivered Meals ELD or PWD Group $ 10,008 $ - $ 10,008 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 $ - $ 5,003 $ 5,003 Program Development ELD or PWD Group $ - $ 4,396 $ 4,396 Legal Assistance ELD or PWD Group $ - $ 5,067 $ 5,067 Long-Term Care Advocacy ELD or PWD Group $ - $ 4,749 $ 4,749 Information & Referral ELD or PWD Group $ - $ 3,209 $ 3,209 Home Care ELD or PWD Group $ - $ 17,282 $ 17,282 Adult Day Care/Adult Day Health Care EDP or PWD Group $ - $ 500 $ 500 $ 53,040 $ 65,108 $ 118,148 NAVAJO TOTALS YAVAPAI COUNTY Administrative Services ELD or PWD Group $ - $ 46,873 $ 46,873 Case Management ELD or PWD Group $ 5,821 $ 123,773 $ 129,594 Home Delivered Meals ELD or PWD or AD Group $ 8,150 $ 3,260 $ 11,410 Respite ELD or PWD Group $ - $ 1,506 $ 1,506 Adult Day Care/Adult Day Health Care ELD or PWD Group $ 9,316 $ 3,090 $ 12,406 Case Management Assistance for Eviction Prevention AFC - Crisis Intervention Group $ 5,821 $ - $ 5,821 Emergency Shelter AFC - Crisis Intervention Group $ 11,644 $ - $ 11,644 May 15, 2017 -40- AZ 2017-2018 STATE PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2018 Case Management AFC - Crisis Intervention Group $ 11,644 $ - $ 11,644 Transportation AFC Group $ 29,108 $ - $ 29,108 Transportation ELD or PWD Group $ - $ 11,007 $ 11,007 Community Ed. & Information ELD or PWD Group $ - $ 34,430 $ 34,430 Program Development ELD or PWD Group $ - $ 22,423 $ 22,423 Legal Assistance ELD or PWD Group $ - $ 24,611 $ 24,611 Long-Term Care Advocacy ELD or PWD Group $ - $ 23,071 $ 23,071 Information & Referral ELD or PWD Group $ - $ 15,588 $ 15,588 Home Care ELD or PWD Group $ - $ 105,826 $ 105,826 $ $ 81,504 233,769 $ $ 415,458 583,939 $ $ 496,962 817,708 YAVAPAI TOTALS DISTRICT III TOTALS May 15, 2017 -41- AZ 2017-2018 STATE PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2018 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 $ 36,519 $ 39,712 Administrative Services ELD or PWD Group $ - $ 12,653 $ 12,653 Case Management ELD or PWD Group $ 5,321 $ 49,848 $ 55,169 Home Delivered Meals ELD or PWD Group $ 13,125 $ 5,000 $ 18,125 Transportation LA PAZ TOTALS ELD or PWD Group $ $ 13,834 35,473 $ $ 225 104,245 $ $ 14,059 139,718 MOHAVE COUNTY Home Care ELD or PWD Group $ 45,448 $ 47,465 $ 92,913 Case Management ELD or PWD Group $ 45,448 $ 100,319 $ 145,767 Administrative Services ELD or PWD Group $ - $ 24,416 $ 24,416 Home Delivered Meals ELD/AD/PWD Group $ 45,448 $ 15,000 $ 60,448 Emergency Shelter Domestic Violence Group $ 45,449 $ - $ 45,449 ELD or PWD Group $ 181,793 $ $ 645 187,845 $ $ 645 369,638 Transportation MOHAVE TOTALS YUMA COUNTY Home Care ELD or PWD Group $ 31,658 $ 22,879 $ 54,537 Case Management ELD or PWD Group $ 20,351 $ 94,485 $ 114,836 Administrative Services ELD or PWD Group $ - $ 21,320 $ 21,320 Adult Day Care/Adult Day Health Care ELD or PWD Group $ 15,829 $ 5,000 $ 20,829 Home Delivered Meals ELD or PWD Group $ 29,397 $ 12,000 $ 41,397 Transportation ELD or PWD Group $ 27,136 $ - $ 27,136 Respite ELD or PWD Group $ 4,523 $ - $ 4,523 Emergency Shelter AFC Group $ 40,703 $ - $ 40,703 Transportation YUMA TOTALS DISTRICT IV TOTALS ELD or PWD Group $ $ 169,597 386,863 $ $ $ 600 156,284 448,374 $ $ $ 600 325,881 835,237 May 15, 2017 -42- AZ 2017-2018 STATE PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2018 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 $ 47,403 $ 65,982 Program Development ELD or PWD Group $ - $ 925 $ 925 Home Delivered Meals ELD or PWD Group $ 19,845 $ 22,442 $ 42,287 Home Repair/Renovation ELD or PWD Group $ 6,242 $ - $ 6,242 Case Management ELD or PWD Group $ 26,228 $ 28,990 $ 55,218 Respite ELD or PWD Group $ - $ 4,709 $ 4,709 Administrative Services ELD or PWD Group $ - $ 17,137 $ 17,137 Emergency Shelter Domestic Violence Group $ 25,652 $ - $ 25,652 Case Management GILA COUNTY TOTALS PINAL COUNTY Home Care AFC Group $ $ 8,048 104,594 $ $ 121,606 $ $ 8,048 226,200 ELD/PWD Group $ 8,486 $ 113,125 $ 121,611 Program Development ELD or PWD Group $ - $ 1,564 $ 1,564 Administrative Services ELD or PWD Group $ - $ 27,219 $ 27,219 Home Delivered Meals ELD or PWD Group $ 23,819 $ 40,912 $ 64,731 Home Repair/Renovation ELD or PWD Group $ 7,623 $ - $ 7,623 Case Management ELD or PWD Group $ 30,120 $ 57,891 $ 88,011 Respite ELD or PWD Group $ - $ 5,977 $ 5,977 Emergency Shelter Domestic Violence Group $ 50,802 $ - $ 50,802 Case Management AFC Group $ 16,096 $ - $ 16,096 $ $ 136,946 241,540 $ $ 246,688 368,294 $ $ 383,634 609,834 PINAL COUNTY TOTALS DISTRICT V TOTALS May 15, 2017 -43- AZ 2017-2018 STATE PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2018 DISTRICT VI (COCHISE, GREENLEE, GRAHAM, SANTA CRUZ COUNTIES) SERVICES TARGET STATUS GROUP ELIG. LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL COCHISE COUNTY Administrative Services ELD or PWD Group $ - $ 36,674 $ 36,674 Home Care ELD or PWD Group $ 22,280 $ 60,216 $ 82,496 Home Delivered Meals ELD or PWD Group $ 56,669 $ 31,601 $ 88,270 Case Management ELD or PWD Group $ 7,073 $ 64,499 $ 71,572 Transportation ELD or PWD Group $ - $ 86,679 $ 86,679 Congregate Meals ELD or PWD Group $ 699 $ 699 Case Management Domestic Violence Group $ 32,128 $ - $ 32,128 Domestic Violence Domestic Violence Group $ - $ 35,865 $ 35,865 $ 118,150 $ 316,233 $ 434,383 COCHISE TOTALS GRAHAM COUNTY Home Care ELD or PWD Group $ 9,251 $ 7,563 $ 16,814 Administrative Services ELD or PWD Group $ - $ 10,000 $ 10,000 Home Delivered Meals ELD or PWD Group $ 25,594 $ - $ 25,594 Case Management ELD or PWD Group $ - $ 24,081 $ 24,081 Transportation GRAHAM TOTALS GREENLEE COUNTY ELD or PWD Group $ $ 34,845 $ $ 11,068 52,712 $ $ 11,068 87,557 Home Care ELD or PWD Group $ 15,929 $ 5,163 $ 21,092 Administrative Services ELD or PWD Group $ - $ 2,000 $ 2,000 Home Delivered Meals ELD or PWD Group $ 19,610 $ - $ 19,610 Transportation ELD or PWD Group $ 2,313 $ 2,000 $ 4,313 Case Management GREENLEE TOTALS ELD or PWD Group $ $ 37,852 $ $ 8,213 17,376 $ $ 8,213 55,228 May 15, 2017 -44- AZ 2017-2018 STATE PLAN DIVISION OF AGING AND ADULT SERVICES (DAAS) SFY 2018 SANTA CRUZ COUNTY Home Care ELD or PWD Group $ 10,793 $ 5,624 $ 16,417 Administrative Services ELD or PWD Group $ - $ 10,000 $ 10,000 Home Delivered Meals ELD or PWD Group $ 22,887 $ - $ 22,887 Case Management ELD or PWD Group $ - $ 28,265 $ 28,265 $ $ 33,680 224,527 $ $ 43,889 430,210 $ $ 77,569 654,737 SANTA CRUZ TOTALS DISTRICT VI TOTALS TRIBAL AND 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 Coordination: Food Bank LOCAL & STATE TOTAL $ 2,532,412 $ 2,532,412 618,557 $ - $ 618,557 $ - $ 620,000 $ 620,000 Group $ - $ 12,000 $ 12,000 AFC Domestic Violence Group $ - $ 20,501 $ 20,501 AFC Hunger Group $ - $ 247,541 $ 247,541 $ 618,557 $ 3,432,454 $ 4,051,011 TRIBAL AND STATEWIDE TOTALS ALL DAAS SERVICES DAAS TOTALS May 15, 2017 -45- LOCAL PLANNED STATE PLANNED $ 5,944,860 $ 8,954,551 LOCAL & STATE TOTAL $ 14,899,411 AZ 2017-2018 STATE PLAN DIVISION OF DEVELOPMENTAL DISABILITIES (DDD) SFY 2018 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 $ $ 33,797 33,797 $ $ - $ $ 33,797 33,797 DD Adults Group $ $ $ 4,000 4,000 37,797 $ $ $ - $ $ $ 4,000 4,000 37,797 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 $ $ 21,118 21,118 $ $ - $ $ 21,118 21,118 PINAL COUNTY Employment Related Services PINAL TOTALS DD Group $ $ 42,243 42,243 $ $ - $ $ 42,243 42,243 $ 63,361 $ - $ 63,361 DISTRICT V TOTALS May 15, 2017 -46- AZ 2017-2018 SSBG PLAN DIVISION OF DEVELOPMENTAL DISABILITIES (DDD) SFY 2018 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 $ $ 31,917 31,917 $ $ - $ $ 31,917 31,917 GRAHAM COUNTY Employment Related Services GRAHAM TOTALS AD-DD Group $ $ 21,590 21,590 $ $ - $ $ 21,590 21,590 GREENLEE COUNTY Day Treatment and Training GREENLEE TOTALS CH-DD Group $ $ 4,375 4,375 $ $ - $ $ 4,375 4,375 AD-DD Group $ $ $ 34,628 34,628 92,510 $ $ $ - $ $ $ 34,628 34,628 92,510 SANTA CRUZ COUNTY Employment Related Services SANTA CRUZ TOTALS DISTRICT VI TOTALS ALL DDD SERVICES LOCAL PLANNED $ 193,668 DDD TOTALS May 15, 2017 -47- STATE PLANNED $ - LOCAL & STATE $ 193,668 AZ 2017-2018 SSBG PLAN WORKFORCE ADMINISTRATION (WA) SFY 2018 DISTRICT II (PIMA COUNTY) SERVICES Employment Services TARGET GROUP AD STATUS ELIG. Group District II TOTALS LOCAL PLANNED STATE PLANNED $ 40,000 $ - LOCAL & STATE TOTAL $ 40,000 $ 40,000 $ - $ 40,000 $ 27,950 $ - $ 27,950 $ 27,950 $ - $ 27,950 DISTRICT IV (YUMA COUNTY) Employment Related Services AD Group District IV TOTALS ALL WA SERVICES LOCAL PLANNED $ 67,950 WA TOTALS May 15, 2017 -48- STATE PLANNED $ - LOCAL & STATE TOTAL $ 67,950 AZ 2017-2018 SSBG PLAN REHABILITATION SERVICES ADMINISTRATION (RSA) SFY 2018 DISTRICT I (MARICOPA COUNTY) SERVICES TARGET GROUP STATUS ELIG. Adaptive Aids and Devices PWD Group $ 1,950 $ - LOCAL & STATE TOTAL $ 1,950 Supported Employment, Extended PWD Group $ 41,229 $ - $ 41,229 Rehabilitation Instructional Services PWD Group $ 2,568 $ - $ 2,568 $ 45,747 $ - $ 45,747 DISTRICT I TOTALS LOCAL PLANNED STATE PLANNED DISTRICT II (PIMA COUNTY) SERVICES TARGET GROUP STATUS ELIG. Interpreter PWD (Deaf) Group Adults $ 20,000 $ - LOCAL & STATE TOTAL $ 20,000 Supportive Intervention/Guidance Counseling PWD Hearing Impaired $ 30,000 $ - $ 30,000 $ 50,000 $ - $ 50,000 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 $ $ 7,218 7,218 $ $ - $ $ 7,218 7,218 NAVAJO COUNTY Job Training NAVAJO TOTALS PWD Adults Group $ $ 12,588 12,588 $ $ - $ $ 12,588 12,588 PWD Adults Group $ $ $ 4,000 4,000 23,806 $ $ $ - $ $ $ 4,000 4,000 23,806 YAVAPAI COUNTY Extended Supported Employment YAVAPAI TOTALS DISTRICT III TOTALS May 15, 2017 -49- AZ 2017-2018 SSBG PLAN REHABILITATION SERVICES ADMINISTRATION (RSA) SFY 2018 DISTRICT V (GILA, PINAL COUNTIES) SERVICES TARGET GROUP GILA COUNTY Extended Supported Employment GILA TOTALS PWD PINAL COUNTY Extended Supported Employment PINAL TOTALS PWD STATUS ELIG. Group Group DISTRICT V TOTALS May 15, 2017 -50- LOCAL PLANNED STATE PLANNED LOCAL & STATE TOTAL $ 11,440 $ 11,440 $ $ - $ $ 11,440 11,440 $ $ 13,200 13,200 $ $ - $ $ 13,200 13,200 $ 24,640 $ - $ 24,640 AZ 2017-2018 SSBG PLAN REHABILITATION SERVICES ADMINISTRATION (RSA) SFY 2018 STATEWIDE SERVICES TARGET GROUP STATUS ELIG. Comprehensive Disability Related Services PWD Group Supported Employment, Extended PWD Group Independent Living PWD Group STATEWIDE TOTALS LOCAL PLANNED $ STATE PLANNED - $ - $ 78,000 LOCAL & STATE TOTAL $ 78,000 $ 10,000 $ 10,000 $ 437,918 $ 437,918 $ 525,918 $ 525,918 ALL RSA SERVICES LOCAL PLANNED RSA TOTALS May 15, 2017 $ -51- 144,193 STATE PLANNED $ 525,918 LOCAL & STATE TOTAL $ 670,111 AZ 2017-2018 SSBG PLAN PLANNED SFY 2018 SSBG SERVICE ALLOCATIONS LISTED BY FEDERAL SSBG SERVICE DEFINITIONS NUMBERS 1 - 29 INDICATING THE RESPONSIBLE DIVISION/ADMINISTRATION/DEPARTMENT THAT PROVIDES OR CONTRACTS FOR THE SERVICE SVC CODE SERVICE (SVC) TITLE ADMIN 1. Adoption Services DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ - 2. Case Management Services DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 2,858,320 5,500,109 8,358,429 3. Congregate Meals DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 3,574 3,574 4. Counseling Services DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ - May 15, 2017 -52- ALLOCATION AZ 2017-2018 SSBG PLAN PLANNED SFY 2018 SSBG SERVICE ALLOCATIONS LISTED BY FEDERAL SSBG SERVICE DEFINITIONS NUMBERS 1 - 29 INDICATING THE RESPONSIBLE DIVISION/ADMINISTRATION/DEPARTMENT THAT PROVIDES OR CONTRACTS FOR THE SERVICE SVC CODE SERVICE (SVC) TITLE ADMIN 5. Day Care Services--Adults DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 251,268 251,268 6. Day Care Services--Children DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 254,527 254,527 7. Education and Training Services DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ - 8. Employment Services DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 67,950 67,950 May 15, 2017 -53- ALLOCATION AZ 2017-2018 SSBG PLAN PLANNED SFY 2018 SSBG SERVICE ALLOCATIONS LISTED BY FEDERAL SSBG SERVICE DEFINITIONS NUMBERS 1 - 29 INDICATING THE RESPONSIBLE DIVISION/ADMINISTRATION/DEPARTMENT THAT PROVIDES OR CONTRACTS FOR THE SERVICE SVC CODE SERVICE (SVC) TITLE ADMIN 9. Family Planning Services DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ - 10. Foster Care Services for Adults DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ - 11. Foster Care Services for Children DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 25,863,630 25,863,630 12. Health Related and Home Health Services DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 9,061 9,061 May 15, 2017 -54- ALLOCATION AZ 2017-2018 SSBG PLAN PLANNED SFY 2018 SSBG SERVICE ALLOCATIONS LISTED BY FEDERAL SSBG SERVICE DEFINITIONS NUMBERS 1 - 29 INDICATING THE RESPONSIBLE DIVISION/ADMINISTRATION/DEPARTMENT THAT PROVIDES OR CONTRACTS FOR THE SERVICE SVC CODE SERVICE (SVC) TITLE ADMIN 13. Home Based Services DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 5,090,078 1,152,115 6,242,193 14. Home Delivered Meals DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 1,031,857 1,031,857 15. Housing Services DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 853,690 853,690 16. Independent and Transitional Living Services DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ - May 15, 2017 -55- ALLOCATION AZ 2017-2018 SSBG PLAN PLANNED SFY 2018 SSBG SERVICE ALLOCATIONS LISTED BY FEDERAL SSBG SERVICE DEFINITIONS NUMBERS 1 - 29 INDICATING THE RESPONSIBLE DIVISION/ADMINISTRATION/DEPARTMENT THAT PROVIDES OR CONTRACTS FOR THE SERVICE SVC CODE SERVICE (SVC) TITLE ADMIN 17. Information and Referral DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 88,847 88,847 18. Legal Services DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 112,420 1,423,764 1,536,184 19. Pregnancy and Parenting Services for Young Parents DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 11,644 11,644 20. Prevention and Intervention Services DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 1,511,380 30,000 783,756 2,325,136 May 15, 2017 -56- ALLOCATION AZ 2017-2018 SSBG PLAN PLANNED SFY 2018 SSBG SERVICE ALLOCATIONS LISTED BY FEDERAL SSBG SERVICE DEFINITIONS NUMBERS 1 - 29 INDICATING THE RESPONSIBLE DIVISION/ADMINISTRATION/DEPARTMENT THAT PROVIDES OR CONTRACTS FOR THE SERVICE SVC CODE SERVICE (SVC) TITLE ADMIN 21. Protective Services for Adults DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 2,577,837 2,577,837 22. Protective Services for Children DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ - 23. Recreational Services DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ - 24. Residential Treatment Services DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ - May 15, 2017 -57- ALLOCATION AZ 2017-2018 SSBG PLAN PLANNED SFY 2018 SSBG SERVICE ALLOCATIONS LISTED BY FEDERAL SSBG SERVICE DEFINITIONS NUMBERS 1 - 29 INDICATING THE RESPONSIBLE DIVISION/ADMINISTRATION/DEPARTMENT 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 WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 640,111 193,668 833,779 26. Special Services for Youth Involved in or at Risk of Involvement with Criminal Activity DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 46,824 46,824 27. Substance Abuse Services DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ - 28. Transportation Services DAAS RSA WA CCA DDD DCS $ $ $ $ $ $ TOTAL $ 231,037 231,037 29. Other Services (Coordination, Consultation, Program Occupancy) DAAS RSA WA CCA DDD DCS Prog. Occupancy $ $ $ $ $ $ $ TOTAL $ 280,042 29,993 550,300 860,335 May 15, 2017 -58- AZ 2017-2018 SSBG PLAN PLANNED SFY 2018 SSBG SERVICE ALLOCATIONS LISTED BY FEDERAL SSBG SERVICE DEFINITIONS NUMBERS 1 - 29 INDICATING THE RESPONSIBLE DIVISION/ADMINISTRATION/DEPARTMENT THAT PROVIDES OR CONTRACTS FOR THE SERVICE SVC CODE 30. 31. SERVICE (SVC) TITLE Total of the SFY 2018 Planned SSBG Funding Allocations Listed Above for Federal Service Definitions Numbers 1 Through 29 TOTAL $ 51,447,802 $ 1,316,228 TOTAL $ 1,316,228 $ $ $ $ $ $ $ $ TOTAL $ 34,811,835 193,668 670,111 254,527 67,950 14,899,411 550,300 1,316,228 52,764,030 Administrative Costs DES All SFY 2018 State and Locally Planned SSBG Funding Allocations Listed by the Administration/Division/Department Responsible for Providing or Contracting for the Services May 15, 2017 ALLOCATION ADMIN DCS DDD RSA CCA WA DAAS Prog. Occupancy Administrative -59- AZ 2017-2018 SSBG PLAN APPENDIX A PUBLIC NOTICE May 15, 2017 - 60 - AZ 2017-2018 SSBG PLAN PUBLIC NOTICE Issue Date: March 14, 2017 ARIZONA DEPARTMENT OF ECONOMIC SECURITY PUBLIC COMMENT ON THE STATE OF ARIZONA SOCIAL SERVICES BLOCK GRANT (SSBG) PLAN JULY 1, 2017 – JUNE 30, 2018 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://des.az.gov/2018-ssbg The Department will accept written comments on the plan sent to any of the following addresses: E-mail: ssbginput@azdes.gov Fax: (602) 542-6000 Mail: Arizona Department of Economic Security ATTN: Rod Huenemann P.O. Box 6123, Mail Drop 1292 Phoenix, Arizona 85005 Written comments should be sent so that the Department will receive them before 5:00 PM, Wednesday, April 5, 2017, 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. May 15, 2017 - 61 - AZ 2017-2018 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 May 15, 2017 - 62 - AZ 2017-2018 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 ~ement shall be subject to a civil penalty of not less than $10,000 and not more than $1 00,0Q0 to/- each such failure. Cl /,, t ~ - ­1 Title Arizona Department of Economic Security Organization May 15, 2017 - 63 - AZ 2017-2018 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 point 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 May 15, 2017 - 64 - AZ 2017-2018 SSBG PLAN the federal or state criminal drug statutes; 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: May 15, 2017 - 65 - AZ 2017-2018 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] /~--> Si~nate V Interim Director Henry Darwin Title Arizona Department of Economic Security Organization May 15, 2017 - 66 - AZ 2017-2018 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 Exclusion-Lower 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. May 15, 2017 - 67 - AZ 2017-2018 SSBG PLAN 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. 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 May 15, 2017 - 68 - AZ 2017-2018 SSBG PLAN 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 Exclusion-Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all 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 certi~tion, such prospective participant shall attach an explanation to this proposal. , I //~ / 7hv=-~-==- - --=~--­ "­ Signa re ,::m Director Henry Darwin Title Arizona Department of Economic Security Organization May 15, 2017 - 69 - AZ 2017-2018 SSBG PLAN CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE Public Law 103-227, 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 . ./ l //// 1~, /-") ~,,./" Si~na Int Title m Director Henry Darwin Arizona Department of Economic Security Organization May 15, 2017 - 70 - AZ 2017-2018 SSBG PLAN APPENDIX C PRE-EXPENDITURE REPORT FORM May 15, 2017 - 71 - AZ 2017-2018 SSBG PLAN Part A. Estimated Expenditures and Proposed Provision Method STATE: Arizona Contact Person: Rod Huenemann Title: SSBG Coordinator Agency: Department of Economic Security OMB NO.: 0970-0234 SSBG Expenditures Service Supported with SSBG Expenditures 1 Adoption Services 2 Case Management 3 Congregate Meals 4 Counseling Services 5 Day Care--Adults 6 Day Care--Children 7 Education and Training Services 8 Employment Services 9 Family Planning Services 10 Foster Care Services--Adults 11 Foster Care Services--Children 12 Health-Related Services 13 Home-Based Services 14 Home-Delivered Meals 15 Housing Services 16 Independent/Transitional Living Services 17 Information & Referral 18 Legal Services 19 Pregnancy & Parenting 20 Prevention & Intervention 21 Protective Services--Adults 22 Protective Services--Children 23 Recreation Services 24 Residential Treatment 25 Special Services--Disabled 26 Special Services--Youth at Risk 27 Substance Abuse Services 28 Transportation 29 Other Services*** 30 SUM OF EXPENDITURES FOR SERVICES 31 Administrative Costs SUM OF EXPENDITURES FOR SERVICES 32 AND ADMINISTRATIVE COSTS EXPIRATION DATE: 11/30/2017 REPORT PERIOD: 7/1/17-6/30/18 FISCAL YEAR: SFY 2018 Phone Number: 602-542-6159 E-Mail Address: rhuenemann@azdes.gov Submission Date: May 30, 2017 8,358,429 3,574 251,268 254,527 67,950 5,849,500 9,061 6,242,193 1,031,857 853,690 88,847 1,536,184 11,644 2,325,136 2,577,837 833,779 46,824 231,037 860,335 31,433,672 1,316,228 Funds transferred into SSBG* 20,014,130 20,014,130 - 32,749,900 20,014,130 SSBG Allocation * From which block grant(s) were these funds transferred? TANF ** Please list the sources of these funds: Federal and State *** Please list other serivces: Coordination, Consultation, and Program Occupancy Page 1 of 2 Expenditures of All Other Federal, State and Local funds** 332,436,000 4,452,520 796,334 81,010,015 40,187,467 276,111,000 135,889 6,261,020 6,283,116 15,468,010 1,273,477 22,027,596 1,041,976 10,173,505 57,813,239 1,334,021 10,177,408 866,982,593 I Provision Method Total Expenditures 340,794,429 4,456,094 1,047,602 81,264,542 40,255,417 301,974,630 144,950 12,503,213 7,314,973 16,321,700 1,362,324 23,563,780 11,644 3,367,112 12,751,342 58,647,018 46,824 1,565,058 11,037,743 918,430,395 Public Private X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Part B. Estimated Recipients OMB NO.: 0970-0234 EXPIRATION DATE: 11/30/2017 STATE: Arizona FISCAL YEAR: SFY 2018 Service Supported with SSBG Expenditures 1 Adoption Services 2 Case Management 3 Congregate Meals 4 Counseling Services 5 Day Care--Adults 6 Day Care--Children 7 Education and Training Services 8 Employment Services 9 Family Planning Services 10 Foster Care Services--Adults 11 Foster Care Services--Children 12 Health-Related Services 13 Home-Based Services 14 Home-Delivered Meals 15 Housing Services 16 Independent/Transitional Living Services 17 Information & Referral 18 Legal Services 19 Pregnancy & Parenting 20 Prevention & Intervention 21 Protective Services--Adults 22 Protective Services--Children 23 Recreation Services 24 Residential Treatment 25 Special Services--Disabled 26 Special Services--Youth at Risk 27 Substance Abuse Services 28 Transportation 29 Other Services*** 30 SUM OF RECIPIENTS OF SERVICES Children 44,448 51,727 3,155 40,190 1,411 1 40,419 410 307 138 322 300,046 482,574 Adults Adults Age Adults Age 59 Years & 60 Years & Younger Older 984 7,554 1,569 17,630 13 103 11,322 1 3 44 888 8,529 349 4,250 49 782 37 257 3,267 18,257 215 951 12,308 3,269 2,599 6,636 3,743 280 829 12,191 94 963 38,269 81,697 Page 2 of 2 Adults of Unknown Total Adults Age 31,214 39,752 19,199 116 0 11,323 47 9,417 4,599 14,113 14,944 294 21,524 5,781 6,947 15,577 9,235 4,023 255 13,275 967,576 968,633 1,018,939 1,138,905 Total 84,200 19,199 116 51,727 0 14,478 40,190 47 9,417 4,599 16,355 295 21,524 47,366 410 15,884 9,235 4,161 322 13,275 1,268,679 1,621,479 ACF-196R : Part 1: Expenditure Data Program Name: Temporary Assistance for Needy Families Grantee Name: ARIZONA Report Name: ACF-196R : Part 1: Expenditure Data Funding/Grant Period: 1701AZTANF Report Period: 01/01/2017 to 03/31/2017 Report Status: Submission in Review by RO Department of Health and Human Services Administration for Children and Families Temporary Assistance for Needy Families (TANF) ACF - 196R Financial Report Part 1: Expenditure Data State ARIZONA Grant Year 2017 Fiscal Year 2017 (A) Federal Funds Report Quarter Next Quarter Ending Ending 03/31/2017 09/30/2017 (B) State Funds (C) State Funds State Family Assistance Grant $102,077,478 1. Awarded 2. Transferred to CCDF Discretionary Report is Submitted as: New Revised Final (D) Federal Funds (E) Federal Funds Contingency Funds Award Reconciliation FS at FMAP Rate of .6924 Emergency Contingency Funds (Authorized by ARRA) $20,014,128 $0 $10,207,703 3. Transfered to SSBG $91,869,775 4. Adjusted Award $0 5. Carryover Expenditure Categories 6. Basic Assistance 6.a. Basic Assistance (excluding Relative Foster Care Maintenance Payments and Adoption and Guardianship Subsidies) 6.b. Relative Foster Care Maintenance Payments and Adoption and Guardianship Subsidies Federal TANF Expenditures State MOE Expenditures in TANF MOE Expenditures Separate State Programs Expenditures with Contigency Funds $12,003,312 $0 $0 $8,415,000 $710,525 $0 $0 $8,415,000 $11,292,787 $0 $0 $0 $2,813,600 $0 $2,813,600 $0 7.b. Juvenile Justice Payments $0 $0 7.c. Emergency Assistance Authorized Solely Under Prior Law $0 $0 $0 $0 8.a. Child Welfare or Foster Care Services $0 $0 8.b. Juvenile Justice Services $0 $0 8.c. Emergency Services Authorized Solely Under Prior Law $0 $0 $211,586 $0 7. Assistance Authorized Solely Under Prior Law 7.a. Foster Care Payments 8. Non-Assistance Authorized Solely Under Prior Law 9. Work, Education, and Training Activities 9.a. Subsidized Employment $0 $0 $0 $0 9.b. Education and Training $40,294 $0 $0 $0 Expenditures with Emergency Contigency Funds Page 1 $171,292 $0 $0 $0 $3,829,189 $0 $0 $0 $0 $0 $0 $0 11.a. Child Care (Assistance and Non-Assistance) $0 $0 $0 $0 11.b. Pre-Kindergarten/Head Start $0 $0 $0 $0 12. Financial Education and Asset Development $0 $0 $0 $0 13. Refundable Earned Income Tax Credits $0 $0 $0 $0 14. Non-EITC Refundable State Tax Credits $0 $0 $0 $0 15. Non-Recurrent Short Term Benefits $2,807,479 $0 $0 $2,406,376 16. Supportive Services $2,264,087 $0 $0 $0 17. Services for Children and Youth $0 $0 $0 $0 18. Prevention of Out-of-Wedlock Pregnancies $0 $0 $0 $0 19. Fatherhood and Two-Parent Family Formation and Maintenance Programs $0 $0 $0 $0 $22,892,299 $45,449,787 $0 $0 $22,263,015 $26,261,780 $0 $0 $0 $10,668,240 $0 $0 $629,284 $8,519,767 $0 $0 $0 $0 $0 $0 $36,020,109 $27,717,308 $0 $1,774,000 $8,344,872 $10,568,904 $0 $1,774,000 $24,756,331 $14,795,360 $0 $0 $2,918,906 $2,353,044 $0 $0 $117,475 $2,340,150 $0 $0 $82,959,136 $75,507,245 $0 $12,595,376 25. Transitional Services for Employed $0 $0 $0 $0 26. Job Access $0 $0 $0 $0 27. Federal Unliquidated Obligations $0 $0 $8,910,639 $7,418,752 9.c. Additional Work Activities 10. Work Supports 11. Early Care and Education 20. Child Welfare Services 20.a. Family Support/Family Preservation /Reunification Services 20.b. Adoption Services 20.c. Additional Child Welfare Services 21. Home Visiting Programs 22. Program Management 22.a. Administrative Costs $8,344,872 Total Cumulative Administrative Costs 22.b. Assessment/Service Provision 22.c. Systems 23. Other 24. Total Expenditures 28. Unobligated Balance $0 29. State Replacement Funds Estimate of TANF Funds Requested Quarterly Estimate 30. Estimate of TANF Funds Requested for the Following Quarter $42,000,000 THIS IS TO CERTIFY THAT THE INFORMATION REPORTED ON ALL PARTS OF THIS FORM IS ACCURATE AND TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. Signature, Approving State Official State Official Name Rebecca D. Clayton Signature Date: 05/15/2017 PAGE 1 OF 1 APPROVED OMB No 0970-0247 expires 08/31/2015 State Official Title Principal Managing Analyst State Official Agency ARIZONA Date Submitted: 05/15/2017 FORM ACF-196 Page 2 OMB Number: 4040-0002 Expiration Date: 5/31/2014 APPLICATION FOR FEDERAL ASSISTANCE SF-424 - MANDATORY 1.a. Type of Submission: 1.b. Frequency: D Application ~ Annual ~ Plan D Quarterly D Other D Funding Request D Other Other (specify): 1.d. Version: ~ Initial D Resubmission D Revision D Update 2. Date Received: STATE USE ONLY: I I 3. Applicant Identifier: Other (specify): 5. Date Received by State: II I 4a. Federal Entity Identifier: I I 6. State Application Identifier: DEA-17-004 I I I 11 1.c. Consolidated Application/Plan/Funding Request? Yes D No ~ I Explanation I 4b. Federal Award Identifier: I 7. APPLICANT INFORMATION: a. Legal Name: I Arizona Department of Economic Security b. Employer/Taxpayer Identification Number (EIN/TIN): c. Organizational DUNS: 86-6004791 1367304340000 I d. Address: Street1: Street2: 1789 West Jefferson, Mail Drop 1111 I City: County / Parish: Phoenix Maricopa State: Province: AZ: Arizona I I I Country: Zip / Postal Code: I USA: UNITED STATES I 85007-3202 e. Organizational Unit: Department Name: Division Name: I AZ Dept of Economic Security I Division of Business & Finance f. Name and contact information of person to be contacted on matters involving this submission: Prefix: I Mr. First Name: Middle Name: Rodney K Last Name: I Suffix: I Huenemann I I Title: SSBG Coordinator I Organizational Affiliation: I Arizona Department of Economic Security Telephone Number: Email: I602-542-6159 Irhuenemann@azdes.gov Fax Number: 602-542-6000 I I l APPLICATION FOR FEDERAL ASSISTANCE SF-424 - MANDATORY 8a. TYPE OF APPLICANT: I A: State Government Other (specify): I b. Additional Description: I 9. Name of Federal Agency: I DHHS 10. Catalog of Federal Domestic Assistance Number: I 93.667 CFDA Title: Social Services Block Grant I 11. Descriptive Title of Applicant's Project: Grant funds are used to furnish social services best suited to the needs of individuals residing in the state. 12. Areas Affected by Funding: State of Arizona 13. CONGRESSIONAL DISTRICTS OF: a. Applicant: IAZ-007 b. Program/Project: I I Iall Attach an additional list of Program/Project Congressional Districts if needed. II Add Attachment 11 Delete Attachment 11 View Attachment I 14. FUNDING PERIOD: b. End Date: a. Start Date: I 07/01/2017 I06/30/2018 I I 15. ESTIMATED FUNDING: a. Federal ($): 32,749,900.00 b. Match ($): I I 0.00 I 16. IS SUBMISSION SUBJECT TO REVIEW BY STATE UNDER EXECUTIVE ORDER 12372 PROCESS? ~ a. This submission was made available to the State under the Executive Order 12372 Process for review on: D b. Program is subject to E.O. 12372 but has not been selected by State for review. D c. Program is not covered by E.O. 12372. I 05/11/2017 I APPLICATION FOR FEDERAL ASSISTANCE SF-424 - MANDATORY 17. Is The Applicant Delinquent On Any Federal Debt? Yes D No ~ I Explanation I 18. By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001) ~ ** I Agree ** This list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions. Authorized Representative: Prefix: First Name: IMr. I IHenry I Middle Name: I I Last Name: IDarwin I Suffix: Title: I I IInterim I Director Organizational Affiliation: IArizona I Dept. of Economic Security Telephone Number: I602-542-5757 I Fax Number: I602-542-5339 I Email: IDirector@azdes.gov I Signature of Authorized Representative: Henry Darwin I I Date Signed: I I 05/19/2017 Attach supporting documents as specified in agency instructions. 11 Add Attachments 11 Delete Attachments 1 1 View Attachments I Federal Financial Report (FFR) OMB Approval Number: 0348-0061 Expiration Date: 02/28/2015 FEDERAL FINANCIAL REPORT (FFR) 1. Federal Agency and Org. Element to Which Report is Submitted Administration for Children and Families 2. Federal Grant or Other Identifying Number Assigned By Fed. Agency (To report multiple grants, use FFR Attachment) 1601AZSOSR 3. Recipient Organization (Name and complete address including Zip code) 4. Grantee Name ARIZONA Grantee Name2 Department of Economic Security Grantee Street Address1 Post Office Box 6123 Grantee Street Address2 Grantee Street Address3 Grantee City Phoenix Grantee State AZ Grantee Zip 5 85005 Grantee Zip +4 4a. DUNS Number 136730434 4b. EIN 1741000283A1 5. Recipient Account Number or Identifying Number (To report multiple grants, use FFR Attachment) G1601AZSOSR 6. Report Type 0 0 Final Report QUARTERLY NO SEMI-ANNUAL YES @ ANNUAL 7. Basis of Accounting (;:., CASH 0 ACCRUAL 8. Project/Grant Period From (Month, Day, Year) 10/01/2015 To: (Month, Day, Year) 09/30/2017 - 9. Reporting Period End Date (Month, Day, Year) 09/30/2016 Transaction Information I10. TRANSACTIONS I Cumulative I Federal Cash (To report multiple grants, also use FFR attachment): a. Cash Receipts $49,829,265 b. Cash Disbursements $49,826,265 c. Cash on hand (line a minus b) $3,000 Federal Expenditures and Unobligated Balance: d. Total Federal funds authorized $53,275,953 e. Federal share of expenditures $53,074,832 f. Federal share of unliquidated obligations $201,121 - g. Total Federal share (sum of line e plus line f) ' . $53,275,953 h. Unobligated balance of Federal funds (line d minus g) $0 Recipient Share: ' ' i. Total recipient share required $0 j. Recipient share of expenditures $0 ~ k. Remaining recipient share to be provided (line i minus j) $0 -- L__ Program Income: l. Total Federal program income earned ' . . $0 - m. Program income expended in accordance with the deduction alternative $0 -- n. Program income expended in accordance with the addition alternative $0 o. Unexpended program income (line l minus line m or line n) $0 - ~ Indirect Expense - l11. Indirect Expense No. 1 a. Type Fixed b. Rate I c. Period From 3.82% 10/01/2015 Period To I d. Base 09/30/0207 g. Totals: e. Amount Charged f. Federal Share $46,634,927 $1,781,454 $1,781,454 $46,634,927 $1,781,454 $1,781,454 12. Remarks Amount charged and Federal Share are $1,779,324 due to rate rounding. 13. Certification: By signing this report, I certify that it is true, complete, and accurate to the best of my knowledge. I am aware that any false, fictitious, or fraudulent information may subject me to criminal, civil, or administrative penalities. (U.S. Code, Title 18, Section 1001) a. Typed or Printed Name and Title of Authorized Certifying Official c. Telephone (Area code, number and extension) Certification Title d. Email address b. Signature of Authorized Certifying Official e. Date Report Submitted (Month, Day, Year) Report Attachment (For reporting multiple grants) 14. List Information below for each grant covered by this report. Federal Grant Number Recipient Account Number Cumulative Federal Cash Disbursement No. 1 $0 Total (Should correspond to the amount on Line 10b) $0 file:///obf-ood/Datafile$/FSA1/FSA_Staff/Callie_Flinn/SSBG_1601AZSOSR_SF-425.htm[5/22/2017 3:47:20 PM]