STATE OF ARKANSAS ARKANSAS DEPARTMENT OF HEALTH … · Project Prevent Youth Coalition for ......

STATE OF ARKANSAS

ARKANSAS DEPARTMENT OF HEALTH

Tobacco Prevention and Cessation Program

REQUEST FOR APPLICATIONS

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for

Project Prevent Youth Coalition for Tobacco Prevention and Cessation Programs

Date Issued:

January 25, 2018

of 86 PPYC Request for Applications

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Application Timeline Event

Date

RFA Issued January 25, 2018

Question and Answer Period January 25, 2018 through February 8, 2018 4:00PM

Due date for Applications February 15, 2018 by 2:00PM

Completion of application reviews, recipients selection and posting of award

March 1, 2018

Posting notification period March 1, 2018 – March 15, 2018

Start date of sub-grant July 1, 2018

The maximum award amount will be $300,000 from July 1, 2018 through June 30, 2019 and will depend on the complexity of the application and justification of the funding. Fiduciary agencies may be awarded more than one sub-grant but must demonstrate and maintain separate staff, separate work plan activities, and separate accounting codes/practices. If TPCP receives limited number of applications in response to this RFA and those do not reach the minimum scoring of 600 points, TPCP will repost this RFA. During this process, there will be no sharing of information regarding status of other applicants.


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Acronyms Used in this RFA: AASA Awarded Applicant Skills Assessment

ADH Arkansas Department of Health

AO Annual Objective

ATQ Arkansas Tobacco Quitline

BRFSS Behavioral Risk Factor Surveillance System

CDC Centers for Disease Control and Prevention

COPD Chronic Obstructive Pulmonary Disease

CST Central Standard Time

E.N.D.S. Electronic Nicotine Delivery System

GEMS Grant Evaluation Management System

IRS Internal Revenue Service

KOI Key Outcome Indicators

MPOWER Monitor, Protect, Offer, Warn, Enforce, and Raise Taxes

MSA Master Settlement Agreement

POS Point of Sale

PPO Project Period Objectives

PPYC Project Prevent Youth Coalition

PSAs Public Service Announcements

RFA Request for Applications

SGR Surgeon General’s Report

SHS Secondhand Smoke

SMART Specific, Measurable, Achievable, Relevant and Time-Bound

TNFM Tobacco and Nicotine Free Media

TNFMUH Tobacco and Nicotine Free Multi-Unit Housing

TNFO Tobacco and Nicotine Free Outdoors

TPCP Tobacco Prevention and Cessation Program

UAPB University of Arkansas at Pine Bluff

VPR Vendor Performance Report

MISRGO Minority Initiative Sub-Recipient Grant Office

YEC Youth Engagement Coordinator

WHO World Health Organization


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TABLE OF CONTENTS Section I Program Overview

A. Purpose B. Background C. Available Funding Section II Application Requirements A. Eligible Applicants B. Requirements for Funding C. Core Requirements for Receiving Funding D. Applicant Commitments/Requirements Section III Scope of Work A. General Scope of Work

Section IV Instructions for Completing an Application A. Application Format B. Application Content C. Application Deadline and Application Submission Section V Review of Application and Award Notification A. Review for Compliance with RFA Requirements B. Evaluation and Scoring C. Award Notification Section VI General Information A. Program Monitoring B. Reimbursement Guidelines C. Past Performance


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APPENDIX I ADH 2014-2019 Strategic Plan II-A Work Plan Instructions II-B Work Plan Example III Declaration of Funding and Certification of Non-Acceptance of Tobacco Funds IV Financial Management and Accounting System Questionnaire V Community Partners List VI Community Partners Plan VII Reference Guide VIII Budget Template Format (Template provided as an attachment) IX Tobacco Prevalence Maps X Contract and Grant Disclosure and Certification Form XI Request for Tax Payer Identification Number and Certification/W-9 Form XII Restriction of Boycott of Israel Certification XIII Application Cover Sheet XIV TPCP Financial and Accountability Guidelines


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SECTION I. PROGRAM OVERVIEW A. Purpose Tobacco use continues to have a devastating toll on Arkansas. It remains our leading cause of preventable death and disease, and is a major risk factor for the top four diseases that account for over fifty-nine (59) percent of all Arkansas deaths. In addition, smoking costs the state over $1.2 billion in health care expenditures. Those financial costs increase when exposure to secondhand smoke (SHS), smokeless tobacco use, cigar and pipe smoking, and smoking-related fires are included. The Arkansas Department of Health (ADH) Tobacco Prevention and Cessation Program’s (TPCP) purpose is to guide and provide strong, comprehensive, evidence-based tobacco control activities to the citizens of Arkansas in order to decrease the risk, incidence, morbidity, mortality, and burden of tobacco-related illness in the state. TPCP is soliciting competitive applications in order to select an organization to implement the Project Prevent Youth Coalition (PPYC) in partnership with TPCP. Under this Request for Applications (RFA), TPCP seeks to develop a statewide network that will demonstrate use of a bilateral approach that combines elements of community engagement and youth action (branded as Project Prevent) under a single contractor. This approach utilizes a community-based strategy which includes efforts to challenge conventional thinking, advocate for policies, and change the social norms around tobacco use for Arkansas’ youth through the facilitation of a statewide coalition. The statewide PPYC role is to work in partnership with TPCP to strengthen Arkansas’ overall youth and young adult tobacco control program by implementing a wide variety of tobacco control strategies. PPYC will engage in community mobilization and advocacy in order to create local environments that demand a new normal. The effort of the contractor will support the prevention and reduction of tobacco use, restriction of youth access to tobacco, and limit exposure to secondhand and third hand smoke by engaging youth, local stakeholders, local community leaders and the public in tobacco control activities. The contractor will include administration of a youth-oriented element called Project Prevent Youth Coalition, which will engage a core group of youth and young adults (age 13-21) in action-oriented activities and impart the necessary leadership skills to engage in tobacco control work. Youth will be involved through a supportive peer group, working with adult guidance, to take action to mitigate, reduce or eliminate the tobacco industry’s influence. Much of the work through this RFA will require strong coordination between the two elements: community engagement and youth action with an aim of improving the health status of communities by changing community norms about tobacco and tobacco use. The PPYC contractor, in partnership with TPCP will 1) implement strategies to address youth initiation; 2) implement projects that engage youth; 3) engage in tobacco control and sustainability activities; 4) plan and host an annual PPYC conference with youth groups and their facilitators; 5) identify and recruit facilitators to create new youth advocacy groups in non-funded locations throughout the state; and 6) attend quarterly meetings with TPCP staff.


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The contractor must be prepared to make program adjustments as required and/or requested by TPCP. Youth engagement in tobacco control provides the opportunity for young people to gain the ability and authority to make decisions that help improve the policy environment, change social norms and reduce smoking initiation and cessation, which aligns with ADH’s strategic plan. A comprehensive approach—one that optimizes synergy from applying a mix of educational, clinical, regulatory, economic and social strategies—is the guiding principle for eliminating the health and economic burden of tobacco use (CDC 2014), which includes sustainability activities. ADH’s 2014-2019 Strategic Plan (Appendix I) incorporates recommended strategies to implement a comprehensive approach in tobacco control and cessation for the state of Arkansas. B. Background Preventing tobacco use is one of the most important public health actions that can be taken to improve the health of Arkansans. Each year, approximately 5,800 Arkansans die prematurely as a result of smoking. Smoking is a major cause of multiple cancers, of heart disease and stroke, and is the leading cause of chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. The toll of tobacco use is disproportionately higher among people with less education, who make lower wages, and individuals who reportedly have poor mental health. These groups have higher smoking rates and greater exposure to SHS and, as a result, suffer more illness, disease and death. According to the Centers for Disease Control and Prevention (CDC), tobacco use is the single most preventable cause of disease, disability and death in the United States. Nearly one-half million Americans die prematurely from tobacco use each year, and more than 16 million Americans suffer from a disease caused by smoking. Despite these risks, approximately 36.5 million U.S. adults currently smoke cigarettes. The harmful effects associated with smoking do not end with the smoker but affect others. Secondhand smoke exposure causes serious disease and death, and even brief exposure can be harmful. In Arkansas, 23.6% of adults and 15.7% of youth use tobacco products (2016 BRFSS, 2016 YRBS). According to Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General (2014 SGR), the majority (88%) of smokers began before 18 years of age and nearly all (99%) occurred before the age of 26. In 2013, 19.1% of high school students, or approximately 26,440 students in Arkansas, reported using cigarettes on one or more of the 30 days before the survey. Approximately 69,000 youth in Arkansas under age 18 who are alive today are projected to die prematurely from smoking-related illness if we do nothing (CDC Best Practices 2014). The tobacco industry’s advertising and promotional activities cause youth and young adults to start smoking, and nicotine addiction keeps individuals smoking into adulthood (SGR 2014). In addition, each year, for every adult who dies prematurely from a


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smoking-related cause, more than two youth or young adults become replacement smokers (SGR 2014). The total annual cost incurred in Arkansas from smoking is $1.215 million (CDC Best Practices 2014). TPCP receives Master Settlement Agreement (MSA) funding to assist in reducing Arkansas’ tobacco use prevalence. Since receiving these funds in 2001, TPCP has engaged in evidence-based practices such as adopting statewide policies, systems change and interventions strategies, and youth advocacy activities to reduce tobacco use, secondhand and third hand smoke exposure, and tobacco-related disparities. As a result, Arkansas’ youth smoking rates have decreased since 2001 from 34.7% to 19.1% in 2013. These activities align with the five CDC-recommended components: (1) state and community interventions (which includes statewide programs and community-focused programs); (2) mass-reach health communication interventions; (3) cessation interventions; (4) surveillance and evaluation; and (5) infrastructure, administration and management. These components have led to establishing laws to protect Arkansas’ youth from the negative effects of tobacco use. In April 2006, the Arkansas State Legislature approved legislation (Act 8 of 2006) to make most workplaces smoke-free. During the 2011 Legislative Session, Act 811 (updated from Act 13 of 2006) was approved, making it a primary offense to smoke in any motor vehicle in which a child less than 14 years of age is a passenger. During the 2013 Legislative Session, Act 1099 was passed, prohibiting the distribution of “alternative nicotine products” by any sort (i.e., directly, indirectly, by an agent or employee, through vending machines) to minors under age 18. CDC Best Practice Areas TPCP’s structure is based on the following CDC Best Practice Intervention Areas:

State and Community Interventions: supports and implements programs and policies to influence societal resources that encourage and support individuals to make behavior choices consistent with tobacco-free norms in order to have the greatest long-term population impact.

Mass-Reach Health Communication Interventions: delivers strategic, culturally appropriate, and high-impact health communication interventions to prevent tobacco use initiation, to promote cessation, and to shape social norms.

Cessation Interventions: promotes health system changes and coordinated treatment that is accessible to all Arkansans through the Arkansas Tobacco Quitline (ATQ).

Surveillance and Evaluation: monitors attitudes, behaviors, and health outcomes over time to assess the process and outcomes of implemented programs to increase efficiency, impact, and demonstrate effectives.

Infrastructure, Administrations and Management: assures that the TPCP’s complex, integrated program have staff with the necessary experience, training, and oversight to provide appropriate fiscal management, accountability, and coordination.

TPCP’s goals are based on CDC’s Best Practices for Comprehensive Tobacco Control Programs and include:


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1) Preventing initiation among youth and young adults (primary focus) 2) Eliminating exposure to secondhand smoke 3) Promoting quitting among adults and youth 4) Identifying and eliminating tobacco-related disparities among population groups

Each of the Best Practice Intervention Areas can be thought of as impacting across goal areas rather than merely being limited to a single goal. For example, the cessation intervention component not only can be expected to promote quitting among adults and young people, but by reducing the number of people who use tobacco. It can be expected to prevent some initiation of tobacco use among young people by changing social norms surrounding tobacco use (e.g. parents and other adults in the lives of youth, etc.) and to reduce nonsmokers’ exposure to SHS. CDC recommended evidence-based interventions; strategies and guidance for comprehensive state tobacco control program are located in the following publications:

• CDC’s Best Practices for Comprehensive Tobacco Control Programs 2014 • The Community Preventive Services Task Force’s guide for Community

Preventive Services • The 2014 Surgeon General’s Report: The Health Consequences of Smoking-50

Years of Progress • The 2012 Surgeon General’s Report: Preventing Tobacco Use Among Youth and

Young Adults • CDC’s Key Outcome Indicators for Evaluating Comprehensive Tobacco Control

Program, Goal Area 1: Preventing Initiation of Tobacco Use Among Young People, 2014.

C. Available Funding TPCP will award, one contract to work within the constraints of this RFA. The proposed effective period is expected to be July 1, 2018 through June 30, 2019. The contract may be extended for up to six (6) additional one-year increments contingent upon collaboration with ADH/TPCP of the work plan, review by the state legislature, and the availability of funding. Funding for this program is made available through the Master Tobacco Settlement Agreement. Therefore, in accordance with Section 6 of Act 88 of 2017, the State of Arkansas is not obligated to continue funding any commitment paid from the proceeds of the Tobacco Settlement in the event that Tobacco Settlement funds are not sufficient; and Section 7, no advertising targeting the prevention or reduction of tobacco use shall include the name, voice, or likeness of any elected official or their immediate family. NOTE: ADH/TPCP reserves all rights regarding this RFA, including, without limitation, the right to:

• Amend or cancel this RFA without liability if it is in the best interest of the public to do so;

• Reject any and all applications received by reason of this RFA upon finding that it is in the best interest of the public to do so;

• Waive any minor informality;


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• Seek clarification of applications; • Reject any application that fails to comply with all prescribed solicitation

procedures and requirements; and • Negotiate the statement of work within the scope of work described in this RFA.

SECTION II: APPLICANT REQUIREMENTS A. Eligible Applicants Eligible applicants include non-profit organizations (must include proof of nonprofit status from the Internal Revenue Service with application), health care systems, primary care networks, academic institutions, youth focused agencies, community-based organizations, volunteer associations and professional associations, with experience and expertise in organizing community members and youth organizations to advance public health policy and in mobilizing communities to address tobacco use. Applicants should demonstrate 1) the financial and administrative capacity to manage a state contract and 2) the technical expertise to successfully implement the full range of activities outlined in this RFA. Applicants must address all aspect outlined in the RFA and submit a quality application describing an effective, comprehensive scope of activities that addresses CDC goal areas with a primary focus on preventing initiation among youth and young adults. The applicant is responsible for implementing the work described in the RFA. All core (required) staff must be employed and supervised by the applicant/fiduciary or an individual/organization appointed by the applicant/fiduciary. However, if the core staff is employed by a designated organization other than the applicant, the overall responsibility of the core staff and deliverables remains the responsibility of the applicant/fiduciary. Applicants should note that the lead organization (contractor) will have overall responsibility for all contract activities and will be the primary contact for TPCP. Applicants must have a written policy that they do not receive from or have an affiliation (membership, ownership, contractual or other) with any organization, including subsidiaries, foundations or other related parties of such organizations, that has any interest in the production, manufacture, marketing, distribution, sale or continued use of tobacco, including Electronic Nicotine Delivery Systems (E.N.D.S.). Preferred Eligibility Preference will be given to applicants that demonstrate the following:

Experience working with youth;

An understanding of the role of community and social norms in influencing

individual’s behavior and how community and social norms can be changed to

support healthier behavior;

At least two (2) years of experience conducting policy work, community

advocacy, community planning, and community organizing, including public


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communication campaigns, that result in the adoption of community policies

supporting tobacco-free norms;

At least two (2) years of experience with administrative, fiscal, and programmatic

oversight of government contracts, including timely and accurate submission of

fiscal and program reports; and

Staff that have the skills and experience to manage the program, including fiscal

and evaluation oversight.

B. Requirements for Funding

Applicants must have a current tobacco-free workplace policy and a current tobacco-free hiring policy for any positions that would be funded by TPCP. Applicants must clearly describe how they will develop, implement and evaluate the Statewide Project Prevent Youth Coalition. The coalition must consist of members who are dedicated to the goal of reducing tobacco use among both youth and young adults. Applicants must involve the entire state in program activities focusing on tobacco control issues; including youth and young adult worksites, schools and colleges, businesses, special groups, etc. Applicants must include, in meaningful ways, representatives from diverse segments and populations with disparities including individuals, organizations, governmental and non-governmental entities/agencies in their efforts to decrease initiation of tobacco use as well as decrease tobacco use prevalence. Applicants must demonstrate how they will engage community partners to carry out the activities within the work plan. If an applicant has not previously worked in tobacco control, the applicant must describe how they plan to recruit members and build a grassroots network. Applicants are required to develop work plans to include strategies and objectives that support the Arkansas Department of Health’s Strategic Plan (Appendix I) and address the four (4) CDC Best Practices for Comprehensive Tobacco Control Programs as noted below:

Preventing initiation among youth and young adults

Eliminating exposure to secondhand smoke

Promoting quitting among adults and youth

Identifying and eliminating tobacco-related disparities among population groups

These four (4) goals align with the six (6) proven policies introduced in the World Health Organization’s (WHO) MPOWER Policy Framework from 2008: Monitor tobacco use and prevention policies Protect people from tobacco smoke Offer help to quit tobacco Warn about the dangers of tobacco use Enforce bans on tobacco advertising, promotion, and sponsorship Raise taxes on tobacco


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In addition to incorporating the above framework, applicants should look towards other strategies that are recommended by the CDC. Suggested resources are listed in the Reference Guide (Appendix VII). C. Core Requirement for Receiving Funding 1. Changing Community Condition and Establishing Local Objectives Community engagement is essential for meaningful change to occur in the way that tobacco products are marketed, sold, and used. The National Association of County and City Health Officials have developed guidelines for comprehensive local tobacco control programs (CDC 2014). Interventions to prevent tobacco use initiation and to encourage cessation among youth and young adults can reshape the environment so that it supports tobacco-free social norms. Thus, intervening during adolescence and young adulthood is critical. Each proposal must demonstrate progress toward shifting social norms related to tobacco in communities, reduce tobacco industry influence on youth groups, and reduce disparities related to tobacco use. Activities should focus on statewide community programs and coordinate multi-component interventions that are part of a comprehensive effort to create tobacco-free social norms. Each proposal must include an examination of current youth tobacco use and tobacco control status in Arkansas. The CDC recommendations below for preventing tobacco use among youth should be included in the proposal. 2. Work Plan All applicants must include deliverables in their application. Required strategies for all activities must demonstrate movement of social norm change among youth and young adults to advance tobacco control in public health. Activities should be planned to help design and target intervention areas that focus on youth and young adults, leading to shifts in social norms. This may include, but is not limited to, tobacco control policy adopting, youth initiation interventions, media and public awareness, and community-based programs. The funded agency is responsible for ensuring all program deliverables are met. A sample work plan is provided in Appendix II-B. D. Applicant Commitments/Requirements Applicants must agree to the following requirements in order to be considered for funding: Collaboration and Communication Applicants should develop and maintain active partnerships that support the mission of reducing morbidity and mortality and alleviating the social and economic burden caused by tobacco use in Arkansas. Applicants should develop and maintain effective communication systems with partners at the state, regional and local level. Applicants should include diverse organizations and youth-focused interest groups with responsibilities related to the prevention and reduction of tobacco use.


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Applicant organizations must provide a description of their organizational structure to include the line of authority with regard to supervision of the Youth Engagement Coordinator (YEC). Applicants may employ a traditional coalition model for governing and decision-making or choose to organize partnership activities according to a different structure. However, under any proposed structure, funded organizations should include advocacy partners, voluntary health organizations, universities, hospitals, youth focused organizations, mental health providers, local health departments, organizations that represent diverse communities, community-based organizations, statewide and local partners, health boards, commissions, or advisory groups with responsibilities related to tobacco control, as needed to achieve TPCP’s goals and objectives. Applicants should ensure the partnership model incorporates systems that empower and motivate members to achieve strong performance standards. Incorporating Youth Action Youth action, under clear adult guidance, should enhance all of the work plan deliverables. Applicants funded under this RFA should ensure that a core group of youth is maintained to carry out activities associated with the PPYC initiatives while supporting the work of community engagement. Applicants must identify how they will conduct activities aimed at recruiting youth 5-21 [based on three (3) sub-groups: (1) elementary, (2) secondary, and (3) post-secondary up to age 21] that are interested in tobacco control.

Recruitment activities should focus on retaining a limited core group of youth who will actively participate in achieving contract deliverables.

Applicants will clearly define the roles of youth, young adults, and staff in the program. Most successful youth programs are youth led and adult monitored, which allows youth to serve as educators and advocates (e.g., interacting with media, decision-makers, and community members) to deliver specific activities. Adults identify the parameters of the project, facilitate planning, and assist youth by providing logistical support and training for youth to deliver successful activities. Staffing Staff must have the appropriate competencies to dedicate and deliver an approved tobacco control work plan.

Staff should reflect professional leadership competencies that enable them to motivate and inspire others; communicate effectively with partners and decision makers; and demonstrate initiative and integrity to implement an effective tobacco control youth program. Applicants must include, at a minimum, one full-time YEC in the budget proposal.

• The required minimum qualifications for the YEC are a bachelor’s degree and

three years of experience in advocacy, tobacco control, or similar field (e.g.,


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health education, teaching). Other job-related education and/or experience may be substituted for all or part of these basic requirements. However, the applicant must be able to clearly demonstrate skills sets that allow for education of business owners, school officials, elected officials and members of the community including all ages and backgrounds.

• Salaries should be commensurate with the level of education and experience required for the job. Please note: if a vacancy occurs (resignation, maternity leave, medical leave, etc.), it is the responsibility of the contract agency to ensure all deliverables continue to be met, including work plan activities, for the duration of the absence.

• The YEC should have knowledge and skills in program development implementation, and management; fiscal and budget management; leadership skills; tobacco control content; cultural competency; advocacy; public relations; public health policy, community outreach and mobilization; training and technical assistance; health communications and counter-marketing, including strategic use of media (i.e., earned and paid); strategic planning; and surveillance and evaluation.

• The YEC responsibilities will consist of managing day-to-day operations of youth and community engagement activities; coordinating and guiding evidence-based tobacco control activities and interventions; recruiting and retaining youth and young adults as tobacco-control advocates; and providing youth and young adults with the necessary skills to interact with community partners, organizations, and decision-makers.

The funded applicant will be required to identify an individual to provide direction and supervision of the YEC. The individual selected as the supervisor should be clearly identified on the organizational chart. The supervisor will be responsible for providing oversight and ensuring effective and efficient tobacco control activities. The supervisor will be required to participate in mandatory TPCP conference calls and meetings. The funded applicant will be required to review, approve, and submit monthly invoices based on TPCP’s financial guidelines and submit program and evaluation reports by TPCP’s established deadlines. The funded applicant must assure that all work plan activities are recorded in TPCP’s web-based Grant Evaluation and Management System. Technical assistance will be provided to ensure effective use of the reporting system. Effective use/reporting will enable the awarded applicant to track activities, services, and outcomes for self-monitoring and program evaluation. YEC and designated supervisor will be considered the primary contacts for TPCP and will be required to attend all site visits and meetings determined by TPCP. The number of staff should be sufficient to deliver work plan deliverables.


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Staff Orientation, Training, Supervision and Program Support The funded applicant should support staff by providing training to equip staff with basic professional competencies such as the ability to engage in effective presentation and public speaking activities and utilization of time management. The organization is also required to provide proper orientation to the policies and procedures of the contracting agency. Appropriate budgeting for the program’s transportation needs; fiscal and budget management support; timely processing of purchasing and subcontracting requests; appropriate administrative supervision and support; access to up-to-date tobacco control information; current computer system with access to an individual mail account and the internet, and office and meeting space.

The funded applicant should ensure that fiscal responsibilities are clearly identified and there is a separation of responsibilities between programmatic and fiscal management. The funded applicant should ensure that funds are used only to support tobacco specific, community-based, primary prevention efforts that utilize evidence-based, science-based, or Best Practice recommendations that address the required intervention area(s). The funded applicant should ensure that funds are not used for:

Projects that are individualized (one-on-one individual activities) to “educate” about tobacco illnesses, cessation interventions, addiction, refusal, or any other low-impact, individual client topics.

Cessation services or cessation supplies which include, but are not limited to, paying for medical services, providing pharmaceuticals, Contract Coordinator providing cessation classes, quitline cessation services which supplant the ATQ, etc.

Treatment or medical services.

Projects unrelated to tobacco control and the primary purpose identified in the proposal.

Lobbying purposes. Lobbying includes any effort to persuade legislative vote.

Meetings and Training The YEC and any additional staff that are hired will:

Participate in all required/recommended webinars, regional, statewide and national meetings; attend required trainings (an estimated two trainings per quarter may be held annually and may require travel to other areas of the state); Travel to Little Rock as required. Applicants should budget for a minimum of six (6) trips to Little Rock per year for the YEC and/or any additional staff.

Organization The funded organization should provide fiscal and budgetary support and demonstrate capacity to expeditiously process budget and purchasing requests in order to facilitate the smooth operation of the contract.


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Paid Media Applicants may use additional paid media to extend local collaborative media efforts. The primary purpose of purchasing media is to educate the public or a subgroup of the public in tobacco control. The funded organization will be required to ensure that all media efforts are coordinated with and approved by TPCP. Media efforts must directly support a work plan element and be approved (in writing) in advance by TPCP. Transition Plan for PPYC ADH/TPCP retains ownership of all programs, property, files, and materials developed, purchased or assigned through this contract by the funded organization. If or when the contract with the funded organization is terminated or expires, the funded organization is responsible for:

Ensuring an orderly transition of services and responsibilities as directed by ADH/TPCP. Returning and/or transferring all programs, property, files, and

materials to TPCP. ADH/TPCP retains rights to the PPYC name, logo and any other associated projects.

SECTION III: SCOPE OF WORK

A. General Scope of Work The funded applicant will implement the Project Prevent Youth Coalition (PPYC) in partnership with TPCP to enhance state and local tobacco control efforts by challenging conventional thinking, advocating for policies, and changing social norms around tobacco use for Arkansas youth and young adults through the facilitation of a statewide coalition and a wide variety of tobacco control strategies. These education and awareness activities will be designed and implemented in ways that take into account specific cultural barriers, challenges and strengths unique to communities. Also, the PPYC will be responsible for community mobilization to increase broad-based support for tobacco control at the state and local levels. The PPYC will demonstrate how to educate and mobilize community members, local leaders and other advocates, including other local coalitions to actively support tobacco control-related policy changes. Overall, the PPYC is to engage youth in tobacco control by providing young individuals with the ability and authority to make sound decisions to help improve the policy environment, change social norms, and reduce smoking initiation and cessation in Arkansas’ communities that align with ADH’s strategic plan. SECTION IV: INSTRUCTIONS FOR COMPLETING AN APPLICATION

A. Application Format Proposal (Maximum of 22 pages)


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Abstract (1 page) Introduction (3 pages) Sustainability (2 pages) Community Partners List (1 page) Community Partners Plan (1 page) Evaluation Plan (2 pages) Work Plan Mission and Vision (2 pages) Work Plan Template (10 pages) Budget (Template Provided) Commitment Letters and Required Forms The page limit does not include the commitment letters, budget, or required forms. An 11-point Arial font is recommended for all sections except the work plan, which may be submitted in 10-point Arial font. All pages must be numbered and on 8½” x 11” white paper. B. Application Content Applications must include the following sections: ABSTRACT (25 Points) [One (1) page limit] The purpose of the abstract is to provide a detailed overview of the application. It should be clear, concise and specific. It should describe your organization, the scope of your project and the amount you are requesting. INTRODUCTION (75 Points) [Three (3) page limit] This section must include the following:

1. Description of any previous funding through ADH/TPCP or UAPB/MISRGO (amount for each award cycle) and other tobacco control funding received.

2. Describe in detail, previous experiences related to reducing tobacco use in your community and policies that have been implemented or are in the process of implementation at schools, worksites, church campuses, or parks.

3. Describe your ability and capacity to develop, implement, and evaluate all activities listed in the application.

4. Describe previous experiences with policy development, media advocacy, developing training, community planning, or developing/implementing community organization strategies.

5. Describe previous experiences with conducting community youth and young adult activities and working with disparate populations.

6. Describe your organizational capacity for sound fiscal management. Include the following:

Description of organizational structure and organization chart. Attach a chart with names, titles of officers, executive, and key staff. (Organizational chart is not counted as part of the introduction page limit.)

Experience with financial administration of federal and/or state funds.

Knowledge of federal and state laws and regulations regarding effective control over and accountability for all funds, property and


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other assets, and assurance that they are used solely for authorized work plan purposes.

A financial management system that provides for adequate financial reporting, adequate accounting records, effective internal controls, budget control, monitoring of allowable costs, maintenance of source documentation, and appropriate cash management (Appendix IV).

7. Assure that adequate equipment (including computers) to support staff and program needs are available or are included in the budget.

8. Identify organizations that support the activities described in the work plan and include letters of support.

SUSTAINABILITY PLAN (100 Points) [Two (2) page limit]

By understanding various sustainability approaches, you can strengthen the capacity of your coalition to function successfully and increase its chances of sustaining its efforts. Your coalition can approach sustainability from many angles. Key among these are core approaches such as policy and partnerships. In addition, your coalition can also engage in complementary approaches such as establishing a community home, building coalition members’ skills, and communication and social marketing strategies. The approaches are shown on page 19 under Community Coalition Action Theory. Core approaches are shown in green, and complementary approaches are shown in blue.

1. Developing and implementing policy, systems, and environmental change strategies.

2. Building the long-term capacity of your coalition and relevant partnerships to achieve policy goals.

3. Establishing a home for your Healthy Communities work.

4. Focusing on building coalition members’ skills.

5. Developing communication strategies.

6. Developing social marketing strategies.

COMMUNITY PARTNERS LIST [One (1) page limit] Each application must include a Community Partners List (Appendix V), not to exceed one (1) page and letters of commitment from key community partners as supporting documentation. In these letters, key partners must indicate their over-all role and support for the objectives and planned activities described in the Program Work Plan including, but not limited to, contributions of resources.

COMMUNITY PARTNERS PLAN (100 Points) [One (1) page limit] This section demonstrates existing and promising community partnerships for tobacco control. The plan (Appendix VI) must be written to address the growth, maintenance, and sustainability of the community partnerships.

EVALUATION PLAN (100 Points) [Two (2) page limit] The applicant must demonstrate their understanding of effective evaluation methods. In addition, applicants must describe how they will utilize their evaluation findings (i.e., to make decisions to improve program effectiveness and to demonstrate accountability to


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stakeholders). Refer to Appendix VII for evaluation resources, CDC “Introduction to Program Evaluation for Public Health Programs: A Self Study Guide”.

Awarded applicants must participate in a program evaluation as directed by TPCP during the contract period. In addition, awarded applicants must provide outcomes of their program evaluation at the end of the award period utilizing the TPCP’s reporting tool. Awarded applicant will be required to record all work plan activities in TPCP’s web-based program and document activity outcomes.

WORK PLAN (250 Points) Work Plan Mission and Vision [Two (2) page limit] Each applicant must provide a description of the mission and vision of the overall work pertinent to this specific RFA. Work Plan [Ten (10) page limit] All applicants should include all deliverables in their application that addresses this RFA using the Work Plan template provided. For additional guidance refer to Appendix II A-B. All strategies used to meet deliverable requirements should incorporate the principles of Community Intervention(s); Youth Engagement; Educating Key Decision Makers; and Mass-Reach Health Communications. In addition to the core deliverables, applicants must dedicate effort toward a statewide activity that addresses tobacco use disparities. The proposed activity should be related to one or more of the core deliverables as noted above. Applicant must demonstrate the capacity to implement the work plan.

BUDGET (150 Points) Applicants must use the budget template form attached (Appendix VIII). The budget template form is set up with dropdown boxes that allow the applicant to choose from a list of allowable items that can be included in the budget request.


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Applicants are required to budget for the following items:

Regular Salary – At least one (1) full-time (40 hours per week) Youth Engagement Coordinator position is required. The YEC is the primary individual responsible for carrying out the activities of the contract.

Résumé and job description must be included with the application. If the position is vacant at the time of application submission, a statement that the résumé will be submitted at a later date will suffice.

Staff position(s) paid with these funds must be dedicated only to tobacco control activities approved in the work plan. Changes in personnel must be submitted to TPCP prior to effective start date of the new employee.

Computer – If a computer with the minimum specifications is not available, applicants must include the purchase of one in the budget. Purchase product minimum specifications are as follows: 3.20 GHz; 1.0 GB memory, 80GB hard drive; Network Interface Card, modem, CDRW/DVD Combo and MS Office Professional 2007 (or newer), to include Microsoft Outlook. The computer must be acquired within fifteen (15) days of the effective date of the award agreement. If a computer meeting these requirements is available, please note this in the budget justification.

Internet service – Applicants must budget for internet service in order to meet communication and reporting requirements of the grant.

Travel – Applicants must budget for the YEC to attend ten (10) meetings/trainings in Little Rock with allocation for lodging. Mileage reimbursement may not exceed the state rate of $0.42 per mile. Reimbursement rates for meals and lodging may be found at: http://www.gsa.gov/portal/category/21287. If the per diem rate for lodging cannot be obtained, a reasonable rate must be sought.

Media and Health Communication – Media and health communication may include radio and print advertising, billboard advertising, digital advertising, and educational items. All media and health communication efforts must be preapproved by the TPCP Health Communications Section and must include all required logos.

Applicants utilizing the services of a contractor or consultant must provide the following information for each contractor/consultant. This information can be included as an attachment to the budget.

a. Name of Contractor/Consultant: Name of contractor/consultant.

Contracting with a person who occupies a position with any city, state, or federal entity is prohibited. There are NO EXCEPTIONS.

b. Method of Selection: Describe how the contractor was selected and the qualifications for the contractor. In addition, identify whether the contractor is a private, for-profit organization.

c. Period of Performance: Specify the beginning and ending dates of the contract. Additionally, indicate whether this is a new or continuation contract.

http://www.gsa.gov/portal/category/21287


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d. Scope of Work: Describe in outcome terms the specific services/tasks to be performed by the contractor and identify the related objectives.

e. Method of Accountability: Describe how the progress and performance of the contractor will be monitored during and on close-out of the contract period. Identify who will be responsible for supervising the contract. In addition, for continuation contracts, describe their previous performance.

f. Itemized Budget and Justification: Provide an itemized budget with appropriate justification.

g. Contract and Grant Disclosure and Certification Form: Provide a completed and signed copy of the form with application. Refer to Appendix X.

h. Request for Tax Payer Identification Number and Certification (W-9): Provide a completed and signed copy of the W-9 form with application. Refer to Appendix XI.

NOTE: If the above information is unknown for any contractor at the time of application, the information must be submitted to TPCP prior to awarding a contract.

Non-expendable items and equipment are allowable, provided they are a reasonable expenditure relative to the work proposed. Allowable items are identified in the dropdown boxes of the budget template form. All equipment purchased with grant funds must be used only for the purposes and intent of the work proposed in the grant application. If equipment is used for other purposes, the sub-grantee will be responsible for reimbursing ADH/TPCP for the cost of the equipment. Sub-grantees must also establish and maintain an effective property management system to track items with an acquisition cost of more than $250. Refer to Appendix XIV, TPCP Financial and Accountability Guidelines (page 19) for additional information on property management. Equipment purchases of $500 or greater must be approved by TPCP prior to purchase. The funded applicant must adhere to State of Arkansas procurement laws with special attention to Amendment 54 that requires all printing jobs to be competitively bid. Printing means the process of transferring images, by the use of standard industrial type printer ink, upon documents such as letterhead, envelopes, pamphlets, booklets, and forms.

Indirect/administrative costs are allowable but cannot exceed ten (10) percent of the total direct costs. Allowable items are identified in the dropdown boxes of the budget template form. The budget template form will automatically calculate the allowable amount as the budget is entered.

NOTE: Applicants are encouraged to review the TPCP Financial and Accountability Guidelines (Appendix XIV) prior to submitting an application in order to gain an understanding of the financial obligations and responsibilities of funded organizations. Failure to review the guidelines may result in disallowed budget items and ultimately impacting an applicant’s score.


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C. Application Deadline and Application Submission

Questions regarding the application and application process will only be taken by the Issuing Officer and must be received no later than the time and date as designated on page 2, Application Timelines. Questions MUST be emailed to the Issuing Officer at:

Emailed to: [email protected]

Agency responses to the questions shall be posted on the ADH website http://www.healthy.arkansas.gov/aboutADH/Pages/GrantBidOpportunities.aspx as an addendum to include both the question and the answer. Sealed applications must be received by the ADH Issuing Officer by 2:00 PM February 15, 2018. Applications received after this date and time will not be reviewed and will be removed from consideration. Applicants must provide a signed original (marked ORIGINAL) and five (5) copies. Sealed applications may be mailed or hand delivered to the following address:

If Mailing: Arkansas Department of Health Procurement Branch Attention: Daniel McNutt 4815 W. Markham St. Slot 58 Little Rock, AR 72205-3867 If Hand Delivering: Arkansas Department of Health Procurement Branch Attention: Daniel McNutt 4815 W. Markham St. – Room L156 Little Rock, AR 72205-3867 *Please include return address on the outside of the sealed package

The following items must be submitted for a complete application. Any item omitted will result in the applicant being removed from award consideration.

Mandatory Items:

Applicant Cover Sheet (Appendix XIII)

Table of Contents

Abstract

Introduction

Declaration of Funding and Certification of Non-Acceptance of Tobacco Funds (Appendix III)

Sustainability Plan

Community Partners List (Appendix V)

Community Partners Plan (Appendix VI)

mailto:[email protected]

http://www.healthy.arkansas.gov/aboutADH/Pages/GrantBidOpportunities.aspx


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Work Plan (Appendix II A-B)

Evaluation Plan

Budget (Appendix VIII)

Letters of Commitment

Certification of Non-Profit Organization (if applicable)

Financial Management and Accounting System Questionnaire (Appendix IV)

Youth Engagement Coordinator Résumé and Job Description (If coordinator is not known at the time of application submission, a statement indicating the résumé will be submitted to TPCP before hiring the coordinator)

Applicant’s Tobacco-Free Workplace Policy (Section II-B. Requirements for Funding)

Applicant’s Tobacco-Free Hiring Policy for Positions Funded by TPCP Funds (Section II-B. Requirements for Funding)

Contract and Grant Disclosure and Certification Form (Appendix X)

Request for Tax Payer Identification Number and Certification/W-9 Form (Appendix XI)

Restriction of Boycott of Israel Certification Form (Appendix XII)

V. REVIEW OF APPLICATIONS AND AWARD NOTIFICATIONS

A. Review for Compliance with RFA Requirements Applications will be date and time stamped upon receipt and must be received by the ADH Issuing Officer on or before the deadline. Omission of any required document or form or failure to respond to any requirement will lead to rejection of the application prior to the review process.


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B. Evaluation and Scoring Each application will be evaluated and scored by a review committee on a scale to 800 points.

CRITERIA

POSSIBLE POINTS

Abstract 25

Introduction 75

Sustainability 100

Community Partners Plan 100

Evaluation 100

Work Plan 250

Budget 150

Total Possible Points

800

If the top scoring applicant does not receive at least 75% of the available points (600 points), the RFA will not be awarded and TPCP will repost this funding opportunity. C. Award Notification: It is anticipated that applicants will be notified of preliminary awards by March 1, 2018. Fiduciary agencies may be awarded more than one sub-grant but must demonstrate and maintain separate staff, separate work plan activities, and separate accounting codes/ practices. During the review process, there will be no sharing of information regarding status of any applications. SECTION VI. GENERAL INFORMATION A. Program Monitoring Awarded Applicant Skills Assessment (AASA) The awarded applicant will be required to participate in an AASA workshop (date and time to be determined) which will include, but is not limited to, round tables that will cover the following:

Competencies in Word, PowerPoint, Outlook, Excel A ten (10) minute presentation on a tobacco prevention topic of applicant’s choice Identify strengths and weaknesses within its work plan Proficiency in TPCP reporting tools after completion of training Cultural Competency Assessment Key Partner Profile document analysis


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Reporting and Monitoring The awarded applicant will be required to record all work plan activities in GEMS. This will enable TPCP and the awarded applicant to track activities, services, and outcomes of program delivery and report outcomes as needed.

Technical assistance will be provided as requested and/or deemed necessary.

TPCP program personnel will conduct a minimum of one (1) site visit or desk review for the purpose of conducting programmatic and financial monitoring reviews to ensure the awarded applicant is in compliance with the sub-recipient agreement. B. Reimbursement Guidelines The awarded applicant will be reimbursed monthly based on an “Actual Cost” incurred. Actual cost reimbursement is based on an itemized listing of allowable program expenses. Expenses must be within the approved budget’s itemized listing of allowable program costs. Backup documentation is required when submitting invoices for payment. No advance payments are allowed. C. Past Performance In accordance with provisions of the State Procurement Law, R2:19-11-230 Competitive Sealed Proposals – Bid Evaluation paragraph (B): a vendor’s past performance with the state may be used in the evaluation of any offer made in response to this solicitation. The past performance should not be greater than three (3) years old and must be supported by written documentation on file in the Office of State Procurement or ADH Procurement Section at the time of the bid opening. Documentation may be in the form of a written or electronic report, Vendor Performance Report (VPR), memo, file or any other appropriate authenticated notation of performance to the vendor file. For previously funded sub-recipients, documented past performance using quality measures including end-of-year self-evaluations is/may be utilized.


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Appendix I ADH 2016-2019 Strategic Plan


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Appendix II - A Work Plan Instructions

Complete the work plan using the template provided. TPCP Strategic Intervention Area: Mark the goal area(s) that will be addressed with each activity planned. Project Period Objectives (PPO): This addresses the entire seven-year funding cycle. The PPO must describe what the applicant intends to accomplish by the end of the funding period. Key Outcome Indicators (KOI): KOI’s are used to measure progress toward outcomes to integrate program and evaluation planning. What is measured must directly correlate to the established objective for the program. For more information on outcome indicators, refer to “Key Outcome Indicators for Evaluating Comprehensive Tobacco Control Programs” at http://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/preventing_initiation/index.htm Annual Objectives (AO): This addresses the priorities in the scope of work as outlined in this RFA. Annual objectives must describe what the program intends to accomplish by the end of the first fiscal year. Both PPO and AO objectives must contain all the elements of a “SMART” objective. The description of a “SMART” objective is below.

“SMART” Objective Description:

Specific: Specifies who or what is expected to change or benefit, what change or benefit is expected, how much of a change or benefit is expected, where will the change or benefit occur, and when the change or benefit will be completed (date). Measurable: Results of the efforts should be measurable, countable, or observable; therefore, establishes a baseline from which change will occur and quantifies the amount of change to be achieved. Achievable and Ambitious: The change or benefit is determined using the baseline data, outcomes found by other programs, and knowledge of the community and stakeholders. Is realistic given available resources and yet challenging enough to accelerate program efforts. Relevant and Results-Oriented: Objective should be logically and empirically linked to the long-term objectives and goals. Time-Bound: Specifies a timeframe for the proposed accomplishments.

When completing work plan activities, define high-level activities for each strategy versus day-to-day tasks.

http://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/preventing_initiation/index.htm



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Strategies:

Community Intervention(s): Refers to conducting activities that create social change and other types of information dissemination that reach, educate, and involve populations experiencing tobacco-related burdens and disparities. Youth Engagement: Refers to engaging youth, influential community members and organizations to publicly support and take action on an intervention.

Educating Key Decision Makers: Refers to activities undertaken to influence organizational decision-makers to change their organizations’ policies, programs or practices; and/or educating local, state, regional or national policy-makers about tobacco issues and the implications of policy change. As with all activities implemented by TPCP, all lobbying is expressly prohibited.

Mass-Reach Health Communications: Primary purpose is to reduce exposure to targeted tobacco industry advertising and promotion; and to promote tobacco control messages. Refers to media contributed as part of a purchase plan or unpaid/earned media opportunities.

Population(s) of Focus: Indicate the category of the population of focus for the activity. The categories are as follows: General Population, or Specific Population broken by Gender, Age, Geographic Area, Race/Ethnicity, Sexual Identity, and/or Other.

Population Description: For specific population, describe population that will be impacted by the activity. Gender Served; Age Geographic Area Served; Race/Ethnicity Served; Sexual Identity (LGBTQ); Other (socioeconomic status, disability, mental health, substance abuse, etc.)

Start and End Date: Identify the start and end date for each activity that will be completed.

Responsible Position/Party: Indicate the responsible position and/or the responsible party for completing each activity.

Collaborations: Include agencies, organizations, and/or groups your organization will collaborate with to complete activities in work plan.

Resource Links: Please use the following resource links as a guide when completing work plan. Preventing Initiation of Tobacco Use: Outcome Indicators for Comprehensive Tobacco Control Programs-2014 Key Outcome Indicators For Evaluating Comprehensive Tobacco Control Programs Best Practices for Comprehensive Tobacco Control Programs—2014 https://truthinitiative.org/sites/default/files/Tobacco-Nation-FINAL.pdf https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/pdf/sustainability_guide.pdf



http://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/key_outcome/index.htm

http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm

https://truthinitiative.org/sites/default/files/Tobacco-Nation-FINAL.pdf

https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/pdf/sustainability_guide.pdf

https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/pdf/sustainability_guide.pdf


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Appendix II - B Work Plan Example

Preventing Initiation - Intervention Area Activity #1 Activity Type: Coalition Building - Youth Description: Project Period Objective: By June 2024, maintain a statewide youth coalition of diverse members devoted to tobacco control initiatives in Arkansas with a strong sustainability plan and utilizing effective evaluation tools. Annual Objective: By June 30, 2019, recruit, train, and engage XXX youth with geographic and ethnic diversity in a collaborative way to form a statewide Project Prevent Youth Coalition. Community Interventions(s): 1. Maintain active members and recruit new youth throughout Arkansas for statewide Project Prevent Youth Coalition (PPYC). 2. Make every effort to maintain active members and recruit new PPYC coalition members for a PPYC Youth Advocacy Board that represents each of the five health regions in Arkansas... 3. Maintain a PPYC Advisory Committee that represents a wide array of community partners… Etc. Community Engagement: 1. Host XXX statewide PPYC coalition meetings per fiscal year for youth PPYC members. 2. Host at least XXX PPYC Advisory Committee meetings per fiscal year. 3. Host at least XXX PPYC Youth Advocacy Board meetings per fiscal year. Etc. Educating Key Decision Makers: 1. Conduct at least XXX PPYC presentations to stakeholders, partners, community-based decision makers to... Mass-Reach Health Communications: 1. Develop social media posts, press releases, and website updates designed to reach youth and young adults about PPYC tobacco prevention activities.

Note: The above is an example. Applicants should expand and develop additional strategies and/or interventions to reach desired outcomes in a statewide youth coalition program.


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Appendix III Declaration of Funding and Certification of Non-Acceptance of Tobacco Funds

List below all sources of funding:

Funding Agency/Organization/Foundation

Funding Cycle Start/End Date

Amount

The applicant, _________________________, hereby certifies that it will not accept funding from nor has an affiliation or contractual relationship with the tobacco manufacturer, any of its subsidiaries or parent company, or any tobacco wholesaler or distributor during the term of the contract with the Arkansas Department of Health.

I, the official named below, hereby swear that I am duly authorized legally to bind the contractor to the above-described certification. I am fully aware that this certification, executed on the date below, is made under penalty of perjury under the laws of the State of Arkansas.

______________________________________________________________________ Signature Title Date

______________________________________________________________________ Printed Name and Title


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Appendix IV Financial Management and Accounting System Questionnaire

Please complete the following questions and sign to certify information provided is accurate and true. (Form should be signed by the Fiscal Agent and/or CFO of the organization.) Note this information is subject to TPCP monitoring. Legal Name of Organization:

Address of Organization:

Is your organization a registered 501c3: Yes No Fiscal Agent Name, if applicable: Organizational Policies and Procedures Please indicate whether the organization has written policies and procedures in the following areas.

Yes No

Financial/Accounting Practices

Staff Code of Conduct/Statement of Ethics

Nepotism Policy

Internal Control Policy

Timekeeping Guide or Policy

Records Retention

Travel and Reimbursement Guide or Policy

Property Management

Smoke Free Policy

Procurement Guide or Policy

Employee Benefits

Salary, and Promotion Policies

Board of Directors Bylaws

Other:

General Information

1. What year was the organization established?

2. List the number of employees in your organization. Full-Time Employees __________ Part-Time Employees __________

3. Enter the beginning and ending dates or your organization’s fiscal (financial) year. From (month, day) _________ To (month, day) ____________


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4. What was the organization’s total operating budget for the most current completed fiscal year:

$0 - $74,999 $75,000 - $124,999 $125,000 - $299,999 $300,000 - $599,999 $600,000 - $1 Million Over $1 Million

5. Has your organization been audited by an independent Certified Public Accountant firm within the past two years?

Yes No

If Yes, please attach a copy of the most recent audit. If No, please attach a copy of the following financial information:

a. A Balance Sheet for most current completed fiscal or calendar year; and

b. A Revenue and Expense Statement for your most current completed fiscal or calendar year

If you answered yes to question 5, who accepts/reviews the audit reports?

Board Chair Board of Directors Other specify: Chief Executive Finance Committee _____________ Audit Committee Chief Financial Officer

6. Please attach a list of the names of your Board of Directors indicating positions and committees on Board letterhead signed by the Board President.

7. Please answer the questions below.

Yes No

Does your organization have a written fund raising plan?

Does your organization have any pending litigations? If yes, please briefly explain the nature of the litigation: ______________________________________________________

Does your organization engage in any activity that would generate program income from events such as conferences, workshops, or trainings in which fees are charged for participation/attendance or from selling products etc.?


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Financial and Reporting Information

8. Which of the following best describes your organization’s accounting system?

Manual Automated Combination

9. Which of the following books of accounts do you maintain?

General Ledger Purchasing Journal Petty Cash Payroll Journal Cash Receipts Journal Other General Journal Disbursements Journal

10. Does your organization maintain its own accounting books or do you

contract with a bookkeeper or accountant to prepare accounting records, financial statements, reports, reconciliations, and request for reimbursements?

In-house Hire outside vendors Both

11. Which of the following reports are prepared for Board of Directors review

and how often?

Yes No NA

Report Type/Financial Information

Monthly Quarterly Annually Other

Balance Sheet Income Statement Budget to Actual Overdraft Fees/Insufficient Funds Budget Revisions IRS 990 Sub-Contract Reports Other:

12. How does your organization identify overspending of grant funds?

Accounting system compares actual to budget

Use Excel spreadsheet to compare actual to budget Other


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13. Is payroll prepared in-house by staff or by a payroll service or by a

contracted accountant/bookkeeper?

In-house Payroll Service Accountant/bookkeeper

14. Please answer the questions below.

Yes No

a Does the accounting system provide for the recording of expenditures for each grant by component project and budget cost category shown in approved budgets?

b Does your accounting system completely and accurately track the receipt and disbursement of funds by each grant or funding source?

c Does your accounting system enable you to track and document disbursements of funds (expenditures) from original invoice through final payment, for a clear audit trail?

d Are common or indirect costs accumulated into cost pools for allocation to project, contract, and grants?

e Does the accounting system provide for the recording of cost sharing for each project and ensure that documentation is available to support recorded cost sharing?

f Is the organization generally familiar with the existing guidelines containing the cost principles and procedures for the determination and allowance of cost in connection with TPCP funds?

g Are time distribution records maintained by funding source and/or project for each employee to account for total actual hours worked?

h Are employee timesheets appropriately signed by the employee and by a responsible supervisory official having firsthand knowledge of the activities performed by the employee?

i Does your organization have the capability to keep accounting records including invoices, vouchers, and timesheets for at least five years after the final request for reimbursement of TPCP funds?

Internal Controls

15. Please answer the Internal Controls questions below.

Yes No

a Is a separate bank account maintained for grant funds?

b Are at least two original signatures required on checks written above a dollar threshold (determined by the organization) from any bank account used for the receipt and/or disbursement of organizational funds, including those from TPCP sources? If yes what is the dollar threshold: $ __________________

c Is Board-level approval required for any of the following financial transactions?


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Opening/Closing Bank Accounts Opening Lines of Credit Assigning Credit Cards Financial Investment/Divestment Other specify: _________________

d Has the organization issued any loans to an employee or officer of the organization, forgiven, or written-off any loans or debts of any type in the past 12 months?

e Do you maintain inventory records for equipment? If so, how often? ____________________

f How often are bank accounts reconciled? Monthly Quarterly Annually Do not reconcile

16. Please indicate the name and position of the individual responsible for:

a Maintaining the accounting records

b Tracking and safeguarding equipment inventory

c Signing checks

d Keeping all receipts and other expense documentation for grants

e Checking expenditures to make sure they are allowable

f Reconciling the bank statement

g Reviewing or approving reconciled bank statements

Preparer Certification: By my signature, I certify that the above information is complete and correct to the best of my knowledge and ability.

Preparer: Name of Preparer: Date: Title of Preparer: Telephone: E-Mail

IDENTIFY ANYONE ELSE INVOLVED IN THE PREPARATION OF THIS SURVEY BY NAME AND POSITION TITLE:


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Appendix V Community Partners List

Provide a list of Community Partners and identify those that will hold a key role in the development and implementation of your PPYC work plan goals and activities. Key community partners must provide a letter of commitment that describes, in detail, their role in the proposed program and that indicates their overall support for the objectives and planned activities described in the PPYC work plan.

Name of Organization Name of Contact

Phone number and address of contact person

Role of Organization


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Appendix VI Community Partners Plan

Describe your plan for maintaining existing partnerships and developing new partnerships. Include partners that will be recruited for general tobacco control support and specific objectives. (Partner information must include name, organization, and role.)


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Appendix VII Reference Guide

ADH’s 2014-2019 Strategic Plan available at https://adhperformancemgmt.arkansas.gov/UserDefinedContent/HomePage.aspx Coalition: State and Community Interventions Best Practice Guide available at ftp://ftp.cdc.gov/pub/fda/fda/user_guide.pdf CDC Best Practices for Comprehensive Tobacco Control Programs – 2014 http://www.cdc.gov/tobacco/stateandcommunity/best_practices/pdfs/2014/comprehensive.pdf CDC Guide to the Community Preventive Services/Tobacco available at http://www.thecommunityguide.org/tobacco/index.html 2012 Surgeon General’s Report – Preventing Tobacco Use Among Youth and Young Adults available at http://www.cdc.gov/tobacco/data_statistics/sgr/2012/index.htm 2014 Surgeon General’s Report – The Health Consequences of Smoking: 50 Years of Progress available at http://www.surgeongeneral.gov/library/reports/50-years-of-progress CDC Best Practices for Comprehensive Tobacco Control Programs Youth Engagement State and Community Interventions Category 2010 available at http://databaseebook.com/de/Youth-Engagement-State-and-Community-Interventions-Category-User-Guide/p1295004726 CDC “Introduction to Program Evaluation for Public Health Programs: A Self Study Guide available at http://www.cdc.gov/eval/guide/CDCEvalManual.pdf CDC Introduction to Program Evaluation available at http://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/evaluation_manual/pdfs/evaluation.pdf Preventing Initiation of Tobacco Use: Outcome Indicators for Comprehensive Tobacco Control Programs 2014 available at http://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/preventing_initiation/index.htm Key Outcome Indicators for Evaluating Comprehensive Tobacco Control Programs – May 2005 (for goal area 1, please use outcome indicators listed in the resource above) available at http://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/key_outcome/pdfs/FrontMaterial.pdf UICC Global Cancer Control: Protecting Our Children from Secondhand Smoke available at http://www2.aap.org/richmondcenter/pdfs/UICC_english.pdf

https://adhperformancemgmt.arkansas.gov/UserDefinedContent/HomePage.aspx

ftp://ftp.cdc.gov/pub/fda/fda/user_guide.pdf

http://www.cdc.gov/tobacco/stateandcommunity/best_practices/pdfs/2014/comprehensive.pdf

http://www.cdc.gov/tobacco/stateandcommunity/best_practices/pdfs/2014/comprehensive.pdf

http://www.thecommunityguide.org/tobacco/index.html

http://www.cdc.gov/tobacco/data_statistics/sgr/2012/index.htm

http://www.surgeongeneral.gov/library/reports/50-years-of-progress

http://www.surgeongeneral.gov/library/reports/50-years-of-progress

http://databaseebook.com/de/Youth-Engagement-State-and-Community-Interventions-Category-User-Guide/p1295004726

http://databaseebook.com/de/Youth-Engagement-State-and-Community-Interventions-Category-User-Guide/p1295004726

http://www.cdc.gov/eval/guide/CDCEvalManual.pdf

http://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/evaluation_manual/pdfs/evaluation.pdf

http://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/evaluation_manual/pdfs/evaluation.pdf



http://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/key_outcome/pdfs/FrontMaterial.pdf

http://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/key_outcome/pdfs/FrontMaterial.pdf

http://www2.aap.org/richmondcenter/pdfs/UICC_english.pdf


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WHO: Six Policies to Revert Tobacco Epidemic available at http://whqlibdoc.who.int/publications/2008/9789241596282_eng.pdf Legacy Youth Activism in Tobacco Control: A Toolkit for Action available at http://www.legacyforhealth.org/content/download/2554/33803/file/LEG-YA%20Toolkit%20Web-Single%20Pages-3.27.13.pdf Legacy Tobacco Document Library available at http://legacy.library.ucsf.edu/# Mobilizing for Action through Planning and Partnerships (MAPP) available at http://www.naccho.org/topics/infrastructure/mapp/framework/index.cfm

http://whqlibdoc.who.int/publications/2008/9789241596282_eng.pdf

http://www.legacyforhealth.org/content/download/2554/33803/file/LEG-YA%20Toolkit%20Web-Single%20Pages-3.27.13.pdf

http://www.legacyforhealth.org/content/download/2554/33803/file/LEG-YA%20Toolkit%20Web-Single%20Pages-3.27.13.pdf

http://legacy.library.ucsf.edu/

http://www.naccho.org/topics/infrastructure/mapp/framework/index.cfm


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Appendix VIII Budget Template Format


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Appendix IX Tobacco Prevalence Maps


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Appendix X Contract and Grant Disclosure and Certification Form


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Appendix XI

Request for Taxpayer Identification Number and Certification / W-9 Form


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Appendix XII Restriction of Boycott of Israel Certification


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Appendix XIII

Application Cover Sheet RFA-18-1

July 1, 2018 to June 30, 2019

Applicant Information Organization Name: Organization Contact Person and Title: Address: City: Zip: Telephone: ( ) Fax: ( ) Email: Fiscal Agent Information (if different from Applicant) Organization Name: Address: City: Zip: Telephone: ( ) Fax: ( ) Email: Awarded Applicant Contact Information

Tobacco Program Coordinator Name: Address: City: Zip: Telephone: ( ) Fax: ( ) Email: Coverage Area and Program Proposal Information County/Community (coverage area of the coalition):

Maximum funding requested: $ I acknowledge the obligations of any grant awarded in connection with this proposal and affirm that the Applicant Agency is a legal entity that will meet the specifications set forth in the RFA.

Signature (Individual authorized to legally bind the proposer)


RFA-18-1

Appendix XIV

TPCP Financial and Accountability Guidelines

FINANCIAL AND ACCOUNTABILITY

GUIDELINES

TOBACCO PREVENTION AND CESSATION PROGRAM


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Contents Section I – General Guidance …………………………………………….…………………..…………………………………….4

Use of the Guide ………………………………………………………….…………………..………………………………………4

Accountability Requirements ……………………………………….…………………..…………………….……………….4

Financial Management Standards ………………………………….…………………..…………………………………….4

Internal Control …………………………………………………………….…………………..……………………………………5

Monitoring/Audit Standards ………………………………………….……………………..…………………………………6

Reporting Requirements ……………………………………………….………………………..……………………………….6

Tax Reporting ……………………………………………………………….………………………..……………………………….6

Section II – Grant Management Guidelines ………………………….………………………..……………………………...7

Use of Funds ………………………………………………………………………………………………..………………………….6

Allowable Costs ……………………………………………………………………………………………..………………………..7

Explicitly Unallowable Costs ……………………………………………………………………………..……………………..9

Unacceptable Accounting Practices ……………………………………………………………………..…………………10

Obligation of Funds ……………………………………………………………………………………………..………………...10

Shared Costs ………………………………………………………………………………………………….……..…….………….11

Program Income .…………………………………………………………………………………………………..…….…………11

Personnel Costs ……………………………………………………………………………………………………..…..…………..12

Other Costs ……………………………………………………………………………………………………………………..……..13

Cell Phone and Internet Monthly Services …………………………………………………………………….…………13

Landline Phone …………………………………………………………………………………………………….……………..…13

Catering/Food Costs ……………………………………………………………………………………………..…………….....13

Unallowable Food and Beverage Costs …………………………………………………………………………..………..14

Speaker Fees …………………………………………………………………………………………………………………....……14

Travel Costs …………………………………………………………………………………………………………………....……..15

Media and Health Communication ……………………………………………………………………………………...…..17

Educational Items …………………………………………………………………………………………………….……………17

Educational Supplies ……………………………………………………………………………………………………………..18

Sponsorship ………………………………………………………………………………………………………..……….……….18

Direct and Indirect/Administrative Costs ……………………………………………………………..………………..18

Property Management ………………………………………………………………………………………….……………….19

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Procurement ………………………………………………………………………………………………………………..….……19

Conflict of Interest ……………………………………………………………………………………….……….……….………20

Contractor/Consultant Services …………………………………………………………………………….………………20

Printing …………………………………………………………………………………………….………………………………..…21

Section III – Reimbursement Guidelines ……………………………………………………………………………..……..21

Monthly Reports …………………………………………………………………………………………………………….……..21

Final Payments ……………………………………………………………………………………………………………………..22

Documentation of Expenses …………………………………………………………………………………………………..22

Personnel Costs …………………………………………………………………………………………………………………….23

Meeting Costs ………………………………………………………………………………………………………………………..23

Minor Purchase Expense Reimbursements ……………………………………………………………………………..24

Travel Costs …………………………………………………………………………………………………………………………..24

Contractor/Consultant Costs ………………………………………………………………………………………………….24

Media/Health Communication Costs ………………………………………………………………………………………24

Section IV – Budgets and Work Plan Adjustments ………………………………………………………………………25

Budget Adjustments ……………………………………………………………………………………………………………....25

Work Plan Adjustments ………………………………………………………………………………………………………....26

Section V – Cancellation …………………………………………………………………………………………………………….26

Section VI – Monitoring ………………………………………………………………………………………………………….....27

Section VII – Fraud Awareness and Legal Compliance ………………………………………………………………..28

Appendices

Appendix I – Items/Transactions Requiring Prior Approval ……………………………………………………….29

Appendix II – Approved Educational Items ………………………………………………………………………………..32

Appendix III – Sign-In Sheet ………………………………………………………………………………………………………33

Appendix IV – Budget Adjustment Request Template …………………………………………………………………34

Appendix V – Acknowledgment Form ………………………………………………………………………………..………37

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Section I – General Guidance As stated on page 8 of the Request for Applications RFA-16-0009 document for this grant, the purpose of this Tobacco Prevention and Cessation Program grant is to implement strategies and interventions which are designed to enhance state and local tobacco control efforts by challenging conventional thinking, educating for smoke-free policies, and changing social norms around tobacco use in Arkansas. Sub-grantees must comply with TPCP Financial and Accountability Guidelines and all federal and state laws.

Use of the Guide This guide should be reviewed by everyone in the organization who is responsible for grant management, including those who prepared the grant application and those who record and report on grant activities. This guide is not offered as a complete manual of procedures on grant administration; it is intended only to provide practical information on what is expected from sub-grantee organizations in terms of fiscal accountability. Important Notice: TPCP requires each sub-grantee organization to submit a signed copy of the Acknowledgement Form (Appendix V) by the end of the second month of the grant period. The Acknowledgement Form must be signed by the coordinator and the organization’s authorized signer or supervisor. For the Acknowledgement Form, see Appendix V.

Accountability Requirements Acceptance of a grant from the Tobacco Prevention and Cessation Program (TPCP) requires the sub-grantee to use the funds in accordance with the terms of the grant and to comply with the grant’s provisions and conditions. The sub-grantee thus assumes full responsibility for the conduct of the project activities and becomes accountable for meeting required standards in the areas of financial management, internal control, monitoring and reporting to TPCP. If work plan deliverables are hindered by barriers and challenges, TPCP reserves the right to cancel the agreement. As stated on page 8 of the Request for Applications RFA-16-0009 document for this grant, “Barriers in accomplishing deliverables may result in a cancellation of the sub-grant agreement.” See Cancellation (Section V).

Financial Management Standards Many alternative methods exist for implementing financial management systems, and the organization should choose methods appropriate for its particular scale of operations. If the organization is unable to meet the standards that are identified, TPCP funding may be terminated and the organization may be deemed ineligible to receive subsequent financial assistance.

Recipients must have accounting structures that provide accurate and complete information

about all financial transactions related to each source of funds.

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Recipients must have an accounting system that can provide accurate, current and complete financial reports that can be duplicated and supported with backup documentation.

Recipients must have an accounting system that can track expenses and revenue by funding source.

Expenditure records must be at least as detailed as the cost categories indicated in the approved budget (including indirect/administrative costs charged to the project).

Actual expenditures are to be compared with budgeted amounts. Costs may be incurred only during the award period, and all obligations must be paid no

later than 45 days after the end of the award period. Records must be supported by source/backup documentation such as cancelled checks,

invoices, contracts, travel reports, timesheets and activity reports, etc. Employees whose salary is charged to the grant must maintain a work activity report that

differentiates time spent on all activities allocated by funding source. Records must be preserved for a period of five (5) years after the agreement expires, or if

any audit is pending at the end of the five-year period, until resolution of the audit.

Organizations will grant access to their records upon request by TPCP personnel. Access will be given to any books, documents, papers or records of the sub-grantee which are related to any services performed under the TPCP award agreement.

Internal Control Organizations must provide safeguards for all grant property, whether cash or other assets, and assure that it is used solely for authorized purposes. Control will be enhanced if the duties of the members of the organization are divided so that no one person handles all aspects of a transaction from beginning to end. Although a complete separation of functions may not be feasible for small organizations, some measure of effective control may be obtained by planning the assignment of duties carefully.

Many effective techniques for providing internal control are very simple. Some examples are: Bank accounts should be reconciled monthly by someone other than the person who signs

the checks. Checks to vendors should be issued only in payment of approved invoices. The person who is responsible for the physical custody of any asset should not also have

responsibility for keeping the records related to that asset. The person who has authority for placing employees on the payroll and establishing wage

rates should not be the same person who signs the checks. The individual signing checks for payment should not be the individual setting up payment

requests. Individuals cannot sign checks made payable to themselves. Signature stamps or pre-signed checks cannot be used. Two signatures should be required on checks. Checks must state that two signatures are

required. Checks with two signature lines do not constitute the requirement for two signatures and will not be challenged by the bank or vendor cashing the check.

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Cash transactions are not acceptable. All transactions paid with TPCP funds must be made with a check or credit/debit card with the exception of small cash purchases (under $100) made through a petty cash fund or personal reimbursements with proper documentation.

Monitoring/Audit Standards Organizations must assure that TPCP staff will be able to review the organization’s expenses, tie them specifically to TPCP funding, and determine if the expenses are reasonable and supported with appropriate backup documentation (e.g., invoices, cancelled checks, timesheets/activity reports and travel logs). Organizations must provide TPCP with a copy of the organization’s general ledger (in Excel) of all expenses charged to the TPCP sub-grant for the period reviewed. If the general ledger total expenses related to the TPCP grant exceed or are less than the amounts reimbursed by TPCP, organizations will be asked to provide an explanation on discrepancies. See Section VI – Monitoring for additional information. TPCP will conduct a review of financial transactions annually. The review may be done in conjunction with an on-site visit. For additional audit requirements, see Section F of the Sub Grant Agreement form (FIN-9600).

Reporting Requirements TPCP requires that all reports and documents be submitted in a timely manner. Organizations must submit a monthly invoice in GEMS and upload or mail the original signed Payment Request Form with backup documents to TPCP no later than the end of the month following the reporting month. The backup documents must be uploaded in GEMS as well. NOTE: Invoices are not reimbursed until the sub-grantee has submitted the required Monthly Report in GEMS.

Tax Reporting It is the organization’s responsibility to ensure their organization follows Internal Revenue Service (IRS) and state tax laws. The IRS Miscellaneous Income form (1099-Misc) is required for some services when an organization pays a vendor $600.00 or more in a calendar year. Refer to the following website for additional information: http://www.irs.gov/pub/irs-pdf/i1099msc.pdf. The IRS Return of Organization Exempt from Income Tax (Form 990) is an annual reporting return that all 501(c)(3) private foundations regardless of income must file with the IRS. It provides information on the filing organization's mission, programs and finances. Refer to the following website for additional information: http://www.irs.gov/pub/irs-pdf/f990.pdf.

Organizations that have a tax-exempt status that has been revoked cannot be funded by TPCP.

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Section II – Grant Management Guidelines TPCP requires prior approval on some items/transactions before the purchase of an item or engaging in an obligation to expend funding. All purchases must meet allowability standards (see Allowable Costs in this section). To assist sub-grantees in determining the types of items requiring prior approval, requirements for the purchase, persons responsible for the approval, and the method to use to get approval, see Appendix I. The following sections provide additional guidelines to assist organizations with managing TPCP funding according to established requirements. NOTE: The financial guidelines in this document must be followed if they are more stringent than those of the funded organization. Otherwise the funded organization’s guidelines must be followed.

Use of Funds Activities conducted under a sub-grantee agreement are an extension of the program. Funds must be used to meet sub-grantee objectives such as for evidence-based tobacco control interventions and reasonable program purposes and activities. Sub-grantees may not use funds for any items that were not identified in the approved budget without a budget adjustment request and/or prior approval.

Allowable Costs Allowable costs are defined as being reasonable, allocable, necessary, authorized, treated consistently, and documented. Recipients should use the following tests to determine the allowability of a purchase: Reasonable: Costs are considered reasonable when the cost does not exceed the market prices

for comparable goods or services. Allocable: Costs are allocable when they are assigned to a specific function where costs are

needed and incurred. Necessary: Costs are considered necessary when they are recognized as ordinary and

necessary to support the operation and/or performance of the program. Authorized: Costs must be authorized in the approved budget and not prohibited under state

or local laws or regulations. Consistent: Costs are considered consistent when treated consistently regardless of the source

of funds. Documented: Costs must be adequately documented. The following scenarios are provided to assist with testing for allowability of a cost. This list is not

inclusive.

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Scenario 1 The approved budget includes the purchase of a computer to replace an obsolete computer that the program coordinator has been using. However, when the computer is received, it is assigned to a staff person that does not perform grant-related tasks. Does this pass the test for allowable cost?

No. Why not? The purchase of the computer was authorized for the program coordinator. By assigning the computer to a staff person not performing grant-related tasks, the cost cannot be allocated to this funding.

Scenario 2 The program coordinator purchases an item for a TPCP event using his or her personal funds. The event is included in the work plan and budget. An itemized receipt along with the organization’s reimbursement/reconciliation form documents the purchase. Does this pass the test for allowable cost?

Yes. Why? It was approved in the budget and work plan, and the expense was documented (itemized receipt and proof of reimbursement).

Scenario 3 Your work plan includes working with a population that does not speak English, and the services of an interpreter are required. You contact someone you know that can provide the service and offer to pay $150 per hour. Does this pass the test for allowable cost?

No. Why not? The work is necessary, you can allocate it, but is the cost reasonable? When hiring a contractor, you cannot pay more than the market rate for services. The current market rate for a Spanish interpreter is between $40 and $60 per hour with a one-hour minimum; therefore, the cost is not reasonable. Amounts paid over the market rate can be disallowed. Market rates for interpreter services can be found quickly by doing online searches.

Scenario 4 The local coalition for alcohol and other drugs has a meeting that includes a tobacco prevention topic on the agenda, and you are asked to provide lunch and snacks (catering) for the meeting. Since the TPCP approved budget does include catering, you agree even though only a portion of the meeting will be devoted to tobacco prevention. Does this pass the test for allowable cost?

No. Why not? The cost is authorized; however, the total cost cannot be allocated to TPCP funding since the event is for other programs as well as TPCP. TPCP funding can only be used for a portion of the costs and must be based on a methodology equally dividing the costs with the other programs involved in the meeting (i.e., percentage of meeting time or portion of the agenda devoted to tobacco prevention).

Scenario 5 Your organization’s policy authorizes an annual salary increase of up to 4% based on performance reviews. You expect to have a surplus in your TPCP budget in salary and fringe. Your performance

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has been outstanding this year, so you ask your supervisor for a 5% salary increase, and your request is approved. Does this pass the test for allowable cost?

No. Why not? TPCP funds must be treated consistently throughout the organization. If the organization’s policy sets a limit of 4% annually for salary increases, all employees must be treated consistently despite having surplus funds.

Scenario 6 An opportunity arises to partner with another organization on a project, but the activity was not included in the approved work plan, and there will be costs associated with the project that were not included in the budget. Does it pass the test for allowable cost?

Maybe. Why? Sub-grantees must seek advice from TPCP prior to commitment. If TPCP agrees, the sub-grantee must submit a budget adjustment request following the guidelines in Section IV, Budget and Work Plan Adjustments.

NOTE: Work plan changes require prior TPCP approval. See Section IV, Budget and Work Plan Adjustments.

Scenario 7 Your approved budget has $1,200 in office supplies. Your organization does not purchase any office supplies until June. On June 10, you purchase $1,000 of toner and $200 of promotional supplies. Does it pass the test for allowable cost?

Maybe. Why? The purchase of $1,200 was authorized; however, it does not seem necessary to purchase $1,000 worth of toner and $200 of promotional supplies when the grant will expire in 20 days. The sub-grantee must provide justification for this purchase.

Explicitly Unallowable Costs Below is a list of explicitly unallowable costs that TPCP will not reimburse. This list is not all-inclusive but provides guidance on costs that are strictly disallowed.

Alcoholic beverages

Bonuses

Cash advances to employees

Construction costs

Contingency provision

Costs incurred outside the grant period

Credit card fees

Dependent care costs (insurance)

Donations or contributions

Dual compensation

Earned sick leave paid upon an employee’s permanent departure from the position

Fines and penalties

Flowers/plants

Fundraising

First class and non-coach travel

Gift cards

Goods and services for personal use

Housing and personal living expenses

Idle facility

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Interest expense

Investment management

Late payment fees

Lobbying

Losses on sponsored projects or contracts

Memberships, subscriptions and professional activity costs in an individual’s name (These costs must be in the organization’s name and must meet the allowability test)

Overtime cost, extra pay or shift pay

Organizational or reorganization costs

Personal entertainment

Pre-agreement costs

Property acquisition (land and/or building)

Relocation costs

Selling products purchased with TPCP funds

Severance pay

Tobacco products

Valet service

Unacceptable Accounting Practices Organizations must avoid the following practices:

Charging costs to spend remaining balances

Assigning charges to the grant with the largest remaining balance

Billing costs to the grant prior to the expense being incurred

Charging the budgeted amount rather than the actual amount

Identifying a cost as something other than what it actually is (e.g., a contractor cost

rather than a personnel cost)

“Rainy day purchases” where a cost may be beneficial to other projects after the project

end date

Obligation of Funds An obligation is orders placed, contracts awarded for services to be received, and similar transactions during the award period that require payment by the sub-grantee. An obligation occurs when funds are committed, such as a valid purchase order or requisition to cover the costs of purchasing an authorized item on or after the begin date and up to the last day of the project period. Obligations must occur during the project period stated in the award agreement. Any funds not obligated by the end of the award period will expire and will not be available.

Contracted services must be performed during the award period. However, invoices for services performed during the award period can be paid after the end date of the award. Entering into a contract for services to be performed after the end date of the award is not acceptable and would be a disallowed cost.

The following scenarios are provided to assist with testing for obligation of funds. This list is not inclusive.

Scenario 1 The advertisement was purchased in May; however, the advertisement ran in June. Can this cost be reimbursed in May?

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No: This is a reimbursable grant. The services must be received before the processing of the payment. Therefore the payment request should be processed in June. Scenario 2 The sub-grantee agreed with the vendor that advertising would be purchased in June. The artwork was completed in June, but the advertisement will be placed in July. Will this cost be reimbursed? Yes, but not all costs: Only the cost of artwork can be reimbursed. The services must be performed during the award period. Scenario 3 The sub-grantee purchased and received services in May. The sub-grantee received the invoice from the vendor in July. Will this cost be reimbursed? Yes: The sub-grantee can invoice TPCP within 45 days after the grant expires. NOTE: TPCP recommends that sub-grantees submit invoices by June 15. Scenario 4 The sub-grantee purchased a newspaper advertisement in May. This advertisement is for May, June and July services. The sub-grantee submits an invoice in May for all three months’ services. Will this cost be reimbursed? Yes, but not all costs: The sub-grantee will not be reimbursed for the payment that crosses grant years and/or in advance. The sub-grantee submitted the invoice in May; therefore, the cost for May services can be reimbursed. The cost for June services can be requested and reimbursed after the services are performed. The cost for July services cannot be reimbursed in this grant period. The sub-grantee must submit a copy of advertisement (tear sheets) along with each invoice.

Shared Costs If an event is held in conjunction with other programs such as drug and alcohol awareness programs, all costs including facility rental, catering and other costs must be prorated based on the content of the meeting agenda. TPCP will not reimburse 100% of the costs if the event is shared with another program.

Program Income Program income is defined as gross income received by the organization that was directly generated by a grant-supported activity or earned only as the result of the grant agreement. Some examples include:

Charging a registration fee for workshops and conferences

Revenue received in return for providing services to a third party

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Membership fees

The sale of commodities, data and information records, services or books and publications,

software, childcare, tutoring, etc.

Rental or usage fees charged for use of supplies or equipment purchased with TPCP grant

funds

The sale of products made or purchased using TPCP grant funds

Organizations must report program income as soon as it is earned. TPCP will determine if the program income can be used to advance TPCP program objectives or if a refund to TPCP is required. Program income can only be used for allowable TPCP program costs and must be reflected in the work plan.

Personnel Costs Organizations must ensure that staffing requirements are in compliance with the applicable Request for Applications (RFA). TPCP requires one full-time coordinator who must dedicate 100% of his or her time to performing TPCP-related activities specified in the work plan. TPCP-funded coordinators must be available to work during normal business hours (8:00 a.m. to 5:00 p.m.) with occasional work beyond normal business hours (i.e., evenings and weekends). Overtime compensation is an unallowable cost. TPCP will not reimburse overtime compensation to the sub-grantee. The coordinator must maintain timesheets and activity reports that are submitted monthly as part of the backup documentation with the invoice. Timesheets must show hours worked and days off. If the program coordinator is absent from work for two weeks or longer, the fiduciary must notify TPCP and propose a plan for ensuring that work will continue without interruption. Failure to provide the required notification could result in cancellation of the agreement. NOTE: Organizations that utilize a time clock system may submit weekly time reports to TPCP. Activity reports and leave balance reports must be provided with each payment request. Within the first month of the grant period, all sub-grantee organizations must provide TPCP with a copy of the organization’s paid time off policy for the current grant period. The written policy should outline how vacation time, sick time and other time off is accrued. The types of paid time off that TPCP will reimburse will follow the sub-grant organization’s policy. In no case is dual compensation allowable. An employee may not receive compensation for the same work from two different funding sources for a single period of time, even though such work may benefit both programs/grants. If staff funded wholly or in part by TPCP (not including the required full-time coordinator) work on multiple grant programs or cost activities, a reasonable allocation of costs to each activity

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must be made based on time and/or effort reports (e.g., timesheets with award and activity designation). These reports must:

Reflect the actual activity of each employee

Account for the total activity for which each employee is compensated

Be prepared at least monthly and coincide with one or more pay periods

Account for the total activities for which employees are compensated

Be signed by the employee and approved by a supervisory official having firsthand

knowledge of the work performed

Be allocated based on a 40-hour work week

NOTE: Allocations for fringe benefits must follow the same allocation percentage as salary. The same is true for budgeting salary.

For program continuity, all changes in personnel must follow qualifications as outlined in the current RFA. TPCP recommends written notification of salary and fringe benefits prior to work beginning. This includes submission of résumés and budget adjustments. Nepotism is highly discouraged, and as a result, related employees should not be placed within the same line of supervision.

Other Costs

Cell Phone and Internet Monthly Services Cell phone and internet monthly service costs are allowable but must be set up in the name of the organization unless the organization requests a waiver that includes justification and the costs are reasonable. TPCP will reimburse up to $50.00 per month for personal cell phone monthly services and $25.00 per month for personal internet service. To receive reimbursement, a copy of the individual’s personal cell phone bill and internet bill must be provided as backup documentation with the monthly invoice.

Landline Phone Landline phone costs are allowable but must be purchased in the name of the organization.

Catering/Food Costs Catering costs for food and beverages at a TPCP-sponsored event are allowable. However, organizations must utilize the National Alliance for Nutrition and Activity meeting guidance as a reference when providing food at meetings. See links below for additional information: http://cspinet.org/nutritionpolicy/Healthy-Meeting-Guidelines.pdf http://cspinet.org/nutritionpolicy/Healthy-Meeting-Toolkit.pdf https://www.cspinet.org/nutritionpolicy/healthy-meeting.html

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In addition, the organization must assure that: The meal is provided to participants of a TPCP-sponsored event (e.g., workshop, meeting,

conference). If the event is in conjunction with other programs, the catering cost must be prorated based on attendance or agenda topics. TPCP will not reimburse 100% of the costs if the event is shared with another program.

A timed agenda and justification should be submitted with the invoice. An itemized invoice for food/beverage costs must be provided. A credit card receipt is not

adequate backup documentation for the expense. A detailed sign-in sheet that includes contact information for the participants must be

submitted to TPCP (see Appendix III). Cost per person (including tax and tip) does not exceed the state per diem rate for the

individual meal. The $5.00 incidental expenses allowance cannot be considered part of the allowable cost per meal. The GSA website defines incidental expenses as fees and tips given to porters, baggage carriers, hotel staff, etc. See https://www.gsa.gov/portal/content/104208#13 for more information.

If the catering expense includes a service fee, TPCP will not reimburse for an additional tip. TPCP will calculate cost per person based on the overall total including all fees and taxes.

The majority of the attendees are not staff of the sub-grantee organization or state employees. (See per diem rates at http://www.gsa.gov/portal/content/104877.)

Snacks and breakfast costs are unallowable without special justification and prior approval. Boxed healthy lunches are preferred.

Unallowable Food and Beverage Costs Following are examples of events where food and beverage costs would not be appropriate and would not be reimbursed by TPCP:

Food for normal daily business (e.g., coffee, water, cups) Staff meetings/working lunches Organizational parties Any non-TPCP related activity

Speaker Fees Reimbursement for speaker fees requires that the use of a speaker be centered on changing social norms with the launching of a tobacco control policy or to engage youth resulting in multiple activities such as interviewing the speaker and using the interview after the event to promote tobacco control.

Speaker fees are budgeted in the Contractor/Consultant Services budget category. If the speaker is identified in the approved budget and/or selected from the list of recommended speakers in the GEMS Resource Library, no further TPCP approval is necessary. If the speaker is not identified in the approved budget or included in the list of recommended speakers, the

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following must be submitted to TPCP prior to contracting with the speaker: Résumé/credentials Itemized costs (fees and reimbursable expenses such as travel, meals, lodging and

presentation materials) Individuals who receive a salary from any of the Master Settlement Agreement (MSA) funded programs cannot be paid speakers at sub-grantee events.

Travel Costs Travel expenses are allowable costs for employees on official business travel related to TPCP activities. Travel costs must be in accordance with travel limits listed in the table below or the sub-grantee organization’s travel policy, whichever is the more stringent policy. Some travel limits may apply to in-state and out-of-state travel. TPCP reimbursement must not exceed per diem limits according to the U.S. General Services Administration website. For example: the current per diem limits for Little Rock are $94 per night for lodging, $13 for breakfast, $15 for lunch and $26 for dinner. These amounts are given only as examples and may be subject to change. For more information, see http://www.gsa.gov/portal/content/104877. * Out-of-state travel is allowed for statewide-funded sub-grantees only.

Detail In-State Travel

Out-of-State Travel*

Travel expenses will be reimbursed at actual expenses but not exceed per diem limits. Itemized receipts are required.

x x

Travel expenses for volunteers are allowable, with prior approval. x x

Meals In-State Travel


To receive meal reimbursement, the traveler must have an overnight lodging and must travel over 50 miles from work location to destination and submit itemized receipts.

x x

If the lodging cost includes breakfast, TPCP will not reimburse for breakfast. An exception might be applied to those who have dietary restrictions, with prior approval.

x x

Breakfast is allowable if in travel status at or before 6:00 a.m. WITH an overnight stay dated the previous day (the night before).

x x

Lunch is allowable if in travel status at or before 10:30 a.m. WITH an overnight stay dated that same day.

x x

Lunch is allowable if in travel status at or after 2:00 p.m. WITH an overnight stay dated the previous day (the night before).

x x

Dinner is allowable if in travel status at or after 6:30 p.m. WITH an overnight stay dated that same day.

x x

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If meals are included with a conference registration fee, TPCP will not reimburse for food purchased outside the conference. An exception might be applied to those who have dietary restrictions, with prior approval.

x x

The $5.00 incidental expenses allowance can be reimbursed only if the traveler is eligible for the full day’s amount for meals. The incidental expense cannot be considered part of the allowable cost per meal. The GSA website defines incidental expenses as fees and tips given to porters, baggage carriers, hotel staff, etc. See https://www.gsa.gov/portal/content/104208#13.

x x

Tips on meals may be reimbursed up to 15% but not to exceed per diem. x x TPCP will not reimburse for grocery items claimed as a meal expense. An exception might be applied with prior approval.

x x

Alcohol purchases are not allowable. x x

Lodging In-State Travel


Hotel rates should follow the government rate. If the organization cannot claim government rates, a reasonable rate should be sought. TPCP will determine whether the rate is reasonable.

x x

If a conference or event begins or ends within working hours (8:00 a.m. to 5:00 p.m. Monday - Friday), TPCP will reimburse lodging expenses for the night before the event begins but not for the night after the event ends. Exceptions may be made on a case-by-case basis with prior approval.

x x

Costs for room service, movie rental, alcoholic beverages, etc. are not allowable costs and will not be reimbursed by TPCP.

x x

If the traveler shares the lodging space with others, the cost should be divided among others equally. A separate invoice is required for each traveler.

x x

Valet parking is not a reimbursable expense. x x

Mileage In-State Travel


Mileage reimbursement is in accordance with the state rate of $0.42 per mile. To receive reimbursement for mileage, the traveler must maintain mileage logs documenting each trip. The mileage log must include the following information:

Date of the trip

Starting location including street address and city

Destination location including street address and city

Purpose of the trip

Total miles traveled based on Rand McNally.com

Amount reimbursed for the trip

x x

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RFA-18-1

Rental car purchases require prior written approval from TPCP granting permission to proceed. The justification must include cost savings for car rental versus public/private vehicle. The estimated total cost must include all charges, such as gasoline, mileage, insurance, etc. (Full coverage insurance must be obtained from the rental car company when renting a vehicle.) NOTE: Rental cars are for official business use and cannot be used for trips to restaurants, shopping, entertainment, etc.

x x

Airfare In-State Travel


First class airfare is not reimbursable. x

Reimbursement may be made for one checked bag per person. x

Transportation to and from hotel to airport is reimbursable. x

Transportation to and from a restaurant is not an allowable cost. x Non-stop flights are not reimbursable unless cheaper than a flight with a stop to the same final destination. x

For out-of-state travel, statewide sub-grantees can choose an option to travel either by driving or flying. Sub-grantees must submit a justification letter for prior approval. The letter should provide cost savings for driving versus flying. The estimated total cost must include all charges such as gasoline, mileage, insurance, lodging and meals.

x

Media and Health Communication

Organizations must allocate a portion (the percent specified in the RFA) of total direct costs to media and advertising costs (e.g., television, radio and print ads, digital media, billboards). All media and health communication efforts must be approved by TPCP prior to purchase and must include all required logos (Master Settlement Agreement logo, StampOutSmoking logo and Arkansas Department of Health logo). Requests for approvals must be submitted on the TPCP Health Communication Approval Form allowing ten business days for the approval process. This form can also be used to identify items that require prior approval.

Pre-Approval is required anytime logos are used and must be submitted on the TPCP Health Communication Approval Form.

Educational Items

Educational items are included as a part of the Media and Health Communication budget subcategory and are items distributed to the public that include an educational message. A list of reimbursable educational items is located in Appendix II and in the GEMS Resource Library.

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RFA-18-1

Prior to purchase, submit a Health Communication Approval Form for approval of the logo placement. The item, quantity and message must support specific work plan activities.

Educational Supplies Educational supplies are budgeted in the M&O budget category and are reusable educational tools such as Mr. Gross Mouth, tarred lung model, etc. If the educational supply item is included in the approved budget, no further TPCP approval is required.

Sponsorship Sponsorships are budgeted in the Contractor/Consultant Services budget category. If the sponsorship is specified in the approved budget, no further TPCP approval is required, with the exception of logo placement and messaging. Submit requests for logo placement and messaging on the Health Communication Approval Form to the TPCP Health Communication Manager.

Direct and Indirect/Administrative Costs Direct costs are costs that can be tracked directly to TPCP events or activities in the work plan. Examples of allowable direct costs include:

Salary and fringe benefits for the coordinator

Supplies used by the coordinator to carry out the activities of the work plan

Equipment for the coordinator that is deemed necessary Media and promotional/educational materials Cell phone and internet service for the coordinator Sub-contractor services for the purpose of carrying out TPCP work plan activities Coordinator travel costs Meeting and event costs (e.g., facility rental, catering) Duplication/copying of program-related materials

Indirect/Administrative Costs are costs that associated with activities or services that benefit more than one project to include TPCP. Organizations are allowed to charge an indirect/ administrative cost of up to 10% of the total expensed direct costs. Examples of indirect/ administrative costs include:

Utilities

Rent/lease

Bookkeeping/accounting

Audit fees

General administrative fees

Equipment maintenance

Organizations cannot charge more indirect/administrative costs than are documented in the general ledger, and the amount cannot exceed 10% of the total expensed direct costs.

18


RFA-18-1

For example: The indirect cost amount approved in the budget is $5,000, but only $4,000 is documented in the general ledger; therefore, the organization can only be reimbursed $4,000.

Property Management Equipment purchases of $500 or greater must be approved by TPCP prior to purchase. If new equipment is purchased when suitable equipment is already available within the organization, the purchase will be considered an unnecessary cost and will not be reimbursed. Organizations must establish/maintain an effective property management system. Sub-grantees are required to track items with an acquisition cost of $500 or greater. The procedure used for maintaining equipment acquired, in whole or in part, with TPCP funds (including replacements) should, at a minimum, meet the following requirements:

Description of the property Serial number or other identification number Identification of the title holder Acquisition date Cost of the property Percentage of TPCP participation in the cost of the property along with other funds used

to purchase property if applicable Location of the property and individual name or title of position using the property Use and condition of the property Disposition data, including the date of disposal and sale price or disposal method A physical inventory of the property and reconciliation of the results must be completed

at least once every two years. Organizations are responsible for replacing or repairing property that is lost, stolen, damaged, or destroyed. Sub-grantees must investigate and fully document any loss, damage or theft of property and make the documentation part of the official project records. Organizations must:

Have a control system in place with adequate safeguards to prevent the loss, theft or

damage of equipment

Promptly and properly investigate any loss, damage, or theft

Establish and use adequate maintenance procedures to keep the property in good condition

Organizations no longer funded by TPCP should contact TPCP to determine the disposition of all equipment purchased. A written response will be sent to the sub-grantee with instructions on the disposition of each item.

Procurement There are times when it may be necessary to procure goods and/or services to accomplish the activities approved in the work plan. For example, it may be necessary to purchase equipment or contract for services that the recipient does not have in-house. Recipients must adhere to the following procurement standards when procuring goods and services:

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RFA-18-1

General – At a minimum, TPCP expects all contracted services to be competitively bid using at least three quotes. Examples include catering costs and professional and technical services.

Adequate Competition – All procurement transactions, whether negotiated or competitively bid and without regard to dollar value, must be conducted in a manner so as to provide maximum open and free competition.

Non-Competitive Practices – Sub-grantees must be alert to organizational conflicts of interest or non-competitive practices among contractors that may restrict or eliminate competition or otherwise restrain trade.

Conflict of Interest To avoid any perception of a conflict of interest, TPCP will not reimburse any organization or individual that is funded by TPCP for services or products if those services or products are being provided by that individual or organization or if the individual or organization has a vested financial interest in the company that provides the products or services. TPCP will not pay for services/products if the TPCP-funded person or organization will gain from the transaction directly or indirectly (e.g., receiving discounts or gifts as a result of the transaction). Definition: A conflict of interest is a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest. The conflict exists whether or not a particular individual is actually influenced by the secondary interest. It exists if the circumstances are reasonably believed (on the basis of past experience and objective evidence) to create a risk that decisions may be unduly influenced by secondary interests. Typical conflict of interest issues include:

Purchasing goods or services from, or hiring an individual from, a related party such as a

family member or a business associated with an employee of the sub-grantee organization

Vendor selections accomplished without a fair and transparent process free of undue

influence

Consultant services selected without a fair selection process, reasonable pay rates and

specific verifiable work product

Contractor/Consultant Services The Contractor/Consultant Services budget category must be used when sponsoring an event, contracting for a service, hiring an individual as an event speaker, or receiving professional advice or services (e.g., training, expert consultant, etc.) but not as an employee of the sub-grantee organization. Contractors, consultants, speakers and sponsorships specifically named in the approved budget do not require further approval from TPCP. If the budget shows “TBD,” the sub-grantee must seek approval for the individual(s) selected. Logo placement and educational messages must be approved by TPCP. Approval of logo placement and educational

20


RFA-18-1

messages must be submitted to the Health Communication Manager using the Health Communication Approval Form. The following information is required by TPCP for contracting and consulting services: 1. Name of Contractor/Consultant: Provide the name of the proposed contractor/consultant.

Contracting with a person who occupies a position with a state agency is prohibited. 2. Method of Selection: Describe how the contractor/consultant was selected. 3. Period of Performance: Specify the beginning and ending dates of the contract. 4. Scope of Work: Describe in outcome terms the specific services/tasks to be performed by the

contractor or consultant as it relates to the accomplishment of program objectives. 5. Method of Accountability: Describe how the progress and performance of the contractor/

consultant will be monitored during and on close-out of the contract period. Identify who will be responsible for supervising the contract. In addition, for continuation contracts, describe the contractor/consultant’s previous performance.

6. Itemized Budget and Justification: Provide an itemized budget with appropriate justification. 7. Contract and Grant Disclosure and Certification Form: Provide a completed and signed copy of

the form.

8. Request for Tax Payer Identification Number and Certification (W-9) Form: Provide a completed and signed copy of the W-9 form to TPCP prior to awarding a contract. When requesting reimbursement, the sub-grantee should send TPCP a copy of the final contract signed by all parties.

Printing Arkansas law ACA19-11*201(30)(a)&(b) requires all government agencies as well as sub-grantees funded by the state to competitively bid printing jobs. Printing is defined as transferring images, by the use of standard industrial type printer ink, upon documents such as letterhead, envelopes, pamphlets, booklets and forms.

Section III – Reimbursement Guidelines Financial reports are due to TPCP monthly no later than the end of the month following the reporting month. Sub-grantees must enter expenditures into GEMS each month and print, sign, and upload or mail to TPCP the Subgrantee Payment Request Form that is generated by GEMS, along with backup documentation supporting the expenditures billed.

Monthly Reports Invoices are not reimbursed until the sub-grantee has submitted the required Monthly Report in GEMS for the reporting month. If any Monthly Report is rated unsatisfactory, TPCP will implement a corrective action plan with the understanding that if the following month’s report is also unsatisfactory, TPCP will initiate a meeting with the fiduciary.

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RFA-18-1

Final Payments Final payment requests requiring reimbursement prior to the end of the fiscal year (June 30) must be submitted no later than June 15. Sub-grantees should avoid entering into a new obligation of funds after May 15. Any anticipated expenditures during June 16 to June 30 should be estimated and included in the June 15 invoice.

All supporting documents for expenditures occurring from June 16 to June 30 must be received no later than July 31. In the event that a sub-grantee over-estimated expenses, which resulted in an overpayment, the overpaid amount must be returned to TPCP with a revised invoice and supporting documents by August 31.

Documentation of Expenses TPCP requires backup documentation (source documents) for all expenses that are submitted on the monthly invoice. A source document is a written document that provides details of a transaction and the evidence that the transaction took place. A statement of account from a vendor is not an acceptable source document for an expense. Source documents must be legible and must relate to the proper time period and event. Below are source documents that should be maintained and submitted with the monthly invoice to document expenses:

Personal travel reimbursements Mileage logs Vendor invoices Store receipts Purchase orders Contract agreements Credit memos Petty cash records Deposit records Bank statements Time and attendance records Work activity reports Leave records Hire and pay records

Accounting records and general ledgers

Tax documents Travel documents Board meeting minutes Cancelled checks Cost allocation plans Agendas Sign-in sheets Asset records (purchase,

inventory and disposal) TPCP sub-grant award Cash register receipts

NOTE: Expenses not supported with backup documentation will not be reimbursed until appropriate documentation is provided. A lack of complete documentation could delay receipt of monthly reimbursement payments. Source documents should show who, what, when, where and quantity and cost of the goods or services purchased. Source documents must be legible. An invoice provided as backup documentation should include the following information:

Name and address of the company

Invoice date and invoice number 22


RFA-18-1

Contract number or other authorization for supplies delivered or services performed (including order number and contract line item number)

Description, quantity, unit of measure, unit price, and extended price of supplies delivered or services performed

Shipping and payment terms (e.g., shipment number and date of shipment, discount for prompt payment terms)

Date of services

Total of invoice including taxes

Taxpayer Identification Number

Statements from vendors and credit card transaction slips are not acceptable as complete supporting documentation of expenses as they lack the necessary details about the transaction.

Although a general ledger (G/L) listing payments is used for audit purposes, it cannot be used, solely, to document an expense.

Sub-grantees must pay vendors from itemized invoices received from the vendor. Sub-grantees are never to create invoices for their vendors.

Personnel Costs Personnel costs (salaries/wages and fringe benefits) must be based on payroll records approved by a responsible official. Organizations invoicing TPCP for personnel costs must include the following information:

Copy of weekly timesheet and activity report signed by the employee and the employee’s supervisor (unless the organization has received a timesheet exemption)

Copy of current paid time off (PTO) document, signed by the employee and the employee’s supervisor.

Copy of employee reconciliation or pay stub detailing salary and fringe breakdown

Meeting Costs Organizations invoicing TPCP for meeting expenses (e.g., room rental, catering) must include the following information:

Sign-in sheets

Meeting agenda

Copy of invoices for expenses such as catering and supplies

Copy of the notice of meeting, if advertised

Copy of meeting minutes, if applicable

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RFA-18-1

Minor Purchase Expense Reimbursements Organizations invoicing TPCP for minor purchase expenses incurred by a staff member who made a purchase with personal funds must include the following information:

Legible itemized receipt showing items purchased

Organization’s reimbursement/reconciliation form signed by the staff member making the purchase and his/her supervisor or the organization’s authorized agent

Travel Costs Organizations invoicing TPCP for official TPCP-related travel expenses incurred by a staff member must include the following information:

Copy of mileage log signed by the traveler and the traveler’s supervisor

Meal receipts showing details of food purchased. A credit card transaction slip alone is not sufficient documentation.

Itemized hotel receipt in the traveler’s name. Entertainment expenses are not reimbursable.

Airline ticket and baggage receipt

Taxi or shuttle receipt

Parking receipt

Other miscellaneous travel expenses

NOTE: Travel related to non-mandatory professional development trainings and workshops must have prior approval from the State and Community Interventions Section Chief on the Professional Development Approval Form.

Contractor/Consultant Costs Organizations invoicing TPCP for contractor or consultant costs must include the following information:

Time accounting for contractor/consultant services

Evidence of deliverables being requested/paid

Copy of itemized invoice from contractor/consultant that describes the services provided and date of services

Media/Health Communication Costs Organizations invoicing TPCP for media/health communication costs (e.g., television, radio and print ads, digital media, and billboards) must include the following information:

Copy of an itemized invoice from the vendor that provided the service

Copy of radio or TV script, picture of billboard, tear sheets or promotion items showing messaging/logos

Copy of the TPCP Health Communication Approval Form

24


RFA-18-1

Section IV – Budget and Work Plan Adjustments

The budget, as approved during the award process, is the sub-grantee’s financial plan. The work plan, as approved during the award process, is the sub-grantee’s action plan to accomplish objectives. Any changes to either the budget or work plan must have prior approval from TPCP. There must be a compelling programmatic justification and rationale for changes, and the changes must be in keeping with the intended goals and objectives of the sub-grant agreement. Failure to obtain prior approval could result in disallowed costs. Budget and work plan adjustments should be submitted to TPCP on or before April 15.

Prior approval must be received from TPCP for the following:

Alternative use of salary support due to receipt of other funding. Caution: A full-time coordinator is required.

Transferring funds from one budget category to another Changes to the work plan Transferring substantial programmatic work to a third party Earning program income Changes in personnel or FTE status

NOTE: This is not an all-inclusive list but provides examples of situations that require prior approval from TPCP.

Line item budget categories and/or line items within budget categories must never be exceeded (no negative balances).

Budget Adjustments A budget adjustment occurs when the sub-grantee determines that a project can be improved if approved funds are moved from one budget category to another within the current budget period. Budget adjustments require prior approval.

To request a budget adjustment, organizations must submit a request to the State and Community Interventions Section Chief and the Administration and Management Section Chief.

The requested budget adjustment must be in a Budget Adjustment Request Template along with letter of justification describing the impact of the change on the delivery of the work plan activities signed by the program coordinator and the organization’s authorized signer or supervisor.

If the total redirect amount in the fiscal year is less than 10% of the approved budget line item and the fund is redirected within the same budget category, prior approval is not required. Only a justification notation in GEMS is required. Failure to notate changes may result in disallowed costs. NOTE: This 10% budget adjustment exception cannot be utilized more than two times per 12-month grant period. The 10% budget adjustment exception does not

25


RFA-18-1

apply to the Salary and Fringe budget categories. All changes to Salary and Fringe require a budget adjustment.

Work Plan Adjustments To request a change to the approved work plan, organizations must submit a request to the State and Community Interventions Section Chief and the Administration and Management Section Chief following the guidelines listed below:

Submit the request on the organization’s letterhead signed by both the coordinator

and the organization’s authorized representative.

Reference the objective/activity in the work plan that is affected, if applicable.

Provide a detailed explanation of the change, including a brief synopsis of the

impact of the change on the program.

Requests to make changes to the work plan or budget can be scanned and emailed to the State and Community Interventions Section Chief and the Administration and Management Section Chief. If the sub-grantee cannot fulfill the objectives of the approved work plan within the expected timeframe, TPCP reserves the right to cancel the contract. See Cancellation (Section V). NOTE: Sub-grantees may not implement any changes until official written notification of approval is received from TPCP. Any changes enacted prior to notification of approval may be disallowed or may become a monitoring finding, and are done so at the sub-grantee’s own risk. Receipt and review of a change request does not imply or indicate pending approval. Approval of a sub-grant agreement modification is dependent upon a justifiable programmatic and/or fiscal need that will be of direct benefit to the project and is permissible under the established sub-grant parameters. Be sure to review the approved modification. In some cases, partial approval may be granted or TPCP may have changed some budget information during the review/approval process. Requests for changes will only be considered if both financial and program-reporting requirements are current and terms and conditions of the agreement have been met at the time the request is made.

Section V – Cancellation

TPCP and the sub-grantee agree that either party may cancel this agreement unilaterally at any time by giving the other party thirty (30) calendar days’ written notice and delivering notice of cancellation either in person or by certified mail, return receipt requested, or restricted delivery. Cancellation notices to the Arkansas Department of Health must be sent to the ADH Director or the authorized representative designated herein.

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RFA-18-1

Section VI – Monitoring

Monitoring involves the review of accounting information through the use of a paper trail to prove transactions are accurate and correct and can be allocated back to the TPCP sub-grant. A paper trail provides a complete history of any given financial transaction by identifying each step in the process from the initiation of the transaction all the way through to the completion of the transaction.

TPCP conducts an annual monitoring review on each organization that is funded and may conduct an on-site visit as part of the monitoring and reporting process.

In preparation for a monitoring review, the TPCP monitor will review the sub-grantee’s budget, reimbursement files, workplan, and program evaluations to gather background information on the program and how the funding is being used. The monitor will also request a copy of the organization’s general ledger (in Excel) of all expenses charged to the TPCP sub-grant for the specific period that is being reviewed – usually the last completed grant cycle but may include a review of current year transactions. Other documents that may be requested include payroll verification, leave ledgers, employee leave requests and timesheets, bank statements, quarterly tax reports, etc.

Examples of tests that will be performed include:

Review of TPCP funder ratings and GA’s comments Review of sub-grantee Monthly Reports to verify that expenses billed meet sub-grant

agreement deliverables Review of source documents to ensure that sub-grantee documentation demonstrates

community will and implementation of measures to address barriers and challenges A comparison of expenses reported to TPCP (monthly payment requests) and those

recorded in the general ledger A comparison of total expenses to total funds requested Tracing selected expenses through the organization’s accounting system Reviewing selected expenses and applying the allowability test to determine if costs are

allowable A comparison of wages requested and wages paid A comparison of timesheet hours records and payroll records A comparison of leave earned and leave taken Tracing payroll through the bank account Ensuring that the required taxes are paid and filed on time

Examples of some common findings include: Insufficient sub-grantee source document reporting

Invoicing TPCP without implementing work plan interventions and/or meeting work plan

and sub-grant agreement deliverables

Charging budgeted amount rather than actual amount

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RFA-18-1

Insufficient time and leave records No documentation to support a transaction Using cash to pay a vendor Charging prior year costs to current year award Not providing a full-time coordinator as required by the RFA Documentation does not support expenses Purchasing unallowable items Required logos are not being used Dual billing – billing two different grants for the same costs Excessive mileage claims – not using Rand McNally mileage Tax documents not filed Amount requested does not equal amount expended Charging for salary with no payroll ledger to support the costs Improper or lack of documentation for leave time Not maintaining accounting records or supporting documentation

An inability to implement the grant effectively in both programmatic and financial matters may result in cancellation of the agreement.

Section VII – Fraud Awareness and Legal Compliance As stated in Item VI (A) in the Sub-Grant Agreement (FIN-9600), “Performance of this sub-grant by the Recipient and the Department must comply with state and federal laws and regulations.” Any evidence of fraud or other criminal conduct will be referred to the appropriate investigative

organization as warranted for any necessary action.

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RFA-18-1

Items/Transactions Requiring Prior Approval from TPCP

Prior approval means that you must obtain approval from TPCP before you purchase an item or engage in any obligation to expend TPCP funds. NOTE: Obligating TPCP funds before obtaining necessary documented approval from TPCP constitutes an after-the-fact situation, which may result in disallowed costs.

If item costs are not in the approved budget, you must request a budget adjustment before you obligate funds.

Type Item Requirements Responsible for Approval Method of Approval

I. Event Items

Educational Items (EI)

Ex: Silicone Wristbands, Youth Team

Uniforms (other items on approved

list)

EI in the approved budget

require no further approval

other than logos and

educational message. If not

specified in the approved

budget preapproval is required.

GA approves request for logo and

message, if the EI is in the

approved budget and sends to

TPCP Health Communications

Form-Health Communication

Approval

Educational Supplies (ES)

Ex: DVDs, Canopy/Table Cloth, Booth

Displays-Lungs, Tar Jar, etc.

ES in the approved budget

require no further approval

other than logos. If not in the

approved preapproval is

required. Items that need logos

added such as tablecloths will

need GA approval.

GA approves request for logo

placement if ES is in the approved

budget. If not in the approved

budget, must be approved by

both GA and TPCP Health

Communication Section Chief


Approval

Media – Print ads, Billboards,

Radio, Newsletters, E-blast, Social

Media ads, TV/Cable, Letter to Editor,

Press Release, etc.

All media must be pre-

approved.

First review by GA. Final review

and approval by TPCP Health

Communication Section.


Approval

Infographics Preapproved infographics do

not need further approval

unless content has been

changed.

GA can approve if there are no

changes to the infographic. If

changes are made, both GA and

TPCP Health Communication

Section Chief must approve.


Approval

Sponsorships Must provide appropriate

visibility and value-added

opportunities for TPCP such as

logo placement, banners, public

service announcements,

advertisements or speaker

opportunities. If sponsorship

was included in the budget, logo

approval is required.

If the sponsorship is preapproved,

the GA approves initials and sends

to TPCP Health Communication

Section for approval of logos and

message.


Approval

29

Appendix I


RFA-18-1


II. Services

Contractors/Consultants Written approval from TPCP.

For details on items that must

be provided to TPCP, see

Section II – Grant Management

Guidelines.

Submit request to Administration

and Management Section Chief

and State and Community

Interventions Section Chief for

approval.

Letter/email: submit request

with appropriate information

Speakers Speakers included and identified

in the approved budget require

no further approval. Speakers

must be high impact, centered

on achieving a school policy or a

youth event with multiple

interventions.

Speakers not included or

identified in the approved budget

require prior approval from the

GA and TPCP Health

Communication Section Chief.


Approval

III. Travel

Travel Reimbursement for

Non-TPCP Paid Coordinator

Identify the role of the person

and provide justification for

travel reimbursement (e.g.

coalition member).


and Management Section Chief &

State and Community Intervent-

ions Section Chief for approval.

Letter/email

Non-TPCP Sponsored

Conference/Trainings (1 per

award cycle)

If the conference was identified

and included in the approved

budget, no further approval

required. If not in the approved

budget, a budget adjustment

may be necessary. If budget

adjustment is necessary,

provide justification describing

how the training supports the

work plan and meets criteria

previously outlined.

Submit request to GA, the State

and Community Interventions

Section Chief and the

Administration and Management

Section Chief for approval (based

on the need for a budget

adjustment)

Letter/email: Submit request


IV. Equipment

CO Monitors, Laptops, PCs,

etc.

If items are in the approved

budget, no further approval is

required. If not, the model type

and cost must be approved by

TPCP. A budget adjustment may

also be necessary.

If not included in the approved

budget, prior approval is required

by GA and Administration and

Management Section Chief.

Letter/email: Submit request


Cell Phone Waiver -

Personal

Submit a request to reimburse

for personal cell phone cost

versus an organization-issued

cell. See Section II – Grant Man-

agement Guidelines/Other Costs.


and Management Section Chief

for approval.

Letter/email: requesting a

waiver

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RFA-18-1


V. Budget/Work Plan Adjustments – All changes to budgets and work plans require approval.

Change in Budget Line

Amount

Justification for changes and

how it affects work plan.

Submit request to GA,

Administration and Management

Section Chief and State and

Community Interventions Section

Chief for approval.

Letter/email

Change in Work Plan

Deliverables

Justification for changes and

how it affects work plan and

budget.

Submit request to GA, State and

Community Interventions Section

Chief and Administration and

Management Section Chief for

approval.

Letter/email

Change in Personnel Status Explanation on why change is

being made and how it will

affect deliverables including the

status of deliverables. Based on

the information provided, TPCP

will determine whether to

continue the contract.

Submit new coordinator’s résumé

to GA, Administration and

Management Section Chief and

State and Community

Interventions Section Chief for

approval.

Letter/email

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Approved Educational Items

Item Name Target Audience Logo Required Purpose

2 A's and R Mousepads Healthcare Providers and Those Individuals

Who Quit Tobacco Use SOS

Given to providers who adopt BTI policy. This will work as a reminder to providers while they are providing services to patients and entering data in their EMR.

Backpacks/Drawstring

backpacks/drawstring totes

Youth and Young Adults Project Prevent

Given to youth during Project Prevent activities and youth-related community events/activities. Item will have continued use through the award period while youth participate in multiple interventions.

Church Fans/Bible Bookmarks Faith-Based

Organizations SOS

Given to faith-based organizations to educate the congregation on tobacco-free campus policies and increase referral to the ATQ.

Pencils Youth Project Prevent

Given to youth at assemblies to provide students with reminders to participate in Project Prevent activities or used when students participate in surveys (APNA, YRBS).

Pens General Population SOS

Given out at health support group sessions, as well as adult/college age health classes and CNA classes; surveillance and evaluation activities; and community events. This is a low cost material which we can use to increase cessation among Arkansans.

Silicone Wristbands Youth Project Prevent

Given to youth as reminders to stay committed to living a tobacco and nicotine free lifestyle during nationally recognized tobacco events within the state. In addition, they provide educational messaging about tobacco prevention and cessation awareness.

Stress Balls in the shape of lungs Tobacco Users/Cigarette

Users to Include ESDs SOS

Given to individuals referred to ATQ through worksite wellness, when employers implement tobacco-free policies and offer cessation resources. Provide an avenue to keep hands busy when attempting to quit tobacco and have the ATQ number available.

T-shirt Uniforms Youth Project Prevent

Given to youth to be strictly used as uniforms and worn when participating in Project Prevent events and local community activities. Provide an avenue to promote PPYC and assist in recruiting youth coalition members. Item will have continued use through the award period while youth participate in multiple interventions.

Water Bottles General Population SOS

Given at health/nutrition-related events to enhance awareness of tobacco use and its impact on one’s ability to exercise. Used by all ages and with tobacco prevention and cessation educational messages.

32

Appendix II


RFA-18-1

Sign-In Sheet

EVENT: __________________

Date: ____________Time: ____________

Sponsored by: CHA/Tobacco Prevention and Cessation Program

Contact Person: ______________

33

Name Organization Phone Email Government

Official Y/N

State Employee

Y/N

Appendix III


RFA-18-1

Budget Adjustment Request Template

Date Name State and Community Interventions Section Chief Tobacco Prevention and Cessation Program Arkansas Department of Health 4815 W Markham St, Slot 3 Little Rock, AR 72205 Re: Budget Adjustment Request Agreement #: __________________ PO #: __________________ Dear ___________, This letter is to request redirection of funds for the agreement listed above. << Insert paragraph indicating the bona fide programmatic need and acknowledging that the redirection remains within the scope of the program awarded and will be used to support the ongoing activities of the agreement. >>

Item

Current

Budget

Amount

Adjustment

(-/+)

Revised

Budget

Amount

Budget Justification

TOTAL $0.00 *

* Total of adjusted amounts must be $0.00.

Submitted by

__________________________________ _______________________________________ Signature of Sub-Grant Coordinator / Date Signature of Supervisor/Authorized Signer / Date

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Sub-Grantee Organization’s Letterhead

Appendix IV

Revised version of page 34 August 2017


RFA-18-1

Sample Budget Adjustment Request Letter

March 11, 2018 Beccy Secrest State and Community Interventions Section Chief Tobacco Prevention and Cessation Program Arkansas Department of Health 4815 W Markham St, Slot 3 Little Rock, AR 72205 Re: Budget Adjustment Request Agreement #: 4600011111 PO #: 4501111111 Dear Ms. Secrest, This letter is to request redirection of funds for the agreement listed above. The ABC Association is asking to redirect funds in the amount of $300. If approved, funds will be redirected as follows:

1. Education Supplies

Reason for redirect: ABCA will conduct a presentation to 11th graders at XYZ High School during Red Ribbon week (Objective 1, Activity 1). ABCA would like to purchase Tobacco-Free Earth Bingo, which is an interactive game that makes it easy to educate all ages about the adverse effects of tobacco products. Tobacco-Free Earth Bingo helps participants absorb the information provided through an educational bingo game. Cost = $25/pack x 4 = $100

2. Registration Fee

Reason for redirect: The coordinator would like to attend the MidSouth Summer School conference in Little Rock. This conference will connect the coordinator with health care providers in the coverage area (Objective 2, Activity 3). Cost = $50/person

3. Print Ads

Reason for redirect: ABC School District will print 1,500 copies of yearbooks. This ad will have an exposure of up to 1,500 high school students (Objective 4, Activity 4). Cost = $150 for 1/4 page ad

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RFA-18-1

Instructions: Provide an itemized budget with justification that identifies the categories and amounts affected by this request. The total of “Adjustment (-/+)” must equal zero. The total Original Budget Amount must equal the total Revised Budget Amount.

Item

Original

Budget

Amount

Adjustment

(-/+)

Revised

Budget

Amount

Budget Justification

Educational

Supplies

$ 500.00 $ 100.00 $ 600.00 To purchase Tobacco-Free Earth

Bingo

Registration Fee

$ 150.00 $ 50.00 $ 200.00 To cover the shipping cost

Print Ads $1,000.00 $ 150.00 $1,150.00 To purchase school district yearbook

ads

Billboards $2,000.00 (-$300.00) $1,700.00 Received a $300.00 discount from the

vendor

Total

$3,650.00 $ 0.00 $3,650.00

Submitted by

Jane Smith 3/11/18 John Frank 3/11/18

____________________________________________ ___________________________________________________

Signature of Sub-Grant Coordinator / Date Signature of Supervisor/Authorized Signer / Date

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RFA-18-1

Acknowledgement Form Instructions: Please submit this completed form along with all documents that must go with this form to TPCP by email or postal mail by the end of the first month of each grant period.

Name of Sub-Grantee Organization: __________________________________________ Agreement #: _________________________ The undersigned hereby acknowledge:

I have read and understand the TPCP Financial and Accountability Guidelines for Fiscal Year 2018. I agree to abide by these guidelines. I have included all required documents with this form. I understand that if I have questions at any time, I may contact the assigned TPCP staff. By signing this document, the parties acknowledge they have reviewed the terms and conditions of the agreement and TPCP Financial and Accountability Guidelines. Sub-Grant Coordinator’s signature: ________________________________

Sub-Grant Coordinator’s printed name: _____________________________

Date: ________________________

Supervisor or Authorized Signer’s signature: ________________________________

Supervisor or Authorized Signer’s printed name: _____________________________

Date: ________________________

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Appendix V

STATE OF ARKANSAS ARKANSAS DEPARTMENT OF HEALTH … · Project Prevent Youth Coalition for ......

Documents

Transcript of STATE OF ARKANSAS ARKANSAS DEPARTMENT OF HEALTH … · Project Prevent Youth Coalition for ......