HomeMy WebLinkAbout880444.tiff mEmORAnDUm
Gene R. Brantner, Chairman
7o Board of County Commissioners Date
June 6, 1987
COLORADO F.om_Walter J. Speckman, Executive Director, Human Resources k2
Weld County Senior Companion Program Grant Application
Subject _ ---
Enclosed for Board approval is the Weld County Division of Human
Resources ' Area Agency on Aging Senior Companion Program Grant
Application.
The Area Agency on Aging is applying for $109,000 for ACTION funds to
pay program costs to support 35 volunteers for one year. The volunteers
will be paid a stipend for the time spent in caring for home bound and
frail elderly citizens.
This is a competitive grant and funding is not guaranteed.
If you have any questions, please telephone me at 353-0540.
• I .. 880444
•
PLI-2.CCANT'S a.NUMBER 3.APPPLLI a.NUMBER
FEDERAL ASSISTANCE
APPLI- CATION
'
1.TYPE - I I NOTICE OF INTENT CATION IDENTI.
OF I b.IDENTI- FIER
SUBMISSION (OPTIONAL) FIER b.DATE NOT RTO RF DATE
.Mart nn [I PREAPPLICATION Yen' Ninth day ABWGNEo ASSIGNED Year n•nik Aar
Angainm 19 BY STATE 19
box . . APPLICATION ,
to
Blank
4.LEGAL APPLICANT/RECIPIENT 5.EMPLOYER IDENTIFICATION NUMBER(EIN)
a.Applicant Name : Weld County Division of Human Resources 84-6000813
b.Organization Unit Area Agency on Aging 6.
PRO- a.NUMBER I I I I ' I
c. Street/P.O. Box P.O. Box 1805 GRAM
d.City Greeley e.County Weld
f. State g.ZIP Code. 'F'""'Cam' MULTIPLE O
< Colorado 80632
eh.Contact Person(Name - Ms. Linda P1 per b.TITLE
tt I Telephone No.
L103) 353-0540. extension 2350
0 7. TITLE OF APPLICANTS PROJECT(Use section IV of this form to provide a summary 8.TYPE Or APPLICANT/RECIPIENT
t description of the project.) A-SUM G-Sp.i.l Pumas District
U
C B-Instar.ate N-Ca.naunity Anon Agency
Senior Companion Program Castings '-tadM Educational
s... o. i..u.. J-IW.Tribe
D-C my K-Ora eISlrrt/yt
U E-City
F-Sc.d District
4
Enter appropriate letter
J. 9.AREA OF PROJECT IMPACT'Na....afros ant......xa,ec. 10.ESTIMATED NO.OF 11.TYPE OF ASSISTANCE
CL PERSONS BENEFITING A—astie Gs* D-lw..m. n■
P `A/ ' taw 6-Oar
Regional G—La. Eislerrrlla.;,.p;.IragAtl
12. PROPOSED FUNDING 13. CONGRESSIONAL DISTRICT OF: 14.TYPE OF APPLICATION
A—New C—IWi.W E—Aapne,Mti..
a.FEDERAL $ 109.oo&00 a.APPLICANT b.PROJECT B-Ri--a' Ease — n
b.APPLICANT 15,822-00 4 17. TYPE OF CHANGE,Mr He ae 140
e.STATE .00 15.PROJECT START 16.PROJECT A—Ines Draw F—Ot .r Iberia.
d.LOCAL .00 lars
DATE y , manta my DURATION c—IMw.Duration
ur
D—Docreme Duration
e-OTHER • .00 19 12 Months EE--G�r on
E Total DATE DUE TO
$ 124.822'00 l8.FEDERAI.AGENCY► l9 RR 06h 10 Err pp
19.FEDERAL AGENCY TO RECEIVE REQUEST 20.EXISTING FEDERAL
a.ORGANIZATIONAL UNIT(IF APPROPRIATE) b.ADMINISTRATIVE CONTACT(IF KNOWN) GRANT IDENT.NO.
c.ADDRESS 21.REMARKS ADDED
❑Yee {No
S 22. to Me belt army knowledge and SUS dots a.YES.THIS NOTICE OF INTENT/PREAPPLICATION/APPLICATION WAS MADE AVAILABLE
P P THE in ado APELICANT and anit.n.w a...ae„te TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON:
C CERTIFIES aaanri.d by the Owning bdydthe er DATE
ETHAT► Want.d the apgin.n will eaangly with
q
the nMand..wnta.du..�.Mrwe It Ix NO,PROGRAM IS NOT COVERED BY E.O. 12372X1aw.rd. OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW O
z 23. a.TYPED NAME AND TITLE 1119,ATURE
O CERTIFYING
1, REPRE- Gene R. Brantner, Chairman �I"� $' DENTIFICATION
SENTATIVE Weld County Roard� of Commissioners all 6/6/88
24.APPLICA. Y,a, nuns jay 25.FEDERAL APPLICATION IDENT.NO. 26RAI-G
REOCEIVED 19
27.ACTION TAKEN 28. FUNDING
Year month day 30. Year month dale
12 I .
, REJ CDATE.- STARTING.b. REJTR'fE 29.ACTION DATE 19 DATE 19
p0 ' C. RETURNED FOR a.FEDERAL $ .00 31.CONTACT FOR ADDITIONAL . Year m,,n.h char Tex 32AMENDMENT
I< a. RETURNED FOR b.APPLICANT .00 INFORMATION/Now and MepAwe na.kri ENDING
=V E.O. IYT/2 SUBMISSION DATE 19
ill BY APPIJCANT TO c.STATE .00 • 33.REMARKS ADDED
OM STATE
�0 •
L
' e. DEFERRED d.LOCAL .00 -
WITHDRAWN e.OTHER .00
x f. Total $ .00 O Yes n :No
PACE t
&no,drd be OMB Cmmin,A-to?
880444
•
PART II
PROJECT APPROVAL INFORMATION
Item I.
Does this assistance request require State,local, . Name of Governing Body _ _--
regional.or other priority rating?
Yes X No
Item 2.
Does this assistance request require State,or local ad- Name of Agency or
visory,educational or health clearances? Board
Yes X No (Attach Documentation)Item 3. eA/C�����/A -
/((��v
Does this assistance request require State,local, Name of Approving Agency__ — �y
regional or other planning approval? Date _ 6 -2- o2_.
X Yes No J� �/ ��� P-6-
Item 4.
•
Is the proposed project covered by an approved com-
Inca)
Check one:State
prehensive plan?
Regional 'I
Yes X No Location of Plan _--__—
Item 5.
Will the assistance requested serve a Federal installation? Name of Federal installation
Yes X No Federal Population benefiting from Project
Item 6.
Will the assistance requested be on Federal land or Name of Federal Installation
installation? Location of Federal land
Percent of Project
Yes X No
Item 7.
Will the assistance requested have an impact or effect See instructions for addtional information to be provided.
on the environment?
Yes X No
Item 8.
Will the assistance requested cause the displacement of Number of:
individuals,families,businesses or farms? Individuals
Families
Yes X No Businesses
Farms _
Item 9. -
Is there other related assistance on this project See instructions for additional information to be provided
previous,pending,or anticipated?
Yes X No
PAGE 5
880444
Virt®88
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