This application is for Technical Assistance to help jurisdictions move from interest in Pay for Success to implementation. Three to four jurisdictions will be selected to receive technical assistance over 9-12 months from the Institute for Child Success. This technical assistance is made possible through grants from the Social Innovation Fund, a program of the Corporation for National and Community Service, and through matching grants from the United Way of Greenville County and other ICS supporters.
For more information on the competition, please review the Request for Applications, available here. If you have any questions or experience technical difficulties with this form, please
Important: This file is available as you prepare your application. All applications must be submitted via online form, on the PFS site. There is no “Save and Continue” feature on the application. We recommend you begin filling out the form only when you have enough time to complete it.
Top of Form
Pay for Success Technical Assistance Application
Entity submitting the application (must be government entity)*
Entity organizing the team (if different):
Primary Team Contact
Geographic area represented by the team (e.g. state, county, city)*
Name*
FirstLast
Title*
Organization*
Email*
Phone*
Address*
Street AddressAddress Line 2CityStateZIP Code
Participant team - Please list all of your team members (name and positions ):*
Please provide any additional context regarding how your team is composed. I.e. How does your team include stakeholders (government representatives from programmatic, policy, and budget departments, service providers, philanthropy, civic orgs, etc)?
Programmatic Questions
PLEASE ANSWER THE FOLLOWING PROGRAMMATIC QUESTIONS BRIEFLY, IN APPROXIMATELY 300 WORDS.
Be sure to address all areas of interest listed in the “Selection Criteria for Technical Assistance” section of the RFA.
What is the goal of your PFS effort? Why are you pursuing this model?*
Does the team include key stakeholders needed for a PFS transaction (e.g. government representatives from programmatic, policy, and budget departments, service providers, philanthropy, civic organizations, etc.)?*
What steps has your team taken to explore PFS?*
Describe the level of support for PFS among senior government officials and other key stakeholders in your jurisdiction. (Have any agencies committed to paying for outcomes should PFS be feasible? If not, what steps have been taken to identify outcome payor agencies and how they have been involved in the process of applying for PFS technical assistance?)*
How would your jurisdiction contribute to the ICS and Social Innovation Fund priorities of serving a diverse group of jurisdictions (including the South and tribal and rural areas with particularly poor child outcomes) and early childhood program types?*
Does the jurisdiction demonstrate the willingness to commit staff to conduct the PFS analysis, secure data and move the project forward (coaching model only) or, if selecting the consulting model, a plan to obtain and commit the matching funds?*
Will sufficient outcome data be available to pursue PFS?*
Staffing and Match
TA for each jurisdiction will use either a coaching model or a consulting model. Please indicate which you prefer:*
Coaching Model
Consulting Model
Please identify any individuals from each category who will be supporting the project (name, title, agency, and funding source that pays for their time). If you have not identified the individual, please describe your plan for identifying the individual and funding their time.
All positions must be addressed for coaching applicants. Consulting applicants must only include a project champion; budget official; and attorney.
Be sure to address the qualifications required in Question 5 of the Selection Criteria in the full RFA.
Project Champion – a senior executive branch official who will prioritize and oversee the project (5% time). Required for both coaching and consulting models*
Project Manager with an early childhood background and/or experience in data and program analysis to gather and analyze data for a literature review, arrange and sometimes lead meetings, and perform much of the feasibility study work. This individual should be a full-time employee who is available in a similar capacity to carry on the necessary work after the feasibility study is completed. (60-75% time). Required for coaching model.
Data Manager/Analyst or several staff members with access to relevant data (e.g. child welfare, Medicaid, education) who can conduct analyses as needed; review existing research literature from multiple sources; and calculate baselines within the jurisdiction. (25% time). Required for coaching model.
Attorney who will address any legal concerns (e.g. data sharing agreements) to ensure the Sub-Recipient can complete the work legally and efficiently (as needed). Required for both coaching and consulting models.*
Budget Official who can review and advise on cost savings analyses (as needed). Required for both coaching and consulting models.*
Required Match
This guidance refers to the question below:
All applicants must meet a required non-federally funded match.
Forcoachingapplicants, you must commit at least $50,000 in non-federally funded staff time to the PFS effort, subject to ICS monitoring. See the full RFA for specifics on the in-kind match required. If the coaching model is your preference, please estimate the dollar value of the time of the staff listed above. In determining the value, you should consider salary, benefits, and the amount of time each person is expected to spend on the project and report it below.
Forconsultingapplicants, there is no required staff time commitment, but the applicant must commit at least $50,000 in non-federal cash match. See the full RFA for details on the in-kind match amount. If applying for the consulting model of TA, please list the dollar value and source of the non-federal cash match that you will provide below. If you have not identified the source of your cash match, what is your plan to secure the match? List at least two possible match funding sources.
Details of Non-Federal Match*
Letter of Support*
Letters of Support - Required: Jurisdictions must submit a letter of support from a senior government official (e.g. Governor, Cabinet Secretary, Mayor, or Department Head).
Additional Letters of Support: Additional Letters of support from legislative leaders are desirable but not necessary.
PLEASE ENSURE THAT THE APPLICATION IS COMPLETE BEFORE CLICKING SUBMIT, BELOW.
POST-SUBMISSION EDITS MAY NOT BE CONSIDERED.
TO BE GUARANTTEED FULL CONSIDERATION, APPLICATIONS MUST BE SUBMITTED BY8PM ET ON THURSDAY, MARCH 16TH, 2017.
1