FY17 Emergency Management Performance Grant ProgramApplication Checklist
Subrecipient Name:Cal OES ID #
Checklist Items / Yes / No / N/A / Comments
- Grant Subaward Face Sheet
1. The Subrecipient is complete (Example: County of Sacramento or Sacramento County).
1a. The nine digit Federal DUNS number for the County is provided and is current, per
2. The Implementing Agency information is complete.
2a. The nine digit Federal DUNS number for the Implementing Agency is provided and is current, per
3. Implementing Agency Address is complete, including all nine digits of the Zip Code.
4. The location of the Project is provided.
5. The Program Title is provided.
6. The Performance Period is exactly the same as on the Supplemental Guide. Dates must include Month, Day, and Year (i.e. 07/01/17 – 06/30/18).
7. Indirect Cost Rate is identified.
If claiming Indirect Costs, identify the method from the two options below:
- 10% de Minimis
- Federally Approved ICR (Indirect Cost Rate)
-from the Negotiated Agreement
8. The correct Grant Year is selected and the Fund Source is EMPG.
8B. The OA’s FY17 EMPG allocated funds are identified under “B. Federal” and the funding amounts are exactly the same as identified in the FY17 EMPG Allocations document.
8D - 8E. The Match is identified and in the correct box(s) (cash or in-kind).
8G. Total Project Cost is the sum of 8B and 8F.
14. Is Section 14 signed, in ink, and datedby the person authorized by the Governing Board to sign and accept the subaward?
14. Name, Title, Telephone, FAX, Email, and Payment Mailing Address including City are provided.
14. In Section 14, the Zip Code +4 is provided.
15. Federal Employer ID number is provided with all nine digits.
- Authorized Body & Contact Information
For the CFDA #, EMPG 97.042 was the option selected from the dropdown menu.
Information is completed for each Authorized Agent under “Additional Authorized Agent” contact information.
“Contact’s Name” section is filled out for those individuals who are going to be everyday subaward contacts and are not Authorized Agents.
- FFATA Financial Disclosure
For the CFDA #, EMPG 97.042 was the option selected from the dropdown menu.
Does the FFATA Financial Disclosure apply to the OA?
If not, is the box checked stating, “Not Subject to FFATA Financial Disclosure?
- Project Description
For the CFDA #, EMPG 97.042 was the option selected from the dropdown menu.
Project Letter is selected (listed in alphabetic order).
Have they identified the supported National Preparedness Goal (NPG) Mission Area, Core Capabilities,andthe Cal OESStrategic Plan Goals?
Project Description is completed for each Project and gives sufficient details for readily identifying their intended activities.
Match Description is completed for each Project and gives sufficient details regarding the source of the match funds.
Need for the Project is filled out.
6-month and 12-month Project Milestones are supplied.
- Project Ledger
For the CFDA #, EMPG 97.042 was the option selected from the dropdown menu.
Initial Application is selected for Ledger Type.
Project Letter is selected (listed in alphabetic order).
Direct/Subaward is identified.
- Direct = County-level Project
- Subaward = City/Town/Special District Project
Project Name is identified. If it is a pass through project, is the name of the pass through subrecipient included in Project Name.
‘EMPG’ is selected for the Funding Source.
‘EMG’ is selected for the Discipline.
Solution Area is completed with proper category selected.
Solution Area Sub-Category is completed with proper sub-category selected.
Total Obligated amount is complete (Whole Dollar Amounts).
Match Amount is provided for each line item.
- Planning
For the CFDA #, EMPG 97.042 was the option selected from the dropdown menu.
Initial Application is selected for Ledger Type.
Project letter is correct (Based on Project Ledger).
Direct/Subaward is identified.
- Direct = County-level Project
- Subaward = City/Town/Special District Project
‘EMPG’ is selected for the Funding Source.
‘EMG’ is selected for the Discipline.
Solution Area Sub-Category is completed and matches the Project Ledger.
Expenditure Category is completed.
Final Product is clearly identified.
Hold Trigger is identified.
Does it include Critical Emergency Supplies (Basic Medical Supplies or Shelf Stable Food Product)?
Part of a Procurement over 150K.
Sole Source Involved.
Budgeted cost is completed.
- Organization
For the CFDA #, EMPG 97.042 was the option selected from the dropdown menu.
Initial Application is selected for Ledger Type.
Project letter is correct (Based on Project Ledger).
Direct/Subaward is identified.
- Direct = County-level Project
- Subaward = City/Town/Special District Project
‘EMPG’ is selected for the Funding Source.
‘EMG’ is selected for the Discipline.
Solution Area Sub-Category is completed and matches the Project Ledger.
Expenditure Category is completed.
Detail is selected.
Budgeted cost is completed.
- Equipment
For the CFDA #, EMPG 97.042 was the option selected from the dropdown menu.
Initial Application is selected for Ledger Type.
Project letter is correct (Based on Project Ledger).
AEL numbers are correct per allowable categories identified in the Department of Homeland Security FY 2016 EMPG Program Notice of Funding Opportunity.
AEL Title is complete and corresponds to the AEL number.
If applicable, has SAFECOM compliance occurred?
‘EMPG’ is selected for the Funding Source.
‘EMG’ is selected for the Discipline.
Solution Area Sub-Category is completed and matches the Project Ledger.
Part of a Procurement over 150K.
Sole Source Involved.
Hold Trigger is identified.
Does it require an EHP approval?
Does it include Controlled Equipment?
Does it include Emergency Food or Water?
Budgeted cost is completed.
- Training
For the CFDA #, EMPG 97.042 was the option selected from the dropdown menu.
Initial Application is selected for Ledger Type.
Project letter is correct (Based on Project Ledger).
Direct/Subaward is identified.
- Direct = County-level Project
- Subaward = City/Town/Special District Project
Course Name is included.
‘EMPG’ is selected for the Funding Source.
‘EMG’ is selected for the Discipline.
Solution Area Sub-Category is completed and matches the Project Ledger.
Expenditure Category is completed.
Does it require an EHP approval?
Hold Trigger is identified.
Part of a Procurement over 150K.
Sole Source Involved.
Budgeted cost is completed.
- Exercise
For the CFDA #, EMPG 97.042 was the option selected from the dropdown menu.
Initial Application is selected for Ledger Type.
Project letter is correct (Based on Project Ledger).
Direct/Subaward is identified.
- Direct = County-level Project
- Subaward = City/Town/Special District Project
Exercise Title is included.
‘EMPG’ is selected for the Funding Source.
‘EMG’ is selected for the Discipline.
Solution Area Sub-Category is completed and matches the Project Ledger.
Expenditure Category is completed.
Does it require an EHP approval?
Hold Trigger is identified.
Date of Exercise is provided.
Exercise Activity is completed.
Identified Host is completed.
Part of a Procurement over 150K.
Sole Source Involved.
Budgeted cost is completed.
- M&A
For the CFDA #, EMPG 97.042 was the option selected from the dropdown menu.
Initial Application is selected for Ledger Type.
Project letter is correct (Based on Project Ledger).
Activity is completed.
‘EMPG’ is selected for the Funding Source.
‘EMG’ is selected for the Discipline.
Solution Area Sub-Category is completed and matches the Project Ledger.
Expenditure Category is completed.
Detail is selected.
Budgeted cost is completed.
- Indirect Cost Ledger
For the CFDA #, EMPG 97.042 was the option selected from the dropdown menu.
Initial Application is selected for Ledger Type.
Project letter is correct (Based on Project Ledger).
‘EMPG’ is selected for the Funding Source.
Solution Area Sub-Category is completed and matches the Project Ledger.
ICR Base is selected.
Rate is entered.
Budgeted cost is completed.
- Consultant / Contractor
For the CFDA #, EMPG 97.042 was the option selected from the dropdown menu.
Initial Application is selected for Ledger Type.
Project letter is correct (Based on Project Ledger).
Consultant Firm/Consultant Name is completed (if known).
Project & Description of Services is completed.
Deliverable is completed.
Solution Area is completed and matches the Project Ledger.
Solution Area Sub-Category is completed and matches the Project Ledger.
Expenditure Category is completed.
- Personnel
For the CFDA #, EMPG 97.042 was the option selected from the dropdown menu.
Initial Application is selected for Ledger Type.
Project letter is correct (Based on Project Ledger).
Employee Name (First and Last) is completed for all project activities that involve staff salaries (regular hours, over time, backfill).
Project & Description of Services/Deliverable is completed.
‘EMPG’ is selected for the Funding Source.
‘EMG’ is selected for the Discipline.
Solution Area is completed and matches the Project Ledger.
Solution Area Sub-Category is completed and matches the Project Ledger.
- Match
For the CFDA #, EMPG 97.042 was the option selected from the dropdown menu.
Initial Application is selected for Ledger Type.
Project letter is correct (Based on Project Ledger).
Direct/Subaward is identified.
- Direct = County-level Project
- Subaward = City/Town/Special District Project
Project Name is completedand matches the Project Ledger.
‘EMPG’ is selected for the Funding Source.
‘EMG’ is selected for the Discipline.
Solution Area is completed and, the proper Solution Area dropdownhas been selected,thataligns and coincides to the specific activities and costs used to meet the required Match.
Solution Area Sub-Category is completed and, the proper Solution Area Sub-Category dropdown has been selected,thataligns and coincides to the specific activities and costs used to meet the required Match.
Type of Match is completed.
Total Obligated Match is completed.
- Authorized Agent
For the CFDA #, EMPG 97.042 was the option selected from the dropdown menu.
Initial Application is selected for type of request.
Signed and dated by Authorized Agent (in Ink).
Authorized Agent’s title is the same as on the Governing Body Resolution.
- Indirect Costs – Summary Recap of Costs Claimed (to be completed if claiming Indirect Costs)
For the CFDA #, EMPG 97.042 was the option selected from the dropdown menu.
Period (Month/Yr through Month/Yr) is completed.
Indirect Cost Rate for Period is entered.
Indirect Cost Rate (ICR) Base is entered.
All applicable entry fields are completed.
- Forms
Governing Body Resolution
Is the Governing Body Resolution included?
Was the Resolution approved/signed by the Board?
(Note: Self Certification is not allowable.)
Were Authorized Agents listed by name or title/position? / Name / Title
Is the Governing Body Resolution a Universal Resolution?
If it is a Universal Resolution, is the resolution approval date less than three (3) years old, and are the majority
(3 out of 5) of the Board of Supervisors who originally approved the Resolution still currently on the Board?
Meeting Minutes Associated with the Governing Body Resolution
Did the applicant supply, as required, the Meeting Minutes from the specific council meeting in which the GBR was voted on and approved by the relevant council?
Addendum to the Governing Body Resolution
Did the applicant supply a letter, on County letterhead, to identify the pertinent information of each person occupying the title/position authorized in the Resolution?
Subrecipient Grants Management Assessment
Is the Subrecipient Grants Management Assessment form included?
The nine digit Federal DUNS number for the County is provided and is current, per
The Performance Period is exactly the same as on the Supplemental Guide. Dates must include Month, Day, and Year (i.e. 07/01/17 – 06/30/18).
The OA’s FY17 EMPG allocated funds are identified under “Subaward Amount Requested” and the funding amounts are exactly the same as identified in the FY17 EMPG Allocations document.
Was Local Gov. selected for Type of Non-Federal Entity?
Are all 13 Assessment Factor questions answered?
Is it signed and dated with an authorized agent signature?
Is the title and/or name (whichever is applicable) of the authorized agent the same as in the Governing Body Resolution?
Grant Assurances
Is the Grant Assurances form included?
Is it signed and dated with an authorized agent signature?
Is the title and/or name (whichever is applicable) of the authorized agent the same as in the Governing Body Resolution?
Excess Funds Statement Form (Optional)
Is the Form included?
Is the applicant information filled out completely?
Has an exact whole dollar amount been identified on the form?
Is it signed and dated by an authorized agent?
Additional Project Using Excess Funds Form (Optional)
Is the Form included?
Was a Project Name provided?
Have all information fields been filled out completely?
Additional Project using Excess Funds Detailed Budget (Optional)
Is the Form included?
Have all applicable fields been filled out completely?
I hereby certify this Application Checklist is accurate and complete to the best of my knowledge.
Applicant’s Authorized Agent
Printed: / Signature: / Date:
Cal OES Emergency Management Grant Program Specialist:
Printed: / Signature: / Date:
Cal OES Emergency Management GrantUnit Chief:
Printed: / Signature: / Date: