In-Home Respite Program (87D)

Application Period: 03/23/2026 - 04/23/2026 : 5:00 pm

Technical Assistance: Offered : Yes; Mandatory : No; Date : 04/01/2026 : 10:30 am; Registration link : https://illinois.webex.com/weblink/register/r0f450a30c715a0f5c0fc9afcaef9c36a

Apply here: https://www.dhs.state.il.us/page.aspx?item=178342

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Application Documents

FileView.aspx

State of Illinois Uniform Notice of Funding Opportunity (NOFO)
Summary Information
Awarding Agency Name Human Services
Agency Contact Shannon Dyson (DHS.DDDGrantProg@Illinois.gov)
Announcement Type Initial
Type of Assistance Instrument Grant
Funding Opportunity Number 27-444-24-0833-01
Funding Opportunity Title In-Home Respite Program (87D)
CSFA Number 444-24-0833
CSFA Popular Name In-Home Respite Program (87D)
Anticipated Number of Awards 0
Estimated Total Program Funding $3,969,600
Award Range Not Applicable
Source of Funding State
Cost Sharing or Matching No
Requirements
Indirect Costs Allowed Yes
Restrictions on Indirect Costs Yes : Yes, requires approval
Posted Date 03/23/2026
Application Date Range 03/23/2026 - 04/23/2026 : 5:00 pm
Grant Application Link Please select the entire address below and paste it into the browser...
https://www.dhs.state.il.us/page.aspx?item=178342
Technical Assistance Session Offered : Yes
Mandatory : No
Date : 04/01/2026 : 10:30 am
Registration link :
https://illinois.webex.com/weblink/register/r0f450a30c715a0f5c0fc9afc
aef9c36a

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27-444-24-0833-01, In-Home Respite
1. Basic Information - (CSFA Data Section)
Awarding Agency Name (1-A) Illinois Department of Human Services
Agency Division Name Division of Developmental Disabilities
Agency Contact Contact Name: Shannon Dyson
Email: DHS.DDDGrantProg@illinois.gov
Announcement Type (1-C) Competitive – Renewal
Funding Opportunity Title (1-B) 0833 In-Home Respite
Funding Opportunity Number (1-D) 27-444-24-0833-01
Application Posting Date March 23, 2026
Application Closing Date April 23, 2026, at 5:00 p.m. CST
Catalog of State Financial Assistance 444-24-0833
(CSFA) Number
Catalog of State Financial Assistance In-Home Respite
(CSFA) Name
Assistance Listing Number(s) (1-E) Not applicable
Awarding Source State
Estimated Total Program Funding $3,969,600
Anticipated Number of Awards TBD
Award Range Negotiable
Cost Sharing or Matching Requirement? No
Indirect Costs Allowed? Yes
Restrictions on Indirect Costs? Yes, requires approval
Technical Assistance Session Session Offered: Yes
Session Mandatory: No
Date: April 1, 2026, at 10:30 a.m. to 11:15
a.m. CST
Registration Link:
https://illinois.webex.com/weblink/register/r0f450a30c715a0f5c0fc9afcaef9c36a
1. Basic Information Continued - Section F through I
F. Funding Details

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1. Total Amount of Funding
a. The Department expects to award approximately $3,969,600.
b. The source of the funding for this program is State funds.
2. Number of Grant Awards
a. The Department anticipate funding approximately “To be determined”
grants awards to provide this program.
3. Expected Dollar Amount of Individual Grant Awards
a. The Department anticipates the dollar amount of individual awards will be
negotiable.
4. Amount of Funding per Grant Award on average in previous years.
a. $263,759.32
5. Renewal or Supplementation of Existing Projects Eligibility.
a. Applications for renewal or supplementation of existing projects are
eligible to compete with applications for new State awards.
b. Successful applicants under this NOFO may be eligible to receive two
subsequent one-year grant renewals for this program. Renewals are at the
discretion of the Department and are based on sufficient appropriation
and performance criteria including, but not limited to:
i. Grantee has performed satisfactorily during the previous reporting
period.
ii. All required reports have been submitted on time, unless a written
exception has been provided by the Division/Department.
iii. No outstanding issues are present (e.g., in good standing with all pre-
qualification requirements and no outstanding corrective action, etc.).
6. Sub-Recipient Agreements
a. Sub-Recipients Agreement(s) and budgets must be pre-approved by the
Department and on file with the Department. Sub-Recipients are subject
to all provisions of this Agreement. The successful applicant Agency shall

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retain sole responsibility for the performance and monitoring of the
subcontractor.
7. Funding restrictions
a. Pre-Award Costs
i. Pre-Award Costs are allowed subject to the discretion, review, and prior
approval of the IDHS Budget Committee. Pre-Award Costs must be
identified as such in the IDHS Uniform Grant Budget Narrative. Pre-
Award costs are allowable for this award. Applicant must complete the
Pre-Award Cost Authorization Letter form –
(https://www.dhs.state.il.us/onenetlibrary/12/documents/Forms/445141
-202406.pdf). Additional payment documentation will be required.
ii. IDHS grants are governed by 2 CFR. Part 200, Subpart E-Cost Principles.
Principles and 30 ILCS 708 which include information on allowable
costs, audit requirements, and financial records.
iii. Principles and 30 ILCS 708 which include information on allowable
costs, audit requirements, and financial records.
b. Indirect Costs
i. Indirect Costs may be applied to this grant award. Indirect Cost rates
must be approved through the Illinois Indirect Cost Rate Election
System (ICRES) -https://www.dhs.state.il.us/page.aspx?item=151738.
8. The release of this NOFO does not obligate the Illinois Department of Human
Services to make an award.
9. IDHS recognizes the language around race and ethnicity is complex, and
continues to evolve as individuals, organizations, and institutions seek to be
respectful and inclusive of all segments of a community. As such, IDHS will
continue to be as responsive as possible to these changes and refinements as
the understanding of these complex constructs related to race and ethnicity
evolves.
G. Key Dates
1. Application Posting Date is March 23, 2026.

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2. The Department must receive the Preliminary Submission materials (Letter of
Intent, etc.): Not applicable.
3. The Department must receive the Full Application by April 23, 2026, at
5:00 p.m. CST.
4. Anticipated Award Date: June 12, 2026.
5. Anticipated Start Dates and Periods of Performance for new grant awards.
a. Subject to appropriation, the grant period will begin no sooner than July 1,
2026, and will continue through June 30, 2029.
H. Executive Summary
1. Program Description
The Division of Developmental Disabilities (DDD) In-Home Respite is a Fee for
Service program providing short-term supports to children and/or adults with
intellectual/developmental disabilities (I/DD) that are not receiving any Home
and Community Based Waiver funded services in either the two children’s
waivers or the adult waiver, operated by the Illinois Department of Human
Services (IDHS) and the Division of Developmental Disabilities. Respite
services are intended to help individuals with intellectual/developmental
disabilities remain in a community-based setting, such as, the individual or
family home, thereby reducing the need for long-term services and supports.
Respite may be utilized for planned or unplanned (emergency and/or agency
deemed crisis) situations.
2. Key Goals (objectives)
a. Ensure the individual receiving in-home respite services has been
diagnosed with an I/DD.
b. Ensure that in-home respite services are provided by an IDHS-contracted
agency's staff.
c. Ensure that In-Home respite services are provided in the individual/family
home or in the community.
d. Ensure that I/DD individual is provided respite supervision, personal care,
and staff supports in the home or on outings and community activities,
consistent with the individual's needs and the direction of the primary
caregiver.

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e. Provide supervision, personal care, and staff supports to assist the I/DD
individual in the home or on outings and community activities, consistent
with the individual's needs and the direction of the primary caregiver.
f. Provide increase the number of families who can access developmental
disabilities supports.
g. Provide relief to and/or reduce the stress of the caregiver of an individual
with an intellectual/developmental disability.
h. Help maintain an individual with an intellectual/developmental disability in
their home and reduce the need for long-term services and supports.
3. Eligible Recipients for DDD are required to have an I/DD and meet the
requirements of the scope of the grant program.
I. Agency Contact Information
1. If you have questions about this NOFO, please contact.
• Email: DHS.DDDGrantProg@illinois.gov
• DHS Contact: Shannon Dyson
• Subject line: “NOFO Questions – In-Home Respite, Name of Agency
Submitting Question”
2. A frequently asked Question and Answer page is posted on the DHS website.
Questions submitted up to 7 business days prior to the end of the NOFO
posting period, will be posted on the website.
2. Eligibility
i. Eligible Applicants.
A. The specific types of applicants that may apply for the grant award are as follows:
1. Has demonstrated experience providing services and supports to individual
with intellectual/developmental disabilities and their families.
2. Has demonstrated the ability to meet all the program goals described in this
NOFO.
3. Has met the criteria laid out in the Application Review Information, Section
6(ii).

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B. The applicant must meet the Registration, Pre-qualification and any other
Mandatory Requirements listed in this funding opportunity -
https://www.dhs.state.il.us/page.aspx?item=85526.
1. Applicants must provide the following information via the Grantee Portal
annually to be registered with the State of Illinois as an awardee:
a. Organization name and contact information.
b. Federal Employee Identification Number (FEIN).
c. Unique Entity Identifier (UEI).
d. Organization type.
2. Applicants must be prequalified; therefore, applications from entities that
have not prequalified prior to the due date of this application will NOT be
reviewed and will NOT be considered for funding. Items (a) through (e) below
are the prequalification requirements.
a. Unique Entity Identifiers and SAM Registration: Each applicant (unless the
applicant is an individual or State awarding agency that is exempt from
those requirements under 2 CFR § 25.110(b) or (c), or has an exception
approved by the Federal or State awarding agency under 2 CFR §
25.110(d)) is required to:
i. Be registered in SAM.gov before the application due date -
https://sam.gov/content/home.
ii. Provide a valid Unique Entity Identifiers (UEI) in its application.
iii. Continue to always maintain an active SAM registration with current
information during which it has an active award or an application or
plan under consideration by the awarding agency.
iv. The State Agency may not make an award until applicant has fully
complied to with all UEI and SAM requirements.
v. The State Agency may determine that an applicant is not qualified if
they have not complied with requirements and use that determination
as a basis to award another applicant or applicants.
b. Must be in "good standing" with the Illinois Secretary of State if the Illinois
Secretary of State requires the entity's organization type to be registered.

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c. Must not be on the Illinois Stop Payment List.
d. Must not be on the Sam.gov Exclusion List.
e. Must not be on the Medicaid Sanctions List -
https://hfs.illinois.gov/oig/sanctionslist.html.
C. Eligibility factors for the principal investigator or project director if any – Not
Applicable.
D. Successful Applicants will not receive an award if pre-award requirements
(https://www.dhs.state.il.us/page.aspx?item=149875) are not met. Qualified status
is verified at time of application. Applicants who are not eligible due to
registration or pre-qualification issues, or late applications will be notified that
they are ineligible for consideration when the requirements of the grant
application or pre-qualification, have not been met. This will be done through
email contact, to the corresponding contact information, on the application
submission. Resubmission of the complete and updated application will be
allowed for consideration if received prior to the application closing date. Refer
to NOFO Basic Information table.
E. See Section Number Section 1(F)7 in NOFO Basic Information for funding
restriction, if applicable.
F. Other, Requirements
1. All applicants will use grant funds according to the guidelines, conditions, and
parameters set forth in this funding notice and in compliance with federal
statutes, regulations and the terms and conditions of any applicable federal
awards.
2. Please refer to 2 CFR 200 - Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards, Part 200 Subpart E -
Cost Principles to determine the appropriateness of costs-
https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-
C/section-200.206.
3. Allowable costs are those that are necessary and reasonable based on the
activities contained in the Scope of Work, are justified in the Budget Narrative,
and are allowable under Subpart E of 2 CFR 200. It is expected that
administrative costs, both direct and indirect, will represent a small portion of
the overall program budget. Any budget deemed to include inappropriate or
excessive administrative costs will not be approved. Program budgets and

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narratives must detail how all proposed expenditures are necessary for
program implementation.
4. Unallowable costs: Please refer to 2 CFR 200 - Uniform Administrative
Requirements, Cost Principles, and Audit Requirements for Federal Awards,
Part 200 Subpart E - Cost Principles to determine the appropriateness of
costs. In addition, and specific to this grant, the following costs will be
unallowable without specific prior written approval from IDHS:
a. Entertainment costs, except where specific costs that might otherwise be
considered entertainment have a programmatic purpose and are
authorized in the approved budget (2 CFR 200.438).
b. Capital expenditures for general purpose equipment, including any vehicle
regardless of cost, buildings, and land (2 CFR 200.439).
c. Capital expenditures for improvements to land, buildings, or equipment
which materially increase their value or useful life (2 CFR 200.439).
d. Food, and other goods or services for personal use of the grantee's
employees, contractors, or consultants of the grantee unless authorized as
per diem under the State of Illinois Governor's Travel Control Board (2 CFR
200.445).
e. Deposits for items, services, or space.
f. That the grantee agency, prior to making a subaward with a total amount
of funds greater than the simplified acquisition threshold, is required to
review and consider any information about the applicant that is in the
designated integrity and performance system accessible through SAM
(currently FAPIIS) (see 41 U.S.C. 2313).
G. Limit on number of applications.
1. Limit of one accepted application per agency.
ii. Cost Sharing.
A. Providers are not required to participate in cost sharing or provide match.
3. Program Description
i. Required Information.

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A. The general purpose of the funding is to provide residential respite services to
individuals with intellectual/ developmental disabilities and it is expected to
achieve a reduction in caregiver stress and reduce the need for long term
supports and services for the public good.
1. In-Home Respite is a Fee for Service program that provides short-term
supports to children and/or adults with intellectual/developmental disabilities
(I/DD) that are not receiving any Home and Community Based Waiver funded
services in either the two children’s waivers or the adult waiver, operated by
the Illinois Department of Human Services (IDHS) and the Division of
Developmental Disabilities.
Respite services are intended to help maintain I/DD individuals remain in a
community-based setting, such as, the individual/family home, thereby
reducing the need for long-term services and supports. Respite may be
utilized for planned or unplanned (emergency and/or agency deemed crisis)
situations.
In-Home respite is individual support in the individual/family home and/or in
the community. Grantees must be contracted with IDHS and in compliance
with applicable rules and regulations that govern the individual in their home
or in the community. The respite services must be provided by the contracted
agency's staff. Services include supervision, personal care, and staff supports
necessary to assist the individual with an intellectual/developmental disability
in the home or on outings and community activities, consistent with the
individual's needs and the direction of the primary caregiver.
Individuals who receive respite must be diagnosed with an intellectual/
developmental disability. The individual cannot be enrolled in waiver services
through the Division of Developmental Disabilities or any other state funded
agency, which the individual is eligible to receive respite services. Examples of
waiver-funded services include, but are not limited to, Home-Based Support
Services, Community Integrated Living Arrangements, Community Day
Services, and Supported Employment.
The In-Home Respite rate is $27.45, beginning FY27. Refer to the DDD rate
sheet for 87D. Individuals served are allowed 360 hours annually. IDHS: DD
Rate Tables - https://www.dhs.state.il.us/page.aspx?item=125310.
The intent of the In-Home respite is to:

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• Provide relief to the caregiver of an individual with an intellectual/
developmental disability.
• Reduce stress of the caregiver, thereby reducing the potential for crises.
• Help maintain an individual with an intellectual/ developmental disability
in their home and reduce the need for long term supports and services.
• Increase the number of families who can access developmental disabilities
supports.
• Provide planned (scheduled) or unplanned (emergency or crisis) services
to an individual with an intellectual/developmental disability to
immediately stabilize and support the family.
Situations that may qualify as planned In-Home Respite include, but are not
limited to the following circumstance:
• Doctor appointments
• Recreational events
• Caregiver vacation
• Sibling needs
Situations that may qualify as Emergency In-Home Respite include, but are
not limited to the following circumstances:
• Caregiver illness (physical, mental, and/or emotional)
• Caregiver hospitalization or doctor appointments
• Illness of a loved one
• Funeral or wake
• Drug or alcohol abuse counseling or support
• Care recipient transitions (i.e. living arrangements)
• Loss of employment or work-related situations
• Declining Mental Health
Situations that may qualify as Crisis In-Home Respite include, but are not
limited to the following circumstances:
a. Homeless
Includes individuals who do not have a permanent residence or are staying
at a shelter; individual/caregiver has received an official eviction notice.
Situation where the authorities, such as the Office of the Inspector General
(OIG), Adult Protective Services (APS), the Department of Children and
Family Services (DCFS), or Illinois Department of Public Health (IDPH) is
currently involved due to abandonment and/or lock out. The individual
lost his/her home due to the primary caregiver's death or admission into

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long term care facility (i.e. hospice, nursing facility, assisted living, senior
living, etc.). The Independent Service Coordination (ISC) agency will also
consider who is supporting or caring for the individual now and what
caused the homeless situation described above
b. Abuse
Includes harm done to the individual with a developmental disability as
well as the maladaptive/aggressive behaviors the individual is displaying
that result in the crisis. The ISC agency will inquire as to the frequency,
intensity, duration and severity of the aggressive behavior(s). The ISC
agency will also consider the circumstances surrounding the abuse, the
relationship of the alleged abuser to the individual, whether the abuse has
been reported to or investigated by the appropriate authorities such as
local police, OIG, IDPH, APS, etc.
c. Neglect
In determining neglectful situations, the ISC agency will consider what the
individual cannot do for himself/herself that is causing the crisis situation
and/or how is the family/caregiver unable to meet the individual's needs
(i.e. Activities of Daily Living (ADL), medical, physical, psychiatric, adequate
food, water, heat, electricity, functional bathrooms and adequate sleep
arrangements in the home, etc.). They will also look at the adverse
outcomes of these unmet needs and recent changes in the
individual/family household that is prompting the crisis.
d. Additional Factors
Additional factors to be considered in determining neglect is the
availability of others who can meet the identified needs of the individual,
services the individual is currently receiving, if the individual has a legal
guardian, the type of guardianship and what the guardian is unable to do
for the individual. It is also important to determine if the neglect has been
reported to the appropriate investigative authorities such as local police,
OIG, IDPH, APS, etc. and the outcome of the investigation, if one has
occurred. NOTE: As a mandated reporter, any/all suspected abuse and/or
neglect must be reported to the proper investigative authority.
B. The State agency's funding priorities or focus areas.
IDHS is working to counteract systemic racism and inequity, and to prioritize and
maximize diversity throughout its service provision process. This work involves
addressing existing institutionalized inequities, aiming to create transformation,
and operationalizing equity and racial justice. It also focuses on the creation of a
culture of inclusivity for all regardless of race, gender, religion, sexual orientation,
or ability.

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C. The goals and objectives of the In-Home Respite
1. Ensure the individual receiving in-home respite services has been diagnosed
with an intellectual/ developmental disability.
2. Ensure that in-home respite services are provided by an IDHS-contracted
agency's staff.
3. Ensure that in-home respite services are provided in the individual/family
home or in the community.
4. Ensure that I/DD individual is provided respite supervision, personal care, and
staff supports in the home or on outings and community activities, consistent
with the individual's needs and the direction of the primary caregiver.
5. Provide supervision, personal care, and staff supports to assist the I/DD
individual in the home or on outings and community activities, consistent with
the individual's needs and the direction of the primary caregiver.
6. Provide increase the number of families who can access developmental
disabilities supports.
7. Provide relief to and/or reduce the stress of the caregiver of an individual with
an intellectual/developmental disability.
8. Help maintain an individual with an intellectual/developmental disability in
their home and reduce the need for long-term services and supports.
D. Additional Requirements for the In-Home Respite
1. In-Home Respite providers must have an intake process for individuals
seeking services.
2. Planned and unplanned In-Home 87D respite services can be provided up to
360 hours in a fiscal year.
3. Mileage may be reimbursed to workers for In-Home (87D) respite consistent
with State of Illinois Travel Control Board Regulations.
4. The provider will maintain the required certifications regarding staff providing
respite services as detailed in Section VIII A. of Attachment A of the DHS
Community Service Agreement. IDHS: Developmental Disabilities CSA
Attachment A - https://www.dhs.state.il.us/page.aspx?item=134482.

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E. In-Home Respite Program Deliverables
1. Provide a list of all unduplicated individuals rendered services or requested
services through in-home respite.
2. Provide a description of services being provided (in-home respite for
caregiver, e.g. doctor appointments, grocery shopping, sibling activities, run
errands, self-care, etc.).
3. Provide whether the individual served was referred to outside services due to
the inability to provide respite or frequent usage of in-home respite services.
(ISC, DD Regional Staff, etc.).
4. Provide a list of individuals on their waitlist for in-home respite services.
5. Distribute surveys to individuals and/or guardian being provide respite
services and a summary of the responses from the Satisfaction Survey.
F. Performance Measures and Standards
1. All individuals served must have an intellectual/developmental disability.
2. Ensure that all I/DD individuals receiving in-home respite services are
provided by IDHS contracted agency’s staff.
3. Ensure that all individuals that receive respite services are not receiving waiver
services or respite services with another State funded agency.
4. A minimum of fifty percent of individuals on the respite waitlist will be moved
to active respite services and must be able to provide a copy of individuals on
waiting list.
5. A minimum of eighty percent of individuals with additional needs, inability to
be served, and/or frequent use of in-home respite services, will be provided
referral services to other available services or agencies (PUNS, DRS, DHS, etc.).
6. Satisfaction surveys must be provided to all individuals and/or guardian
reporting receiving respite services. Eighty-five percent of all surveys must
receive a positive rating in the reduction in caregiver stress, due to service
being provided.
G. For cooperative agreements, the “substantial involvement” that State agency
expects to have are (or are located) - Not Applicable

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H. Specific Unallowable costs described in Eligibility Information, Section 2(F4).
I. Program beneficiaries or program participants must meet the following
requirements: In-Home Respite is a Fee for Service program that provides short-
term supports to children and/or adults with intellectual or developmental
disability that are not receiving any Home and Community Based Waiver funded
services in either the two children’s waivers or the adult waiver, operated by the
Illinois Department of Human Services (IDHS) Division of Developmental
Disabilities.
Authorizing statutes and regulations for the funding opportunity include the
following:
Federal Grants and Agreements (2 CFR 200) - https://www.ecfr.gov/current/title-
2/subtitle-A/chapter-II/part-200
Developmental Disabilities CSA Attachment A -
https://www.dhs.state.il.us/page.aspx?item=161317
Developmental Disabilities Program Manual -
https://www.dhs.state.il.us/page.aspx?item=161320
Mental Health and Developmental Disabilities Code (405 ILCS 5) -
https://witnessslips.ilga.gov/legislation/ilcs/ilcs4.asp?DocName=040500050HCh%
2E+I&ActID=1496&ChapterID=34&SeqStart=100000&SeqEnd=5000000
Department of Human Services Act (20 ILCS 1305) -
https://witnessslips.ilga.gov/legislation/ilcs/ilcs4.asp?DocName=002013050HArt
%2E+1&ActID=305&ChapterID=5&SeqStart=100000&SeqEnd=1818750
Community Services Act (405 ILCS 30) -
https://ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1501&ChapterID=34
Adult Protective Services Act (320 ILCS 20) -
https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1452&ChapterID=31
IDHS: DDD Pre-Admission Screening (PAS) Manual -
https://www.dhs.state.il.us/page.aspx?item=53018
Abused and Neglected Child Reporting Act (325 ILCS 5) -
https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1460&ChapterID=32

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4. Application Contents and Format
i. Content and Format Requirements.
A. Content and Form of Application Submission
Applications must include the required documents and demonstrate that the
program eligibility requirements have been met. The Department will not contact
applicants for missing items listed below. Applicants that do not include all the
following documents will be considered substantially incomplete and will not be
considered for funding. Refer to Submission Instructions, Section 5(iii).
1. Pre-applications, letters of intent, or white papers are not required.
2. Required Content of Application
a. Applications must include the required documents and demonstrate that
the program eligibility requirements have been met. The Department will
not contact applicants for missing items listed below. Applicants that do
not include all the following documents will be considered substantially
incomplete and will not be considered for funding.
3. Program Narrative and Proposal Narrative Content with Attachments
a. Program Narrative: IMPORTANT, the program (proposal) narrative makes
up the bulk of the application. Please provide a complete response to the
following sections. If the program narrative is missing from your
application packet, your application will receive a score of zero points, and
your agency will not meet the criteria to receive a grant under this notice
of funding opportunity.
b. Proposal Narrative Content and Attachments: If the applicant believes that
the subject has been adequately addressed in another part of the
application narrative, then provide the cross-reference to the appropriate
part of the narrative. If a cross-reference is not included in the section, the
reviewer will consider content contained within that specific section.
i. Executive Summary
ii. Need
iii. Capacity

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iv. Quality
4. Budget and Budget Narrative
a. Applicants must enter a budget electronically in the CSA and provide a
copy of the completed budget in PDF format. (Refer to Appendix A: CSA
Budget Information for more information and a link to budget forms). The
Budget entered in the CSA system will include a narrative or detailed
description/justification for each line in the budget, a describe why each
expenditure is necessary for program implementation, and how you
arrived at the specific amount. Please include cost allocations as necessary.
This narrative must clearly identify indirect costs, direct program costs,
direct administrative costs, and match within each line item as appropriate.
The budget (including MTDC base exclusions as appropriate) should
clearly describe how the specified resources and personnel have been
allocated for the tasks and activities described in your plan.
b. The Budget must be electronically signed and submitted in the CSA
system. The Budget must be signed by the Provider's Chief Executive
Officer and/or Chief Financial Officer.
c. IMPORTANT: When entering the budget in CSA, this grant program is a
fee-for-service grant program. Budgets are entered, as a Fixed Rate
Budget (FRB)
(https://www.dhs.state.il.us/page.aspx?item=118576#a_toc43) and are
NOT a Uniform Grant Budget.
d. The Budget must be electronically signed and submitted in the CSA
system. The Budget must be signed by the Provider's Chief Executive
Officer and/or Chief Financial Officer.
e. IMPORTANT: Please be sure the budget status in CSA says "GATA Budget
signed and submitted to program review." This status will appear after the
budget is electronically signed by the agency CEO or CFO and submitted
to IDHS. See IDHS CSA Tracking System webpage for additional
information on CSA at IDHS: CSA Tracking System (state.il.us)
(https://www.dhs.state.il.us/page.aspx?item=61069).
f. The budget and narrative must tie fiscal activity, to program objectives and
deliverables, and demonstrate that all proposed costs are:
i. Reasonable and necessary

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ii. Allocable
iii. Allowable as defined by program regulatory requirements and the
Uniform Guidance (2CFR 200), as applicable.
g. Additional information for entering a Uniform Grant Budget can be found
at Budget Template (https://www.dhs.state.il.us/page.aspx?item=85366)
and Budget Template Instructions
(https://www.dhs.state.il.us/page.aspx?item=84585). Be sure to follow
instructions on website on how to download the Template.
5. Required Forms
a. Uniform Application for State Grant Assistance – This is a three-page
document used to formalize organization's request to apply for funding.
The document requires the signature and email address of the
organization's authorized representative. This email address will be used
for official communication between the Department and the applicant
organization for matters regarding this application. IL444-5262 -
UNIFORM APPLICATION FOR STATE GRANT ASSISTANCE (.pdf) -
https://www.dhs.state.il.us/page.aspx?item=145490.
b. Grantee Conflict of Interest Disclosure – This is a required for all grant
award programs. The document requires agencies to identify actual or
potential conflicts of interest. The form must be signed by a representative
of the organization. IL444-5205 - GRANTEE CONFLICT OF INTEREST
DISCLOSURE (.pdf) - https://www.dhs.state.il.us/page.aspx?item=142947.
6. Required Format
a. Application Format Requirements: Electronic submission is required in PDF
format.
b. Document Submission Requirements:
i. 8.5” X 11” Paper size, Single spaced, 12-size font, Calibri typeface, one-
inch margins, and display page numbers.
ii. The applicant should not use agency letter head or agency
identification formatting features on the application. Limit reference to
the agency’s name, specifically, in the program narrative. The agency’s
name and identifiers will be redacted, from the documentation, for the
Merit Review Process. This ensures a fair and unbiased scoring process.

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iii. File name should be “Funding Opportunity Number, Program Name,
and Agency Name”.
iv. All forms must be signed and dated.
v. The application must be no more than 25 pages. This includes the
application and narrative. (Grantee Conflict of Interest Disclosure form
and budget are not included in this count.)
c. The narrative portion must follow the page maximums where prescribed
and must be organized in the format outlined or points may be deducted.
d. The Department may determine that an applicant is not qualified, if they
have not complied with requirements, and use that determination as a
basis to award another applicant.
5. Submission Requirements and Deadlines
i. Address to Request Application Packet.
A. Actions Needed Prior to Applying:
1. The complete application packet (this Notice of Funding Opportunity,
including links to required forms) is available through the Illinois Catalog of
Financial Assistance and the IDHS Grants Website -
https://www.dhs.state.il.us/page.aspx?item=149872.
2. Each applicant must have access to the internet. The Department's website
will contain information regarding the NOFO and materials necessary for
submission. Questions and answers will also be posted on the Department's
website as described in this announcement in Section I. It is the responsibility
of each applicant to monitor the website and comply with any instructions or
requirements related to the NOFO.
ii. Unique entity identifier and System for Award Management (SAM.gov).
A. Each applicant must:
1. Be registered in SAM.gov before submitting its application -
https://sam.gov/content/home.
2. Provide a valid Unique Entity Identifier (UEI) in its application.

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3. Continue to maintain an active registration in SAM.gov with current
information, at all times, during which it has an active award or an application
or plan under consideration.
4. The Department may not make an award until applicant has fully complied to
all UEI and SAM requirements.
5. The Department may determine that an applicant is not qualified if they have
not complied to requirements and use that determination as a basis to award
to another applicant.
B. If individuals are eligible to apply, they are exempt from this requirement under 2
CFR 25.110(b).
C. If the agency exempts any applicants from this requirement under 2 CFR
25.110(c) or (d), a statement to that effect.
iii. Submission Instructions.
A. Actions needed prior to applying:
B. Applicants must be registered with the State of Illinois and Pre-qualified in the
GATA portal prior to applying for Illinois awards. Instructions for creating an
account and registering are located at the following link: Illinois GATA Grantee
Portal (https://grants.illinois.gov/portal/). Additionally, detailed instructions for
registration and prequalification requirements, including the expected amount of
time for completion are located here: Grant Applicant Pre-Qualification and Pre-
Award Requirements (https://www.dhs.state.il.us/page.aspx?item=149875).
C. The methods for submitting the application:
1. Applicants must electronically submit the complete application including all
required narratives and attachments in the prescribed order:
a. Program Narrative - https://www.dhs.state.il.us/page.aspx?item=159921
b. Uniform Application for State Grant Assistance -
https://www.dhs.state.il.us/OneNetLibrary/27896/documents/Contracts/GA
TA/Uniform-Application-for-State-Grant-Assistance.pdf
c. Grantee Conflict of Interest Disclosure -
https://www.dhs.state.il.us/onenetlibrary/12/documents/Forms/445205-
220203.pdf

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d. Budget- entered into the CSA system and copy in PDF format.
2. Applications must be sent electronically to:
• Email: DHS.DDDGrantProg@illinois.gov
• Subject Line: “27-444-24-0833-01, In-Home Respite, Name of Agency
Submitting Application”
IMPORTANT: The Department will ONLY accept applications submitted by
electronic mail sent to DHS.DDDGrantProg@illinois.gov .
3. Application submissions or delivery to any other email address or contact,
including other IDHS offices or employees, will not be considered for review
or funding.
4. Applications will not be accepted if received by fax machine, hard copy, disk,
thumb drive, password protected emails, password protected documents, and
emails from encrypted email protection companies (such as, Prevail,
Barracuda Network, Trustifi, etc. list not fully inclusive).
• The application will be electronically time-stamped upon receipt.
5. Software or electronic capabilities required are as follows: Internet access,
preferable high-speed, Email capability, Microsoft Word, Microsoft Excel, and
Abode Reader.
6. Applicants are required to notify the Department within 48 hours of the
deadline, if they did not receive an email notifying them that their application
was received. If the applicant does not receive an email and does not notify
the Department within 48 hours, their application will be considered a late
submission and will NOT be reviewed or scored. The applicant will NOT have
the right to protest the submission/receipt of their application to the
Department after the 48 hours. In the event of a dispute, the applicant bears
the burden of proof that the application was received on time at the email
location listed above (and that the budget was submitted into the CSA system
on time).
D. Pre-application materials must be submitted as follows: Not applicable.
E. If you are experiencing system problems or technical difficulties submitting your
application, you may contact us at:
• Name: Shannon Dyson

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• Email: DHS.DDDGrantProg@illinois.gov
• Subject line: “NOFO Technical Difficulties, In-Home Respite, Name of Agency”
iv. Submission Dates and Times.
A. Full applications are due on the following dates April 23, 2026, at the following
time 5:00 p.m. (CST).
B. Any preliminary submissions, such as letters of intent, white papers, or pre-
applications are due on the following date - Not Applicable
C. Other submissions required before the award - Not Applicable.
v. Missed Deadlines.
1. Applications received after the due date and time will not be considered for
review or funding. All applicants/applications determined to be non-
compliant or otherwise determined to be disqualified from consideration will
be separately notified in writing, by email, upon determination. This email will
be sent to the email addresses provided in the application and will identify the
reason for disqualification.
2. For your records, please keep a copy of your submission with the date and
time the application was submitted along with the email address to which it
was sent. The deadline will be strictly enforced.
3. IMPORTANT: It is strongly recommended that the applicant not wait until the
last minute to submit an application, in case they experience technical
difficulties with the submission process. Applicants should keep copies of all
documentation that may prove their application was submitted to the correct
location and that it was received by IDHS on or before the deadline.
Applicants should also maintain all electronic documentation, including
screen shots, email correspondence, help desk ticket numbers, etc. that would
document any unforeseen difficulties the applicant may have encountered
regarding the timely submission of the application.
vi. Intergovernmental Review.
A. This funding opportunity is NOT subject to Executive Order 12372,
"Intergovernmental Review of Federal Programs" -
https://www.federalregister.gov/executive-order/12372.

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6. Application Review Information
i. Eligibility Review.
B. Applications that are received will be reviewed April 24, 2026, to May 29, 2026, to
ensure they meet the criteria for consideration. Applications that do not meet the
criteria described in paragraph B below will be rejected and not entered into the
Merit Review process.
C. The following are the criteria that must be met for eligibility:
1. Applicant has a current registration with the State of Illinois in the Grantee
Portal.
2. Applicant has an active Sam.gov public account.
3. Applicant has an active Unique Entity Identifier (UEI) with Sam.gov
4. Applicant is in "good standing" with the Secretary of State.
5. Applicant is not on the DHS Stop Payment List Service or the Illinois Stop
Payment List.
6. Applicant is not on the Sam.gov Exclusion List.
7. Applicant is not on the Illinois Medicaid Sanctions List.
8. Program specific eligibility restrictions refer to Eligibility, Section 2(i).
D. Restrictions on eligibility for State awards are referenced in 44 Ill Admin Code
7000.70. Program specific eligibility restrictions are referenced in this Notice of
Funding Opportunity.
E. All applicants/applications determined to be non-compliant or otherwise
determined to be disqualified from consideration will be notified. This email will
be sent to the email addresses provided in the application and will identify the
reason for disqualification.
ii. Review Criteria.
A. Review Criteria
1. Evaluation criteria is based upon requirements set forth in 44 Ill Admin Code
7000.350 Merit Review of Applications and the IDHS Merit Review Manual.

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a. Applications will be evaluated based applicant's response to the program
narrative described in Section 4.i.3 Program Narrative and Contents. Each
section will be weighted as described below.
2. Criteria and Weighting of each criterion -100-point scale.
3. Statutory, regulatory, or other preferences – Not Applicable.
4. Cost Sharing will not be considered in the review process.
5. Information regarding Applicant-nominated reviewers - Not Applicable.
B. Reviewing Criteria and Scoring Weight – Maximum Total 100 Points.
Program Plan/Narrative – 75 Total Points in this Section
1. Need (Description of Need) - 25 Points
The applicant's proposal will be evaluated based on the following:
a. Analysis of the needs of individuals with I/DD in the proposed service
area(s) and target communities.
b. Identify ways the agency will target new recipients for program support.
c. Identify ways the agency identifies individuals with I/DD from minority
group.
d. Provide data, facts and/or evidence demonstrating the ways the proposed
program will meet programmatic needs.
The ideal applicant will:
a. Clearly define the service area and target communities to be supported.
b. Clearly define minority groups needs and the ways the program will
support them.
c. Present a plan to address the needs that is realistic and will meet
individual and family needs based on the program goals.
d. Provides data, facts, and/or evidence demonstrating that the proposal
supports the grant program purpose.
2. Capacity (Agency Qualification/Organizational Capacity) - 25 Points

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The applicant's proposal will be evaluated based on the following:
a. Agency's ability to be fully ready to begin providing services by July 1,
2026.
b. Agency’s prior experience providing services to individuals with I/DD or
program specifics and their families. Detailed description as to how the
agency will directly engage individual with I/DD and their families.
c. Copy of the Agency’s proposed Needs Assessment.
d. Agency’s ability to execute the in-home respite according to the grant
requirements.
e. Agency’s ability to share data received through the Program's work.
The ideal applicant will:
a. Provide a detailed description of the process the agency will undergo to
ensure services are operational no later than July 1, 2026, including a
timeline that is feasible and includes enough detail for the Division to
evaluate the merits and potential risks.
b. Clearly articulates experience to provide service that will meet the program
needs.
c. Demonstrates that the agency has staff with appropriate clinical
credentials to operate as described in this program.
d. Demonstrate that the agency has experience providing in-home respite
services and programs serving individuals with I/DD and their families with
a specific focus on the program goals.
e. Agency’s ability to provide an establishment that is ADA accessible.
3. Quality of Program/Services - 25 Points
a. Demonstrates that the proposal is well articulated in alignment with the
program goals.
b. Provides a detailed summary of the provider’s support team and processes
for providing quality.

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c. Provides examples of agency satisfaction measurements process and how
services and supports will be adjusted on feedback.
d. Provides a detailed summary of the agency's quality assurance processes
to ensure compliance with the program goals as well as DDD, IDHS, and
GATA requirements.
e. Ensure the agency has appropriate processes in place to measure quality
assurance and make changes/updates as needed.
The ideal applicant will:
a. Provide a detailed description as to how the agency will directly engage
with individuals with I/DD and their families who are referred for in-home
respite assistance.
b. Provides a detailed summary of the agency's quality assurance processes
to ensure compliance with the program goals as well as DDD, IDHS, and
GATA requirements.
c. Provide a detailed description that the agency has experience providing
in-home respite services and programs to individuals with I/DD and their
families with a specific focus on the program goals.
d. Ensure the agency has appropriate processes in place to measure quality
assurance and make changes/updates as needed.
4. Executive Summary - 15 Points
The Executive Summary will serve as a stand-alone document for successful
applicants that will be shared with various state-level stakeholders and others
requesting a brief overview of each funded project. Therefore, applicants
should be concise and direct in their description. Information in this section
should include, but not be limited to, the following:
a. Identify the amount being requested under this proposal.
b. Identify target service areas/communities.
c. Identify the number of individuals with I/DD who are projected to
participate.
d. Briefly describe agency experience in providing in-home respite services
and supports to individuals with I/DD and their families.

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e. Provide an overview of the in-home respite services to be provided.
f. Describe how the program will address the Program Goals across the State
of Illinois. Refer to 3. Program Description, subsection C.
g. Share data regarding previous work completed with the agency, as
applicable.
The ideal applicant will:
a. Demonstrate an understanding in in-home respite needs in the State of
Illinois and present a plan to address these needs in a logical manner. The
applicant’s plan will address appropriate service resources required to
meet the level of need.
b. Clearly define the target audience and area of operations for services. The
plan to meet the needs of target audience and full service in area
operations must be realistic. Additional consideration will be provided for
those that provide services across a broader geographic area.
c. Provide data, facts, and/or evidence demonstrating that the proposal
supports the grant program purpose.
d. Support and services provided will meet the program goals.
5. Budget and Cost Justification - 10 Points
The applicant's budget proposal narrative will be evaluated based
completeness and signature. The budget proposal narrative shall include the
following information as it relates to the NOFO program:
a. Thorough and clear justification for the fixed rate expenditures.
b. Proposed number of individuals served and number of hours at the
current fixed rate.
c. Detail description of proposed services (emergency, crisis, general
services), individuals served, and number of hours to complete these
services.
d. Verify the proposed budget total matches the total funding amount listed
on the application.
6. Definitions

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a. Minority Group: A minority group is any group of people who, because of
their physical or cultural characteristics, are singled out from others in the
society in which they live for differential and unequal treatment.
iii. Review and Selection Process.
A. The process for evaluation of the application is as follows:
The numerical score may not be the sole award criterion. The Department
reserves the right to consider any factors such as: geographical distribution,
demonstrated need, and agency past performance as a State of Illinois grantee,
etc. While the recommendation of the review panel will be a key factor in the
funding decision the Department maintains final authority over funding decisions
and considers the findings of the reviewers to be non-binding recommendations.
Any internal documentation used in scoring or awarding of grants shall not be
considered public information.
B. In the event of a tie with insufficient funding for all tied applications, the
Department may choose to elect one or more of the following options:
1. Apply one or more of the additional factors for consideration described above
to prioritize the applications; or
2. Partially fund each of the tied applications; or
3. Not fund any of the tied applications. The Department reserves the right to
negotiate with successful applicants to adjust award amounts, targets,
deliverables, etc.
C. Anticipated Announcement and State Award Date is projected for June 12, 2026;
however, this date may be subject to change if additional time is required to
complete the review process.
D. Merit Review Appeal Process
1. In accordance with GATA Administrative Rules, Section 350, Merit Review of
Grant Applications, a merit application review is required for competitive
(discretionary) Grants and Cooperative Agreements, unless prohibited by
State or federal statute. 44 Ill. Adm. Code 7000.350 -
https://www.ilga.gov/commission/jcar/admincode/044/044070000D03500R.ht
ml.

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2. Competitive grant appeals are limited to the evaluation process. Evaluation
scores may not be protested. Only the evaluation process is subject to appeal
and shall be reviewed by IDHS' Appeal Review Officer (ARO).
a. Submission of Appeal - contact information.
i. Appeals submission IDHS Contact information:
• Contact Name: Shannon Dyson
• Email address: DHS.DDDGrantProg@illinois.gov
• Email Subject Line: “Appeal Review Requested, In-Home Respite,
Name of Agency Submitting Application”
ii. An appeal must be submitted in writing to the appeals submission
IDHS contact listed above, who will send to the IDHS Appeal Review
Officer (ARO) for consideration.
iii. An appeal must be received within 14 calendar days after the date that
the grant award notice has been published.
iv. The written appeal shall include at a minimum the following:
1. Name and address of the appealing party
2. Identification of the grant
3. Statement of the reasons for the appeal
4. Supporting documentation, if applicable
b. Response to appeal
i. IDHS will acknowledge receipt of an appeal within 14 calendar days
from the date the appeal was received.
1. IDHS will respond to the appeal within 60 days or supply a
written explanation to the appealing party as to why additional
time is required.
2. The appealing party must supply any additional information
requested by IDHS within the time period set in the request.

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c. Resolution
i. The ARO will make a recommendation to the Agency Head or designee
as expeditiously as possible after receiving all relevant, requested
information.
ii. In determining the appropriate recommendation, the ARO shall
consider the integrity of the competitive grant process and the impact
of the recommendation on the State Agency.
iii. The Agency will resolve the appeal by means of written determination.
iv. The determination shall include, but not be limited to:
v. Review of the appeal.
vi. Appeal determination; and
vii. Rationale for the determination.
iv. Risk Review.
A. Requirements
1. IDHS conducts risk assessments for all awardees, prior to the award being
issued.
a. An agency wide Internal Control Questionnaire (ICQ) to be completed by
the awardee within the Grantee Portal. The ICQ evaluates fiscal,
administrative, and programmatic risk in the following categories:
i. Quality of Management Systems
ii. Financial and Programmatic Reporting
iii. Ability to Effectively Implement Award Requirements
iv. Awardee Audits
b. A program specific Programmatic Risk Assessment conducted by the
awarding agency to evaluate the following categories:
i. Programmatic financial stability.

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ii. Management systems and standards that would affect the program.
iii. Programmatic audit and monitoring findings.
iv. Ability to effectively implement program requirements.
v. External partnerships.
vi. Programmatic reporting.
c. Risk assessments are not intended to be punitive in nature, rather they are
conducted in order to evaluate the support, technical assistance, and
training that may be needed for the awardee and the level of monitoring
that is needed for the award.
d. Risk assessments may result in Specific Conditions being placed on the
award to include more frequent monitoring or the implementation of a
corrective action plan.
2. Simplified Acquisition Threshold - Federal and State awards
a. This award is not anticipated to exceed the Simplified Acquisition
Threshold defined in 48 CFR part 2, subpart 2.1 (OR)
b. It is anticipated that grants under this award may receive an award over
the Simplified Acquisition Threshold as defined in 48 CFR part 2, subpart
2.1; the dollar amount set by the Federal Acquisition Regulation (FAR),
currently at $250,000 (with some exceptions). Potential grantees under this
notice of funding opportunity may receive an award in excess of the
simplified acquisition threshold of $250,000. Therefore, the grantee is
subject to the simplified acquisition threshold and related requirements.
i. Prior to making an award with a total amount greater than the
simplified acquisition threshold, IDHS is required to review and
consider any information about the applicant that is in the designated
integrity and performance system accessible through SAM. (Currently
FAPIIS) (See 41 U.S.C. 2313)
ii. That an applicant, at its option, may review information in the
designated integrity and performance systems accessible through SAM
and comment on any information about itself that a State or Federal
awarding agency previously entered and is currently in the designated
integrity and performance system accessible through SAM.

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iii. IDHS will consider any comments by the applicant, in addition to the
other information in the designated integrity and performance system,
in making a judgment about the applicants' integrity, business ethics,
and record of performance under State and Federal awards when
completing the review of risk posed by applicants as described in 2 CFR
200.206.
7. Award Notices
i. This section must address what a successful applicant can expect to receive
following selection.
A. State Award Notices
1. Applicants recommended for funding under this NOFO following the review
and selection process will receive a Notice of State Award (NOSA). The NOSA
shall include:
a. Grant award amount.
b. The terms and conditions of the award.
c. Specific conditions, if any, assigned to the applicant based on the fiscal
and administrative risk assessment (ICQ), programmatic risk assessments
(PRA), and the Merit Review.
2. The applicant shall receive the NOSA through the Grantee Portal. The NOSA
must be signed by the grants officer (or equivalent). This signature effectively
accepts the state award amount, and all conditions set forth within the notice.
The signed NOSA is the document authorizing the department to proceed
with issuing an agreement. The Agency signed NOSA must be remitted to the
Department as instructed in the notice.
3. The notice is not an authorization to begin performance (to the extent that it
allows charging to State awards of pre-award costs; pre-award costs are
incurred at the non-State entities own risk unless they have received written
prior approval to begin performance).
4. The authorizing document to begin performance is the fully executed Uniform
Grant Agreement (UGA) signed by the grants officer, or equivalent. This is the
official document that obligates funds. The UGA is sent to the non-State
entity via the CSA system. The non-State entity will print and sign the

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signature page of the UGA and return the signature page to
DHS.OCA.SignaturePages@illinois.gov. A final signed copy of the UGA will be
provided to the non-State entity via an upload into the CSA Tracking system.
5. Applicants who are not eligible due to registration or pre-qualification issues,
or late applications will receive a Notice of Ineligibility prior to the Merit
Review.
6. Applicants who are not selected to receive an award following the Merit
Review process will receive a Notice of Denial/Non-Selection.
8. Post-Award Requirements and Administration
i. Administrative and National Policy Requirements.
A. The agency awarded funds shall provide services as set forth in the IDHS grant
agreement and shall act in accordance with all State and Federal statutes and
administrative rules applicable to the provision of the services.
B. Sample of the IDHS Uniform Grant Agreement -
https://www.dhs.state.il.us/OneNetLibrary/27896/documents/Contracts/FY25/DH
SFY25UGAClean3.11.24_A11Y.pdf
C. Payment Terms
1. It is the policy of the Illinois Department of Human Services (IDHS) that this
policy complies with 2 CFR 200.302, 2 CFR 200.305, 31 CFR 205 (Procedures
implementing the Cash Management Improvement Act and Treasury State
Agreement (TSA)) and 44 Ill. Admin. Code 7000.120 (GOMB Adoption of
Supplemental Rules for Grant Payment Methods).
D. Payment Forms
1. Payment will be made pursuant to entry of services reported monthly via the
Reporting of Community Services (ROCS) database.
ii. Reporting.
A. Reporting upon execution of the grant agreement shall be in accordance with the
requirements set forth in the UGA and related exhibits which include but is not
limited to the following:

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1. Periodic Programmatic Reports submitted electronically in accordance with
instructions in the UGA no more frequent than quarterly and no less frequent
than annually, unless unusual circumstances exist.
2. Other Unique Programmatic Reporting Requirements: additional annual
performance data may be collected as directed by the Department and in the
format prescribed by the Department.
3. If the State share of any State award may include more than $500,000 over
the period of performance applicants are also subject to the reporting
requirements reflected in Appendix XII to 2 CFR 200. Noncompliance with any
of the identified reports may lead to being placed on the Illinois Stop-
Payment List
B. All performance measurements require the demographic information of the
individuals being served. This includes individual’s name, age, gender identity,
race/ ethnicity, Recipient Identification Number (RIN), last four of Social Security
Number (SSN), and county resides. Refer to 20 ILCS 65 –
(https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=4079&ChapAct=20%A0ILCS
%A065/&ChapterID=5&ChapterName=EXECUTIVE%20BRANCH&ActName=Data
%20Governance%20and%20Organization%20to%20Support%20Equity%20and%
20Racial%20Justice%20Act.). A deliverable spreadsheet will be provided to
document collected data.
9. Other Information - Optional
i. Additional Information.
A. Mandatory Forms and Submission:
1. Uniform Application for State Grant Assistance -
https://www.dhs.state.il.us/OneNetLibrary/27896/documents/Contracts/GATA
/Uniform-Application-for-State-Grant-Assistance.pdf.
2. Proposal Narrative - https://www.dhs.state.il.us/page.aspx?item=159921.
3. Uniform Grant Budget in CSA and copy of budget in pdf format -
https://www.dhs.state.il.us/page.aspx?item=61069.
4. Grantee Conflict of Interest Disclosure -
https://www.dhs.state.il.us/onenetlibrary/12/documents/Forms/445205-
220203.pdf.