Form 1 AV Application

Child Access and Visitation Grant Application Form

Directions: Provide a narrative description for sections 1-12 of the application. Instructions for each section are italicized above the response field.

1. Target population to be served with grant funds.

Describe the target population for AV services and include the following details:

1. Describe the parents the state/territory plans to serve with AV grant funded services and resources (e.g. noncustodial parents who were not married to the other parent, low-income parents, and parents establishing child support orders in the Title IV- D system), how those parents were identified as the service population, and an estimated number of parents the state/territory plans to serve in the grant year.

2. Describe outreach and recruitment efforts the state/territory will take to ensure the target population is aware of and effectively reached with AV program services.

3. If the state plans to use AV Grant funds to provide services to parents involved in the child welfare system (Title IV-E or Title IV-B), describe how the state will ensure the AV grant funded services do not duplicate services funded through Title IV-E or Title IV-B.

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2. Direct Services.

Describe the direct services the state/territory plans to provide and how those direct services will support increased non-custodial parent time with and access to their children. Allowable activities include, but are not limited to: parent education, visitation enforcement, development of parenting plans/orders, mediation, counseling, development of guidelines for visitation (parenting time). Include the following details:

1. Location of services - indicate where the state/territory plans to implement program services and a rationale for areas chosen if less than statewide.

2. Coordination with Title IV-D Child Support Agency - describe efforts or plans to integrate delivery of AV grant services with state/local child support services.

3. Rationale - describe the process used by the state to determine funding priorities for planned activities and how those activities are likely to maximize the impact of the AV grant on noncustodial parenting time.

4. Service Providers – describe the process used to secure professional service providers, including the standards for examining their qualifications, determining the reasonableness of the costs for their services, establishing deliverables, measuring the work quantity, and evaluating its quality.

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3. Indirect Services/Activities.

Describe planned indirect services and activities that support increased parenting time for NCPs. Examples of in-direct activities include: training for family court judges or child support staff regarding domestic violence and safe parenting time, outreach to community organizations to build support for parenting time services, inclusion of parenting time information on child support agency or court websites, and development of parenting time templates/forms.

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4. Administrative Structure:

Describe how AV grant oversight and administration will be conducted including: rationale used to determine the state agency responsible for administration, a description of staff qualifications for the program coordinator, expected amount of staff time dedicated to program administration, and accounting controls in place to ensure grant funds are expended for allowable purposes.

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5. Safeguards:

Describe how the state will ensure the safety of parents and children who are served through AV grant funded services. Include the following details as required:

1. If the state/territory plans to fund supervised visitation and/or neutral drop-off and pick-up services, this description must provide details of the operational standards with which providers of supervised visitation services must comply (e.g. state standards, Supervised Visitation Network standards, Department of Justice- Safe Havens standards). Include descriptions of screening procedures and provide copies of screening tools and protocols.

2. For services other than supervised visitation/neutral exchange, describe how the state/territory will incorporate a domestic violence informed approach to parenting time services, including a description of current and planned collaborations with domestic violence experts.

3. If grant services are provided by a sub-recipient, how will the state monitor sub-grantee safety procedures?

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6. Expenditures by program activity.

Estimate the amount and percent of total AV grant funds the state/territory plans to use for each direct activity, in-direct activity, and for administrative purposes. Include estimated travel costs for the program coordinator to attend the annual coordinators’ meeting. Include estimated numbers of parents to be served by direct activity area.

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7. Other funding sources.

Describe any funds (state funds, private foundation funds, local funds) the state/territory expects to be dedicated to AV program activities. Also describe any plans the state/territory has to try and secure additional funding for AV program activities.

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8. Partner agencies.

Describe any existing partnerships with other government agencies, community, or faith-based agencies the AV grant program has to serve as referrals or resources for families participating in AV grant funded activities. Also list partnerships you are exploring or ones that you would like to explore with assistance from OCSE.

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9. Funds obligation process.

Briefly describe the procedure the state is likely to use in obligating the FY 2017 grant funds, such as: request-for-proposals, sole source, interagency transfer of funds (e.g., Administrative Office of the Courts), and/or continuing grants/contracts to existing providers. If the state/territory plans to distribute funds to other entities, include copies of MOUs or contracts controlling use of funds.

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10. Monitoring and Reporting.

Describe how the state intends to conduct the required monitoring to ensure funds are properly spent, including a schedule and planned methods for sub-recipient monitoring. If an issue is identified requiring a special review, notify OCSE within 10 business days.

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11. Data collection and accuracy.

Describe how the state will gather data on AV grant services and ensure the accuracy of program performance data submitted to OCSE by December 30 of each year. Describe reporting required of sub-recipients in addition to federal reporting requirements.

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12. Evaluation.

Describe the current or planned evaluation of AV grant activities and include copies of evaluation reports/findings from any evaluations conducted in the previous three grant years.

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Submission Date: Click here to enter text.

Submission Instructions:

Send an electronic copy of the signed cover letter and accompanying application to: michael.hayes@acf.hhs.gov with a copy to john.langrock@acf.hhs.gov . If you have questions regarding this application or the requirements of the AV grant, please contact Michael Hayes via email.

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104 – 13)Public reporting burden for this collection of information is estimated to average 10 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

OMB Control Number: 0970-0482

Expiration: August 31, 2019