N.Y. Comp. Codes R. & Regs. tit. 14, Appendices, app 4
INSTRUCTIONS FOR COMPLETING APPLICATION FOR
PROJECT CONSTRUCTION
GENERAL INSTRUCTIONS
Copies of the application and drawings are to be submitted by the applicant to the Division of Community Services as follows:
____________
Number of Copies
Part 1 (Including supplements and and continuation page) 3
Parts 2 and 3 3
Part 4 4
Stage 1 drawings 2
Stage 2 drawings 2
Stage 3 drawings 2
____________
Note: Stage 1 drawings must accompany Part 1 of the application.
The Application is divided into four parts for the convenience of applicants. Part 1, including narrative, is designed to elicit such information from applicants as is necessary for the Commissioner to reach a judgment as to the project's eligibility and suitability for State Aid. The applicant will be notified when Part 1 has been approved. Since final certification of approval of an application can be given only after all four parts of the application and the plans and specifications have been submitted the receipt and approval of Part 1 is but one step in the final grant making process and is not the obligation of State funds. Part 1 applications will be reviewed by the Division of Community Services, and approvable applications will be submitted to the Division of the Budget for review and inclusion in the department's budget. Approval of the Legislature is necessary before an application for reimbursement can be made. Consequently it should not be assumed by the applicant that State grant funds requested will necessarily be committed to the project. It is recommended that in most instances the four parts of the form be submitted successively.
For the most part information requested in the application is self-explanatory. Instructions are given below for those items which may require further explanation.
EQUIPMENT LISTS
Three copies each of the list of fixed equipment not in the construction contract should be submitted by the applicant to the Division of Community Services with the Part 1 application.
PART 1
This application part consists of a section designated GENERAL INFORMATION AND a section designated SUPPLEMENTAL PROJECT INFORMATION--FACILITIES FOR THE MENTALLY RETARDED, or COMMUNITY MENTAL HEALTH FACILITIES.
GENERAL INFORMATION SECTION
Item 5-Estimate of Capital Costs
A. Estimated Costs in which the State Government may Participate:
Enter costs of construction work, including coats of fixed equipment to be acquired through the construction contract.
Enter costs of all fixed equipment which is not to be acquired through the construction contract. Types of fixed equipment which way be purchased without competitive bidding include equipment which is unique to the facility as well as kitchen, laundry and laboratory equipment. The Division of Community Services should be consulted concerning the manner in which such fixed equipment is to be purchased.
An engineer on surveyor specializing in the preparation ofsurveys and soil data should be consulted, if possible. Also, local architects or contractors can estimate this cost.
An estimate of architectural fees may be obtained from localarchitects if an architect has not already been engaged.
Include necessary costs incident to the provision of adequate inspection at the site to insure that the completed work conforms with the approved plans and specifications. Costs such as fees or salaries of inspectors and incidental expenses are allowable.
The acquisition of a building or site for a Mental Retardation Facility or Mental Health Facility is eligible for State participation. Incidental costs such as indicated in Part 1 Item 6-A through D, should be entered separately from the actual cost of site or building. The value of a donated site is not allowable for participation.
Include in this item any costs such as consultant's fees in which the State is expected to participate Consultant's fees are allowable to the extent that they involve work in connection with plans and specifications and the selection and purchase of equipment. Any portion of a consultant's fee which involves services performed in operational procedures, staffing or other functions not related to construction of the facility is not allowable as a capital cost.
Enter the sum of Item (1) through (7).
B. Estimated costs in which the State may not participate:
All other costs in which the State is not expected to participate should be listed separately under this item. Include parts of the facility to be used for other than Mental Health or Mental Retardation.
Item 6 - Applicant's Financial Resources
The financial resources of the applicant entered here should represent the total amount which will be available for capital costs.
A. Enter only the net amount of cash available free from claims. The current market value of stocks and bonds owned by the applicant should be used. Submit documentary evidence that cash in the amount shown is available.
B. Enter the estimated cash value of pledges already made but unpaid (i.e., the face value) and the amount after discounting by a bank or lending agency. Attach a statement from the bank or lending agency.
C. Enter the total amount or contingent gifts and bequests and attach description of contingency or contingencies.
D. Enter the current net market value of authorized bonds which have not yet been sold. Do not enter the amount of cash resulting from bonds already sold since this amount must be entered as cash under A above The current net market value is the best available estimate of the current sale price.
E. Enter the amount of any encumbrance to be placed against the property. Attach a letter from a recognized financial institution verifying the value of the mortgage and stating the terms and amount of the mortgage.
Note: If a City or County alone is the applicant, complete only Item F.
Item 7 - Preliminary Financial Analysis
A. Enter the amount of funds, if any, made available through Federal aid.
B. The State share will be determined by multiplying the figure in Item 5 A(9) by 33 1/3%.
Item 8 - Maintenance and Operation
A. The estimated costs of operating and maintaining the facility will be the total from such expenses as the following: Salaries, wages, fees. allowances, supplies, Group II or Group III equipment, the cost of services performed by outside concerns, the cost of repairs to equipment and buildings, insurance and bonding, the cost of raising funds for operating purposes (excluding costs for construction of new buildings or additions) rent, interest on notes, bonds, mortgages, bank loans, etc.
B. Estimated Income
Enter the estimated amount to be realized from services to patients for which payment is received and other revenue items.
Financial Support of Facility:
.
Attach a statement showing a detailed operating budget covering a two--year period for the proposed facility.
Show the anticipated sources of financial support, estimating the proportion or support to be provided by each source.
Describe any formal agreements in existence or will be executed regarding financial support.
Item 9 - The Applicant Gives Assurance
N. If the applicant is unable to give this assurance with respect to the furnishing of services below cost or without charge to persons unable to pay therefore, it shall submit information to establish that it is not financially feasible for the applicant to provide such service.
Note
If the project involves the replacement of an existing facility, the applicant must attach a statement with Part 1 of the application that upon completion of the project the facility being replaced will no longer operate for the same purpose for which the new facility (replacement) is constructed.
SPECIFIC INSTRUCTIONS
SUPPLEMENTAL PROJECT INFORMATION--FACILITIES FOR THE
MENTALLY RETARDED
Item 17 - Narrative Description. The outline set forth below is to be followed in presenting the narrative description of the program of the proposed facility:
A. Need for Services for the Retarded
Describe the facilities, services, and programs available in the community service area or region, at the time the application is being submitted showing both the availability of general community services and specialized services.
Describe in detail the manner and extent to which the services of the proposed facility will be coordinated with other facilities and services for the retarded available within the area.
Describe any working agreements or affiliations which are in existence or which will be developed with other facilities providing services for the mentally retarded.
B. Services to be Provided
Describe in detail the types of programs to be offered in each of the services and show the relative emphasis to be placed on each program and on each service to be provided.
C. Proposed Staffing of Facility
Show the proposed staffing of the facility covering all professional staff by type of position and number of full time equivalent personnel to be employed.
Indicate anticipated sources of personnel for the proposed facility and describe any programs to be initiated to recruit needed professional staff.
D. Source of Referrals of Clients or Patients
Describe the anticipated source or referrals for clients or patients to the proposed facility.
Describe any formal agreements which are in existence or will be executed regarding referrals.
E. Research and Inservice Training Programs
Describe any inservice training programs to be carried out in the proposed facility for professional and technical personnel other than those employed by the applicant.
F. Space Requirements of Facility
List the space requirements for the proposed facility. These requirements should provide:
Number of rooms available for each program including office space for professional and administrative personnel.
Approximate square footage of each area to be provided in the facility including all service and maintenance areas such as kitchens, dining rooms, recreational areas, power plant, toilets, etc.
Total square footage of proposed facility.
Describe the functional relationship between all program areas and related services areas, such as training areas, treatment areas, dining rooms and recreational areas.
To the extent that it is necessary to the understanding of the program, escribe the functional relationship between program areas.
SUPPLEMENTAL PROJECT INFORMATION -- COMMUNITY MENTAL
HEALTH FACILITIES
With the two exceptions noted below, the items in the supplemental form for Community Mental Health Facilities are considered self-explanatory. If any assistance is needed to complete the form, please contact the staff of the Division of Community Services.
Item 13. When indicating the services to be provided in the facility(ies) for which construction assistance is requested, also indicate whether the services (1) are presently available; (2) are to be made available; or (3) are to be of a combination of (1) and (2) . Where the services are to be a combination of both old and new, indicate the proportion of services which falls in each category.
Item 16B. With the exception of data concerning substandard housing and public assistance recipients, all the data requested in this item can be obtained from Census tract data. The data on public assistance recipients should be available locally if the applicant cannot obtain local data on "substandard housing", the applicant should use Census tract data on dilapidated housing".
PART 2--FINANCIAL INFORMATION
Item 4.
E. Enter the amount of the encumbrance to be placed against the property. Attach a letter from the lending agency verifying the loan.
Note: At least one--third of the applicant's resources for the project are to be liquid and free from any claim or encumbrances.
The total of the value of the bonds and the face value of mortgages should not exceed one--third the value of the total facility. In a new facility, the "value of the total facility" includes the value of the site costs of construction, equipment, landscaping, off--site improvements, fees, etc. In an existing facility, the "value of the total facility" is the estimated value of the facility upon completion of the project. This requirement may be waived by the Commissioner in unusual instances.
PART 3--SITE INFORMATION
Site information should be submitted as soon as the site survey and soil investigation have been completed. It is expected that the estate or interest in the site will have been acquired by this time. If possible, this part should be submitted before the working drawings and specifications are submitted.
The estate or interest in the site must be that which the Commissioner finds sufficient to assure undisturbed use and possession for purposes of construction and operation of the project for a period of not less than fifty years. Such interest or estate may be fee simple title, a leasehold interest if the rental does not exceed four per cent of the value of the land, or such other interest as the Commissioner finds to be sufficient. It may be vested in
The applicant, or
In one or more agencies filing the application if more than one agency files the application, or
The operating agency if the project when completed is to be operated by an agency other than the applicant. When the estate or interest in the site is held by the operating agency, the word "applicant" in items 6 and 8 should be deleted and the name of the operating agency substituted therefor. In addition, the operating agency should sign a certification to be made a part of the application to the effect that the attachments and statements contained in the application which refers to its interest or estate in the site are correct to the best of its knowledge and belief.
Item 8. The applicant should obtain this opinion from an attorney who specializes in the examination of land titles, or from a title company.
PART 4
The working drawings and specifications (third stage) must be approved prior to the approval of Part 4. Part 4 must be approved prior to reimbursement.
The drawings and specifications shall be bound securely and identified by the applicant and private architect as those being submitted for approval in connection with Part 4 of the application. Identification should be made in the following manner: Attach to Part 4 a statement signed by the applicant, listing the drawings by number and date, the date of the specification, the number and date of each addendum, and the name and address of the architect, and setting forth that the documents enumerated and enclosed are duplicates of those which are to be used for contract purposes.
Each of the sets of drawings and specifications shall be numbered. The front page of each specification and each set of drawings shall be signed by the applicant and the private architect.
N.Y. Comp. Codes R. & Regs. tit. 14, Appendices, app 4