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4 <br />North Carolina Department of Health and Human Services <br />Office of Long-Term Services and Supports <br />o aule of Contents <br />Introduction ' <br />Background <br />Scope of Services <br />Target Population <br />Award Amounts ' <br />Eligibility <br />Grant Award Period <br />Reporting <br />The procurement Process <br />Number of Copies <br />General Instructions • <br />Application Face Sheet <br />Notification of Intent to Apply <br />Application Review Process <br />Scoring <br />Project Profile-Form A <br />Project Abstract-Form B <br />Scope of Work Elements-Forms C1-7 <br />Budget-Form D1 <br />Budget Narrative-Form D2 <br />Conflict of Interest-Form E <br />IRS Federal Tax Exempt Letter -Form F <br />Certification Regarding Drug-Free Workplace Requirements--Form G <br />Disclosure of Lobbying Activities-Form H <br />Certification Regarding Lobbying-Form I <br />Notice of Certain Reporting anal Audit Requirements-Form J <br />State Grant Certification of No Overdue Taxes--Form K <br />Consumer Survey-Form L <br />Request for Application <br />Application Checklist <br />Page <br />5 <br />6 <br />6 <br />8 <br />8 <br />9 <br />9 <br />10 <br />10 <br />10 <br />11 <br />15 <br />17 <br />i1 <br />21 <br />23 <br />25 <br />~7 <br />37 <br />38 <br />41 <br />45' <br />47 <br />49 <br />53 <br />57 <br />61 <br />63 <br />67• <br />69 <br />3 of 69 <br />