2015-622-E Aging - NC Dept of Insurance SHIIP contract

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DocuSign Envelope ID: D37C6C9E-3CC6-4586-B782-34070527DC90 Attachment B For the period 7/1/2015—6/30/2016 Statement of Work Grantee: Orange County,North Carolina This statement should be a short summary describing what the Grantee does and how the Grantee will use these funds. The terms of the contract between the SHIIP office and the agencies require local programs meet these goals for SFY2015. The uses of these funds are not limited to but MUST include the following activities: 1) Conduct a minimum of seven (7)dedicated enrollment events(counseling clinics)--one(1)must be dedicated to the disability population--during the period 10/15/2015 through 12/7/2015 and conduct two or more counseling clinics during the period 1/1/2016 through 2/14/2016; 2) Coordinate a county volunteer recognition event during the grant period; 3) Submit Client Counseling(CC)Contact and Public&Media(PAM) Outreach(NPR)forms by the 15th of the month following the counseling session or event through the SHIPtalk website or mail completed paper forms to the SHEEP office in Raleigh; 4) Each SHIIP coordinating site must reach out to 50% of the county's total population for activity events(PAM)and report in SHIPtalk; 5) Each SHIIP coordinating site must counsel 5% of their county's Medicare population(CC)and report in SHIPtalk; 6) Represent SHIIP at a minimum of 2 health fair/senior fair/special events utilizing local certified SHIIP counselors; 7) Conduct a minimum of two(2)presentations-at least one(1)New to Medicare or Medicare 101 presentation to the general public and one(1)Medicare Education presentation to a disability group or potential LIS group in your county; and 8) Participate in 75% of the monthly coordinator conference calls conducted from August 2015 through June 2016. SCOPE OF WORK: (Maximum 2 pages) 1)The Orange County SHIIP Coordinator and/or SHIIP counselors will conduct weekly enrollment events(counseling clinics),including at least one(1)dedicated to the disability population between 10/15/2015 - 12/7/2015.The Coordinator and/or counselors will conduct weekly counseling clinics between 1/1/2016- 6/30/2016. 2) Orange County SHIIP Coordinator will hold a volunteer recognition event during the grant period. 3)The Orange County SHIIP Coordinator attended the annual SHIIP Coordinators'Training Conference,June 24,25 & 26,2015 and will attend the July 2016 conference. 4)Orange County SHIIP will submit NPR Client Counseling(CC)Contact and Public&Medica(PAM)Outreach forms by the 15th of each month through SHIPtalk or by mailing paper forms to the SHIIP office in Raleigh. )The Orange County SHIIP site will reach 50%of the county's total population for activity events(PAM)through advertising and outreach events and report events in SHIPtalk. it Page 10 of 16