Healthy Food Financing Initiative Questionnaire

Healthy Food Financing Initiative Supplemental Questionnaire: Financial Assistance Request

• OMB No. 1559-XXXX

• According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 1559-XXXX; expires XX/XX/XXXX. The time required to complete this information collection is estimated to average 30 hours, including the time to review instructions, search existing data resources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Comments concerning the accuracy of the time estimate and suggestions for reducing this burden should be directed to the Program Manager, Community Development Financial Institutions Fund, 601 13th Street NW, Suite 200 South, Washington, DC 20003.

Requested HFFI-FA Award Amount and Matching Funds

A. Total dollar amount of HFFI-FA award requested in this Application: $______________

NOTE: Applicants are encouraged to request an amount which they believe can be used to finance activities that support the Healthy Food Financing Initiative, and which they believe can be committed within two years of an award and fully expended within three years of entering into an Assistance Agreement. The CDFI The CDFI Fund anticipates making individual HFFI-FA awards of up to $5 million although it reserves the right to make awards in excess of this amount.

B. Complete Chart A. Matching Funds Summary (and Chart B1-B3 if necessary) and attach the relevant charts and matching funds documentation to this submission.

1. Target Market Profile for Healthy Food Financing Initiative

A. Provide a detailed description of the Applicant’s Target Market for its Healthy Food Financing Initiative (HFFI) activities.

1. Provide a brief overview of the HFFI Target Market’s principal characteristics. Quantify the extent to which the Applicant’s activities will provide goods and services to communities that: (i) lack access to healthy food options (for example, food deserts, which do not have a supermarket or large grocery store within a 1 mile radius; 10 miles, in the case of rural areas); (ii) indicate patterns of non-healthy food consumption (such as low rates of fruit and vegetable consumption); (iii) suffer from poor health indicators (such as high rates of obesity, diabetes and other diet-related chronic diseases); (iv) have high concentrations of persons participating in food assistance programs (for instance, Supplemental Nutrition Assistance Program ; Women, Infants, and Children food packages; school lunch programs); or (v) demonstrate other indications of need for healthy food finance interventions.

TIP: HFFI awardees will be required, as a condition of their Assistance Agreements with the CDFI Fund, to ensure that at least 75% of their HFFI investments will be used to finance healthy food retail outlets¹ in census tracts that have been identified as “food deserts” by the U.S.D.A. A complete list of these food desert census tracts may be found at http://www.usda.gov/hffi

In addition, to further facilitate completing the response to question #1 above, Applicants are encouraged to use other tools available for identifying areas with high need for healthy food interventions, including:

1. U.S.D.A.’s Food Environment Atlas, available on the U.S.D.A. website at http://maps.ers.usda.gov/FoodAtlas/, which provides a resource for obtaining county-level data relating to food access, food consumption, diet-related health indicators, and participation in food assistance programs.

2. The Center for Disease Control’s Behavioral Risk Factors Surveillance System at http://apps.nccd.cdc.gov/BRFSS-SMART/.

2. Describe the Applicant’s pipeline of HFFI projects. Be sure to identify the number and dollar amount of transactions that have already been identified, for which underwriting is completed or underway. Of those underway, please describe a sample of transactions (up to three) that can reasonably be expected to close within 24 months. Provide the amount of HFFI financing needed and total activity or project costs, and the status of project financing.

3. Describe the Applicant’s strategy for identifying potential borrowers, investees or activities, including the extent to which the Applicant has used or will be using community alliances or strategic partners (including banks, credit unions, CDFIs, local governments, tribal agencies, schools, health departments, community based organizations, non-governmental organizations, etc.) to identify projects aimed at increasing access to healthy foods.

4. Describe the extent to which the Applicant’s HFFI interventions will work in concert with other Federal and local initiatives as part of a broader strategy for revitalizing local communities and creating quality jobs.

2. Healthy Food Financial Products

A. Describe the Applicant’s proposed and/or current Financial Products that will be used to support the Healthy Food Financing Initiative.

1. Describe the proposed financial product/s that will be funded through a HFFI-FA award, and how these compare with prior financial products that the Applicant has previously provided in support of healthy food interventions.

2. Describe how the Applicant’s proposed and/or current financial product/s that support healthy food interventions address the financing needs of the Applicant’s customers.

3. Discuss how the Applicant’s current and/or proposed financial products that support healthy food interventions are (or will be) leveraged with:

• Public sector resources made available under other programs identified as part of the Federal government’s proposed Healthy Food Financing Initiative²);

• Other public sector resources, such as Choice Neighborhoods (HUD) or Promise Neighborhoods (Education), that promote a comprehensive approach to neighborhood transformation;

• Private sector resources, including philanthropic contributions; and

• Local community resources.

3. Development Services for Healthy Food Financing

A. Describe the Applicant’s Development Services that will be used to support the Healthy Food Financing Initiative.

1. Describe the development services (e.g., training, technical assistance) that the Applicant offers and/or intends to offer in conjunction with its HFFI activities. Describe the format of the instruction (such as one-on-one sessions, group training, or on-line counseling), any fees or costs charged to the customer, and any systems used to evaluate effectiveness.

2. Discuss how these development services are linked to the financial products that support healthy food interventions. What is the relationship between the number of clients receiving development services and ultimately qualifying for financial products that support healthy food interventions?

3. Describe the Applicant’s strategy to ensure that community residents will utilize the healthy food options being financed through HFFI-FA. The Applicant should specifically discuss its (and any partner’s) education and outreach efforts to residents of the communities.

4. Track Record and Management Capacity for Providing Healthy Food Financing

A. Describe the Applicant’s track record in financing healthy food interventions.

1. Discuss prior Healthy Food financing activities, with a particular focus on those that were specifically provided in the Applicant’s designated Target Market.

B. Describe the Applicant’s management team and key staff for its Healthy Food financing activities.

1. What key staff and management team are responsible for implementing the Applicant’s Healthy Food financing activities? What are the qualifications of these staff members and how do they help implement the Applicant’s products and services?

2. Describe the status of new or vacant positions and the strategy for filling the positions, as well as the expected date of filling them.

C. Describe the Applicant’s ability to track and report HFFI outcomes.

1. What outcomes does the Applicant intend to track and measure to report on program success (e.g., number and type of healthy food retail outlets developed or rehabilitated; total square footage of commercial retail space developed and rehabilitated; number of jobs created for residents of low-income communities; etc.)?

2. Describe the Applicant’s experiences in collecting and analyzing outcome data, particularly as it relates to healthy food financing activities, tracking those results over time, and reporting findings.

3. Discuss how the Applicant will ensure that its HFFI-FA financed activities will lead to significantly improved healthy food options in low-income communities.

4. Describe specific program design features, outreach methods or other aspects of the Applicant’s HFFI strategy that the Applicant believes can be replicated by other service providers.

5. Discuss the Applicant’s strategy for sharing program outcomes, including both “best practices” and “lessons learned,” to better inform the national agenda.

1 Healthy food retail outlets are for-profit or non-profit sellers of fruits, vegetables, and other foods recommended in the Dietary Guidelines for Americans, and can include, but are not limited to, a grocery store, mobile food retailer, farmers market, cooperative, corner store, bodega or a store that sells other food and non food items, including an existing retail store that upgrades to offer a full range of healthy food choices.

2 For a complete list of HFFI programs, please see the following website: http://www.usda.gov/hffi