Form 1 DDC State Plan Council

GUIDANCE FOR COMPLETING THE FIVE YEAR STATE PLAN TEMPLATE DEVELOPMENTAL DISABILITIES COUNCIL

OMB No. 0985-0029

Exp. XX/XX/20XX

SECTION I: COUNCIL IDENTIFICATION

PART A. State Plan Period: October 1, 2016 through September 30, 2021

PART B. Contact Person: Name the person to be contacted with questions about the Plan.

Phone Number: Provide contact person’s direct phone number.

E-mail: Provide contact person’s direct e-mail address.

PART C. Council Establishment:

1. Date of Establishment: Provide the exact date the Council was established.

2. Authorization: State Statute Executive Order N/A

3. Authorization Citation: Provide the actual citation for the Statute or Executive Order establishing the Council.

PART D: Council Membership. [Section 125(b)(1)-(6)].

1. Council membership rotation plan (1,000 character limit): Provide information about the Council’s membership rotation plan, including Council terms and term limits.

2. Council Members: Provide full names of all Council members, beginning and ending dates of each appointment, and category of membership using the codes provided. Begin with agency/organizational representatives (category A), then list public members (categories B and C). For people representing an agency/organization, provide the name of the agency/organization and the name of any official proxy/alternate. If more than one agency/organization representative represents a particular federal program (e.g. IDEA Part B and Part C) put that category code (A2) next to each individual’s name and

identify the appropriate program in the space provided.

1 DRAFT- 2017-2021- DDC State Plan Template

Council Membership Category Codes

Agency/Organizational Representatives

A1 = Rehab Act A2 = IDEA

A3 = Older Americans Act

A4 = SSA, Title XIX A5 = P&A

A6 = University Center(s) A7 = NGO/Local

A8 = SSA/Title V

A9 = Other

Gender

M= Male F= Female

O= Other

Geographical E1= Urban

E2= Rural

Citizen Member Representatives

B1 = Individual with DD

B2 = Parent/Guardian of child

B3 = Immediate Relative/Guardian of adult with mental impairment

C1 = Individual now/ever in institution

C2 = Immediate relative/guardian of individual in institution

Race/Ethnicity

D1= White

D2= Black or African American D3= Asian

D4= American Indian and Alaska Native D5= Hispanic/Latino

D6= Native Hawaiian & Other Pacific Islander

D7= Race unknown D9- Some other race

#	Last Name	First Name	MI	Gender	Race/ Ethnicity	Geographical	Agency /Org. / Citizen Rep Code	Agency/ Org. name	Appt. date	Appt. Expire d Date	Alt/ Proxy for State Agenc y Rep Name
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Part E. Council Staff. [Section 125(c)(8)(B)]. Provide information about all full-time and part- time Council staff positions. Check the appropriate box to indicate full-time or part-time; for part-time staff, indicate percentage. Full-time staff on furlough should be counted as full-time staff. Do not include consultants. If the official classification of the staff member does not adequately describe the role of that position, include a working title (e.g., Council Executive Director, NOT Health Administrator IX).

Disability data of Council staff will be collected. Response is voluntary and information shared will be kept confidential and serve for data purposes only. Self-identification of disability will be captured in the following manner:

25. Yes, has a disability (or previously had a disability) N- No, does not have a disability

DWA- Does not wish to answer.

# Position or

Working Title

FT PT % PT

Last name of person in position

First name of person in position

MI Gender Race/

Ethnicity

Disability

1

2

3

4

5

6

7

8

9

10

SECTION II: DESIGNATED STATE AGENCY [Section 125(d)].

PART A. The Designated State Agency (DSA).

The DSA is:

The Council Other agency:

1. Agency Name:

2. State DSA Official’s Name:

3. Address:

4. Phone:

5. FAX:

6. E-mail:

PART B. Direct Services. [Section 125(d)(2)(A)-(B)]

If DSA is other than the Council, does it provide or pay for direct services to persons with developmental disabilities?

No Yes

If yes, describe the general category of services it provides (eg. Health, education, vocational, residential, etc.). (250 character limit)

PART C. Memorandum of Understanding/Agreement. [Section 125(d)(3)(G)]

Does Your Council have a Memorandum of Understanding/Agreement with your DSA?

No Yes

PART D. DSA Roles and Responsibilities related to Council. [Section 125(d)(3)(A)- (G)]

If DSA is other than the Council, describe how the DSA supports the Council (250 character limit).

PART E. Calendar Year DSA was designated. [Section 125(d)(2)(B)]

SECTION III: COMPREHENSIVE REVIEW AND ANALYSIS [Section 124(c)(3)]

Overall, the Council’s Comprehensive Review and Analysis (CRA) should demonstrate a thorough understanding and analysis of the extent to which:

• Services, supports, and other assistance are available to individuals with developmental disabilities and their families, and

• There are unmet needs for services, supports, and other assistance for those individuals and their families.

How Council members and members of the public provided input into the development of the plan and how their feedback was used to developing the goals and objectives outlined in the five-year plan

INTRODUCTION:

Include a broad overview of the Comprehensive Review and Analysis (CRA) conducted by the Council. Below is information that can be included in the Introduction:

• The Council’s state planning process including obtaining multi-stakeholder and culturally diverse input to develop the CRA; the process used to identify state plan goals and objectives

• Any data, research and/or information that influenced the Council’s goal selections;

• How information was gathered from focus groups and/or directly from a culturally diverse group of people with developmental disabilities and their families;

• Information on any federally assisted State programs, plans and policies that are not included in Parts A – D; and

• Other, broader issues, such as social policy, culture change, funding issues, etc. that are not incorporated into Parts A – D.

PART A. State Information

1. Racial and Ethnic Diversity of the State Population:

Complete the chart below by filling in information from the Census Bureau or some other source on the racial and ethnic diversity in the State

Race/Ethnicity	Percentage of Population
White
Black or African American
American Indian and Alaska Native
Asian
Native Hawaiian and Other Pacific Islander alone
Hispanic or Latino
Some other race
Race Unknown

2. Poverty Rate:

The poverty rate can come from the Census Bureau or some other source based upon the current Federal Poverty Guidelines.

3. ate Disability Characteristics

   1. Prevalence of Developmental Disabilities in the State:

Provide the estimated number of people with developmental disabilities living in the State. Include a brief description of how the estimate was created (e.g., using national prevalence rate or some other source)

2. Residential Settings:

Using the chart, provide information on the number of people with developmental disabilities living in the different types of residential settings. In terms of the definitions,

1. should include foster/host homes and other similar non-family home settings with paid caregivers while C. and D. should not.

Year	Total Served	A. Number Served in Setting of <6 (per 100,000)	B. Number Served in Setting of >7 (per 100,000)	C. Number Served in Family Setting (per 100,000)	D. Number Served in Home of Their Own (per 100,000)
2014
2013
2012

3. Demographic Information about People with Disabilities

Using information collected by the Census Bureau through the American Community Survey, complete the charts below.

People in the State with a disability	Percentage
Population 5 to 17 years
Population 18 – 64 years
Population 65 years and over

	Percentage
White
Black or African American
American Indian and Alaska Native
Asian
Native Hawaiian and Other Pacific Islander alone
Hispanic or Latino
Some other race
Race Unknown

Employment Status Population Age 16 and Over	Percentage with a disability	Percentage without a disability
Employed
Not in labor force

Educational Attainment Population Age 25 and Over	Percentage with a disability	Percentage without a disability
Less than high school graduate
High school graduate, GED, or alternative
Some college or associate’s degree
Bachelor’s degree or higher

Earnings in Past 12 months Population Age 16 and Over with Earnings	Percentage with a disability	Percentage without a disability
$1 to $4,999 or loss
$5,000 to $14,999
$15,000 to $24,999
$25,000 to $34,999

Poverty Status Population Age 16 and Over	Percentage with a disability	Percentage without a disability
Below 100 percent of the poverty level
100 to 149 percent of the poverty level
At or above 150 percent of the poverty level

PART B. Portrait of the State Services [Section 124(c)(3)(A)(B)]:

Use the following sub-sections to describe the state’s services, supports, and other assistance available to people with developmental disabilities and their families. There is an 8,000 character limit for required subsections and a 4,000 character limit for non-required subsections. Only some of the fields in this section are required, as noted by the * sign.

1. Health/Healthcare^:

   • Describe available medical assistance, maternal and child health care, services for children with special health care needs, mental health services for children and adults, institutional care options, and other comprehensive health and mental health services.

   • To the extent available also include information on public/private insurance access, prevention and wellness initiatives, and long term services and supports.

^ Required field

• To the extent available, include data regarding the number of children and adults with developmental disabilities and, as applicable, their families receiving each type of such health services and supports

• Information about health is required per Section 124(c)(3)(A)(i).

• This section is limited to 8,000 characters.

2. Employment*:

   • Describe job training, job placement, worksite accommodation, vocational rehabilitation, and other work assistance incentive and benefits programs that are available to people with developmental disabilities. You may choose to include information about “school to work” transition efforts here.

   • To the extent available also include information on competitive, integrated employment efforts; sheltered workshops; Employment First policies/efforts; and sub- minimum wage.

   • To the extent available, include data regarding the number of youth and adults with developmental disabilities receiving each type of such employment services and supports

   • Information about employment is required per Section 124(c)(3)(A)(ii).

   • This section is limited to 8,000 characters.

3. Informal and formal services and supports*:

   • Describe available social, child welfare, aging, independent living, and other such services not described elsewhere that are available to people with developmental disabilities and their families.

   • To the extent available, also include information on family support efforts/policies, peer support initiatives, faith-based community efforts, volunteer activities, home and community based services, and long term services and supports.

   • To the extent available, include data regarding the number of children and adults with developmental disabilities and, as applicable, their families receiving each type of

such services and supports.

• Information about informal and formal services and supports is required per Section 124(c)(3)(A)(iii).

• This section is limited to 8,000 characters.

4. Interagency Initiatives*:

   • Describe the extent to which agencies operating other federally assisted State programs (including activities authorized under section 101 or 102 of the Assistive Technology Act of 1998 (29 U.S.C. 3011, 3012)) pursue interagency initiatives to improve and enhance community services, individualized supports, and other forms of assistance for individuals with developmental disabilities.

   • To the extent available, also include information on other state collaborations, such as the state early learning councils required under the Head Start program, State Interagency Coordinating Councils required under Part C of IDEA, Work Investment Boards, Centers for Independent Living, State Rehabilitation Council, Aging and

Disability Resource Centers and other relevant state-established Councils, Committees, and/or Cabinets.

• As possible, include specific information about participation of individuals with developmental disabilities, family members, and organizations representing people with disabilities on these Councils, Committees and/or Cabinets. Information about interagency initiatives is required per Section 124(c)(3)(B).

• This section is limited to 4,000 characters.

5. Quality Assurance:

   • Provide information on monitoring of services, supports, and assistance to prevent abuse, neglect, sexual or financial exploitation, violation of legal or human rights, and inappropriate use of restraints or seclusion; interagency coordination and systems integration efforts that result in improved and enhanced services, supports, and other assistance; access to person-centered planning services; and training in leadership, self-advocacy, and self-determination.

   • This information is optional.

   • This section is limited to 4,000 characters.

6. Education/Early Intervention:

   • Provide information on general and special education services; early intervention services; early childhood services; private school services; education supports; and teacher training.

   • This information is optional.

   • This section is limited to 4,000 characters.

7. Housing:

   • Provide information on the availability of affordable, accessible, integrated housing; housing supports and services; and services related to renting, owning, or modifying a residence.

   • This information is optional.

   • This section is limited to 4,000 characters.

8. Transportation:

   • Provide information on accessible public transportation services, paratransit services, and/or programs that promote community accessibility.

   • This information is optional.

   • This section is limited to 4,000 characters.

9. Child care:

   • Provide information on before-school, after-school, and early care services in communities.

   • This information is optional.

   • This section is limited to 4,000 characters.

10. Recreation:

    • Provide information on recreational, leisure, and social activities in communities that are available to individuals with developmental disabilities.

    • This information is optional.

    • This section is limited to 4,000 characters.

PART C. Analysis of State Issues and Challenges [Section 124(c)(3)(C)]:

Use the sub-sections to summarize the Councils’ comprehensive analysis of the extent to which individuals with developmental disabilities directly benefit from the available community services, supports, and other assistance provided in the state. Focus on the ability of individuals with developmental disabilities to access and use services provided in their communities; to participate in opportunities, activities, and events offered in their communities; and to contribute to community life. Describe how people experience the services and supports they receive or don’t receive, and how they view their lives rather the service system. Summarize the Council’s analysis of obstacles that impact the ability of people with developmental disabilities and their families in the state to fully participate in and contribute to their community through full integration and inclusion in economic, political, social, cultural, and education activities. Fields required are noted by the * sign.

1. Criteria for eligibility for services*:

   • Summarize the Council’s analysis of the eligibility criteria used to determine access to specialized services provided by State agencies that may exclude individuals with developmental disabilities from receiving services.

   • This may include if available an analysis of eligibility criteria for generic services, waiver services, early intervention services, special education services, employment

services, and long-term services and supports.

• Information about eligibility for services is required per Section 124(c)(3)(C)(ii).

2. Analysis of the barriers to full participation of unserved and underserved groups of individuals with developmental disabilities and their families*:

   • State what populations are identified by the Council as unserved and underserved.

This may include populations such as: gender, individuals from racial and ethnic minority backgrounds; Lesbian Gay, Bi-Sexual, Transgender (LGBTQ), disadvantaged individuals, people who speak a primary language other than English, individuals from underserved geographic areas (rural or urban); specific groups of individuals within the population of individuals with developmental disabilities, including individuals who require assistive technology in order to participate in and contribute to community life;

or some other group.

• Describe the process the Council used to identify the unserved and underserved population in the State and the rationale for identifying these population(s) over others.

• Review and analyze barriers to full participation of unserved and underserved groups is required per Section 124(c)(3)(C)(iii).

 Review and summarize the needs for the identified unserved and underserved population(s).

3. The availability of assistive technology*:

   • Summarize the Council’s analysis of the availability of assistive technology, assistive technology services, rehabilitation technology, and/or the availability of information about these three things, to individuals with developmental disabilities.

   • This may include if available information about access to generic technologies, such as universally designed technology, smart home-based technology, monitoring technology, etc.

   • Information about the availability of assistive technology is required per Section 124(c)(3)(C)(iv).

4. Waiting Lists*:

1. Numbers on Waiting Lists in the State:

   • Provide the number of people waiting for residential services per 100,000.

   • To the extent possible, include state data on all other types of wait-lists per 100,000.

   • Information on the number of people with developmental disabilities on waiting lists for services is required per Section 124(c)(3)(C)(v).

Year	State Pop (100,000)	Total Served	Number Served per 100,000 state pop.	National Average served per 100,000	Total persons waiting for residential services needed in the next year as reported by the State, per 100,000	Total persons waiting for other services as reported by the State, per 100,000
2014
2013
2012

Entity who maintains wait-list data in the state for the chart above: b.

Case management authorities Providers

Counties

State Agencies

Other

3. There is a statewide standardized data collection system in place for the chart above: yes

no

3. Individuals on the wait-list are receiving (select all that apply) for the chart above: No services

Only case management services Inadequate services

3. Description of the state’s wait-list definition, including the definitions for other wait lists:

(2,000 characters)

3. To the extent possible, provide information about how the state places or prioritizes individuals to be on the wait-list:

Include if available whether the state has uniform statewide guidance regarding wait- lists, whether the state breaks the wait-list into categories or tiers, how individuals are prioritized, breakdowns by urgency of need, demographic characteristics, wait-lists for specific services, order of selection policy, evaluation policy, etc. (?? characters)

Comprehensive services but are waiting for preferred options (e.g., persons in nursing facilities, institutions, or large group homes waiting for HCBS)

Other Use space below to provide any information or data available related to the response above: (1,000 characters)

3. Individuals on the wait-list have gone through an eligibility and needs assessment: yes

no

Use space below to provide any information or data related to the response above:

(1,000 characters)

3. There are structured activities for individuals or families waiting for services to help them understand their options or assistance in planning their use of supports when they become available (e.g., person-centered planning services):

yes no

3. Specify any other data or information related to wait-lists:

Use this section to provide any other relevant information that is available related to the waitlists in the state. (1,000 characters)

3. Summary of Waiting List Issues and Challenges

Based on the information provided in items a – h, describe the Councils’ analysis of the issues, challenges, and limitations, if any related to the state waiting list(s). (?? characters)

5. Analysis of the adequacy of current resources and projected availability of future resources to fund services*:

   • Using available tools and/or data, summarize the State’s current resources to fund services for people with developmental disabilities and their families.

   • In reviewing the State resources, Councils may want to:

     • Include information about the State’s fiscal resources to fund home and community-based services, long-term services and supports, education services, employment services, transportation services, etc.

     • Estimate the State’s future resources for funding services (sources for this type of information may be the State’s proposed budget, studies of State spending trends, etc.).

     • Use data from the National Core Indicators project, the State of the State in Developmental Disabilities study, the Annual Residential Services and Trends Report, the Annual Report on Day and Employment Supports, and the Special Education Expenditure Project.

   • Information about resources is required per Section 124(c)(3)(C)(vi).

6. Analysis of the adequacy of health care and other services, supports, and assistance that individuals with developmental disabilities who are in facilities receive *:

   • Provide information that describes the Council’s analysis of the adequacy of health care and other services, supports, and assistance that people with developmental disabilities who are in facilities receive. This description should be based in part on each independent review (pursuant to section 1902(a)(30)(C) of the Social Security Act (42 U.S.C. 1396a(a)(30)(C))) of an Intermediate Care Facility within the State, which the State shall provide to the Council not later than 30 days after the availability of the review.

   • Adequacy may be described in terms of quality and/or population served versus need.

   • Facilities can include state-run institutions, privately run institutions, intermediary care facilities, nursing homes or some other type of facility identified by the Council.

   • Information about health care and other services, supports, and assistance is

required per Section 124(c)(3)(C)(vii).

7. To the extent that information is available, the adequacy of home and community-based waivers services (authorized under section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)))*:

   • Summarize the Council’s analysis of the adequacy of services provided through home and community-based waivers for people with developmental disabilities authorized under Section 1915(c) of the Social Security Act.

   • Adequacy may be described in terms of quality and/or population served versus need.

   • Information about home and community-based waivers services is required per Section 124(c)(3)(C)(viii).

PART D. Rationale for Goal Selection [Section 124(c)(3)(E)]:

• Provide a rationale for the Council’s selection of specific goals based on and related to the information in Part A and information from the CRA provided in Parts B and C; including rationale for strategies selected to address the goals. There should be a direct relationship between the goals and the needs identified based on the data collected and/or reviewed and feedback from a wide range of diverse stakeholders.

• Given that the DD Act provides a broad mandate to address needs in the State, it is essential that Councils prioritize their work. Not all the issues identified and analyzed in Parts B and C can be addressed by the Council. Include a brief explanation of how the Council prioritized issues to be addressed in the Plan.

• The rationale is required per Section 124(c)(3)(E).

• This section is limited to ?? characters

PART E. 5-YEAR GOALS [Section 124(4); Section 125(c)(5)] Identify the 5 year state plan goals, objectives, and outcomes.

• Goal (s)

• Objective (s)

• Expected Goal Outcomes – (expected outcomes should be reflected for the 5 year goals)

Included in the Council’s goals are

Self-Advocacy Goal(s)/objectives

3. oals, objectives, and/or activities to address the self-advocacy requirement to:

• Establish or strengthen a program for the direct funding of a State self-advocacy organization led by individuals with developmental disabilities;

• Support opportunities for individuals with developmental disabilities who are considered leaders to provide leadership training to individuals with developmental disabilities who may become leaders; and

• Support and expand participation of individuals with developmental disabilities in cross- disability and culturally diverse leadership coalitions

Note: For each of the years of a 5-Year State Plan, there must be obvious work being done related to the three requirements of self-advocacy (as mandated in the DD Act– strengthen a statewide SA organization, SA leaders training others, and; SA as part of coalitions.

Include at least one goal, objective or activity to address the following two components during the course of the 5-year State plan implementation:

Targeted Disparity

Based on the findings of the comprehensive review and analysis (1) identify a subpopulation (i.e., racial, ethnic, sexual orientation, gender minority groups with developmental disabilities) vulnerable to disparities (e.g., health, education, employment, housing, etc.) (2) Identify a disparity and develop an impact statement in a targeted area of emphasis around individual/family advocacy and/or systems change; and implement strategies to decrease the differences in access, service use, and outcomes among such sub population during the course of the 5 year state plan implementation. The identified targeted disparity could be a goal, an objective, or an activity within a goal or objective. These strategies should include evidenced based, best and/or promising practices, to the extent feasible.

Collaboration [Section 124(c)(3)(D)]

Describe how, through interagency agreements or other mechanisms, the UCEDD(s) and P&A will collaborate with the Council to achieve outcomes consistent with the Council purpose. Information about DD Network collaboration is required per Section 124(c)(3)(D).

1. As a Network: Describe the planning of collaborative efforts (goals, objectives, or activities of a goal or objective) of the Council, P&A, and UCEDD(s), and how each entity will use their resources in collaboration with the effort(s) that are supported by the Comprehensive Review and Analysis.

2. With each other: Describe plans the Council has to collaborate with the UCEDD(s). Describe plans the Council has to collaborate with the P&A and how each of these plans will assist in the Council purpose.

3. With other entities: Describe how the DD Network will collaborate with other entities in the State, including both disability and non-disability organizations, as well as the State agency responsible for developmental disabilities services, to assist with the goals and outcomes of the Council’s 5 year state plan. Identify the organizations and summarize the collaborative activities planned, such as joint meetings, joint public education events/initiatives, joint trainings, etc.

LOGIC MODEL Submit a logic model for the 5 year state plan

• Develop a 5 year logic model that presents the logical connections between DD Council activities and desired DD Council outcomes. The logic model should reflect an understanding of the relationships among the resources a DD Council has to operate, the strategies/activities the DD Council plans to implement, and the outputs and outcomes the DD Council expects to achieve.

• The logic model should include inputs, activities, outputs, short-term outcomes, long-term outcomes, and impact.

• SECTION IV: EVALUATION PLAN [Section 125(c)(3) and (7)]

• Outline how the Council will examine the progress made in achieving the goals of the State Plan to determine:

  • The extent to which the goals were achieved;

  • The strategies that contributed to achieving the goals;

  • Factors that impeded achievement of the goal(s);

  • Separate information on the self-advocacy goal and the three required elements;

  • As appropriate, an update on the results of the comprehensive review and analysis; and

  • As appropriate, consumer satisfaction with Council supported or conducted activities.

• Explain the methodology, which may be qualitative or quantitative, that will be used to determine if the needs identified and discussed are being met and if the Council results are

being achieved.

• Define the procedures the Council will use to monitor progress in meeting its goals

• Discuss Council activities that will measure or otherwise address the Council’s

effectiveness.

• The Evaluation Plan does not have to measure progress by using the performance measures that are the indicators of progress used by AIDD for the Bi-annual Report to Congress.

• Councils are encouraged to develop its own methods and measures for determining progress, such as annual benchmarks for the goals that are tied to measuring outcomes.

• In describing the evaluation plan, Councils are required to use and submit a logic model. The logic model generally summarizes the logical connections between the needs that are the focus of the Council, Council goals and objectives, the target population, Council inputs (resources), the proposed activities/processes/outputs

directed toward the target needs/population, the expected short- and long-term outcomes the Council plans to achieve, and the data sources the DD Council will use to measuring the extent to which proposed processes and outcomes actually occur and have been achieved.

• Describe the Council’s role in reviewing and commenting on the progress towards reaching the goals of the Plan.

• Describe how the annual review will identify emerging trends and needs as a means for updating the Comprehensive Review and Analysis.

SECTION V: PROJECTED COUNCIL BUDGET [Section 124(c)(5) (B) and 125(c)(8)]

• Provide the budget, broken down into three cost categories (Goals, General Management, and DSA functions) for the first year of the grant only. The Council will submit budget for subsequent years of the grant through the State Plan Amendments.

• Provide the breakdown of Part B funds (the Council’s allotment from ADD) for each cost category; the amount of money from other sources, such as match, for each cost category; and the total amount for each cost category.

  • GOALS COST CATEGORY: Break down the costs associated with the goals of the plan by each goal. For example, if the Council has 5 goals, there should be 5 line items identifying the budget amount for each goal. The budget amounts for the goals may vary and should be based on the planned activities. Section 124(c)(5) requires that not less than 70 percent of the funds available to the Council will be expended for

activities related to the goals. Therefore, the total amount for the goals must be at least 70 percent of the Council’s total allotment. For example, if the Council has 5 goals, the total budget for the 5 goals should amount to at least 70 percent of the Council’s total allotment.

• GENERAL MANAGEMENT COST CATEGORY: Show the amount of money budgeted for administrative type functions. This may include personnel, budget, finance, and reporting administrative functions that are not related specifically to a state plan goal or goals.

• DSA COST CATEGORY: Provide the amount of money provided to the DSA to carry out its functions. Section 124(c)(5) requires that not more than 5 percent of the Council’s allotment for any fiscal year, or $50,000, whichever is less, shall be made available for total expenditures for the purposes of the DSA agency.

• NON-FEDERAL SHARE (Match): Indicate the non-federal share amount. The non- federal share may include cash or in kind contributions, fairly evaluated, including plant, equipment, or services. Federal funds from other sources cannot be the source of the non-federal share. Section 126 requires that the Federal share of the cost of all projects in a State supported by an allotment to the State may not be more than 75 percent of the aggregate necessary cost of such projects, with the exception of:

  • Projects whose activities or products target individuals with developmental disabilities who live in poverty areas; the Federal share of the cost of all such projects may not be more than 90 percent of the aggregate necessary cost of such projects.

  • Projects undertaken by the Council or Council staff to implement State plan activities; the Federal share of the cost of all such projects may be not more than 100 percent of the aggregate necessary cost of such activities.

Goal	Subtitle B $	Other(s) $	TOTAL
1. Goal
2. Goal
3. Goal
4. Goal
5. Goal
6. General management (Personnel, Budget, Finance, Reporting)
7. Functions of the DSA
8. TOTAL	$	$	$

SECTION VI: ASSURANCES [Section [124(c)(5)(A)-(N)]

Submit Assurances with the 5 Year State plan. Assurances only have to be submitted at the beginning of the 5 Year plan unless there have been substantive changes to the plan or the Council Chairperson or Designated State Agency has changed since the assurances have last been submitted.

Written and signed assurances have been submitted to the Administration on Intellectual and Developmental Disabilities, Administration for Community Living , United States Department of Health and Human Services, regarding compliance with all requirements specified in Section 124 (C)(5)(A) – (N) in the Developmental Disabilities Assurance and Bill of Rights Act.

Approving Officials for Assurances

For the Council (if the Council is its own DSA)(Chairperson)

For the State or Territory (DSA is to assist the DD Council in obtaining assurances)

SECTION VII: PUBLIC INPUT AND REVIEW [Section 124(d)(1)]

The DD Act requires public input and review of the Council Plan. Provide information on how the Council received and used public input on the Plan.

1. Describe how the Council made the plan available for public review and comment. Include how the Council provided appropriate and sufficient notice in accessible formats of the opportunity for review and comment.

2. Describe the revisions made to the Plan to take into account and respond to significant comments.