Outreach Plan Template

1. Cover Page/Contact Information/Signatures

M ltiple year plans: Complete Section ! eac" year# FOOD STAMP P O! AM Annual Plan for Outreach State: Enter the name of your State State Agency: Enter the name of your State food stamp agency Fiscal Year: Enter the Federal fiscal year. Primary Contacts: Complete the table with the name, title, phone and email address for those State food stamp agency personnel who should be contacted with questions about the outreach plan. Add additional rows if needed. "ame Insert more rows as needed. Title Phone #mail

Certifie$ %&' <Signature of Authorized erson! (((((((((((((((((((((((((((((((((((((((((( State Food Stamp Agency Director (or Commissioner) Certifie$ %&' "Signature of Authorized erson! ((((((((((((((((((((((((((((((((((( State Food Stamp Agency Fiscal Reviewer (((((((((((((( Date ((((((((((((((( Date

). Statement of "ee$
ro#ide a concise description of the need for the pro$ects. Include data such as trends in food stamp participation, and the incidence of hunger and food insecurity. Include the source and date of the data. Additional data such as demand for emergency food pro#iders, po#erty rates, unemployment rates, or other similar information may also be pro#ided to support the need. %Suggested length& 'ot more than ( pages)

*. Outreach Plan Summaries

$%ec tive S mmary: ro#ide a brief o#er#iew of your outreach plan. *riefly describe your goals and e+pected results. Include the target audiences and the outreach strategies that will be implemented. ,i#e a general description of your e#aluation plan. %Suggested length& 'ot more than - page) S mmary o& Pro'ects: Complete the table to pro#ide a summary of the pro$ects.initiati#es you will implement. ,i#e each pro$ect.initiati#e a number and a title. /efer to each pro$ect.initiati#e by number and title throughout the rest of your outreach plan. Add more lines as needed. 0he first row of this table is completed to pro#ide an e+ample.

Pro+ect "um,er

Title

!eographic Area

Target Au$ience

Contracte$ -list contractor. or In/0ouse1

1n,"o se

( treac" )or*er +rain,t"e,+rainer

-ewtown

Food Pantry .ol nteers/ 0ealt" Center Case Managers/ Paris" - rses

2 Insert more rows as needed.

2. Outreach Pro+ect Details

Pro'ect +a3le: Complete this section for each pro$ect listed in the Summary of ro$ects 0able in Section 1 abo#e. (Suggested length& 'ot more than ( pages for each pro$ect ) Pro+ect "um,er !oal 2ist the pro$ect number as noted in the table in Section 1. 2ist the goal of the pro$ect. 0he goal should be measurable %a numeric goal, if possible). 2i3ely, the goal will focus on increasing food stamp participation. Indicate if the number of people is contacts, applicants, appro#ed applicants, etc. Start 4onth and year, quarter, or #n$ 4onth and year, quarter, or annual.ongoing. annual.ongoing. ro#ide a description of the acti#ity and how it will be implemented. If a contractor will be hired, list the name of the contractor. If there is no contractor, indicate so. 5escribe the role of the contractor. Add rows for additional contractors, if necessary. 2ist the name of partner -. artners may be community or faith6based organizations, local food stamp offices, food ban3s or pantries, retailers, or other community organizations. 7btaining a letter of commitment from your partners is good pro$ect management. It is suggested that you obtain such a letter from each partner and maintain the letter in your files. Add rows for additional partners, if necessary. 5escribe the role of partner -. Add rows for additional partners, if necessary. E+plain how the pro$ect will be e#aluated. Include your data collection and analysis plan. 'ote if your e#aluation will be able to assess how many people reached by the outreach acti#ities were certified or denied for food stamp benefits.

Timeline Description of Activit& Contractor ole of the Contractor Partner 1

ole of Partner 1 #valuation

3. Outreach Pro+ect Staffing Details

Sta&&ing +a3le: 8se this table as a wor3sheet to calculate the staffing cost for each pro$ect. Add more lines to the table as needed. 0he total in column f should be placed in the personnel line item %column f, row g) on your pro$ect budget detail table in section 9. 0he first row of this table is completed to pro#ide an e+ample. M ltiple year plans: Complete Section 4 eac" year#

Pro+ect "um,er Staff Person Title

( treac" )or*er

2ist the pro$ect number as noted in the table in Section 1. "ame of Staff Person
Smit"

-a. 4 FT# Outreach

4

-,. Salar&

-c 5 a6,. Outreach Salar&

5!26477

-$. %enefits ate

27 8

-e 5 c6$. Outreach %enefits

52477

-f5c7e. Total

5246777

5!4777

Insert more rows as needed.

8. Outreach Pro+ect %u$get Details an$ "arrative

9 dget Detail +a3le: Complete the budget detail table for each pro$ect listed in the Summary
Pro+ect "um,er' %9D!#T D#TAI: "on/Fe$eral Fun$s #;penses -a. Pu,lic Cash -,. Pu,lic In/<in$ -c. Private Cash -$5a7,7c. Total -e. Fe$eral Fun$s -f5$7e. Total Fun$s

(g) Personnel (Salary and 9ene&its) (t"er Direct Costs (") Copying:Printing:Materials (i) 1nternet:+elep"one (') $< ipment and (t"er Capital $%pendit res (*) S pplies -on Complete Capital $%pendit res M ltiple yearand plans: Section A eac" year# Approval o& 3 dgets is on an ann al 3asis# +" s6 approval o& t"e pcoming &iscal year 3 dget does not constit te approval o& any & t re (l) 9 ilding:Space year 3 dget presented in m lti,year plans# S c" 3 dgets will contin e to 3e approved ann ally# (m) (t"er (n=">i>'>*>l>m) S 3total (t"er Direct Costs +ravel (n) ?ong Distance (o) ?ocal (p=n>o) S 3total +ravel (<) Contract al -r5g7n7p7=. Total Personnel> Direct Costs> Travel> an$ Contractual (s = indirect cost rate @ r) 1ndirect Costs -t5r7s. TOTA:

0able in Section 1 abo#e. 0he table rows and columns are labeled and include math formulas to help you calculate the budget. Enter the personnel costs from your staffing table in section : in column f, row g. If there are no contracts, lea#e row q blan3. 9 dget -arrative:; sti&ication: ro#ide a budget narrati#e that e+plains and $ustifies each cost and clearly e+plains how the amount for each line was determined. *e sure to pro#ide details for what is included in the line labeled ;other< on the line item budget. %Suggested length& 'ot more than ( pages each.) =ustification E+ample& 2ocal tra#el is calculated at 9 round trips from Capital City to 'ewtown to train outreach wor3ers. Each trip is -(> miles round trip. %9+-(>?@(> total miles) 0he mileage rate is A.BC:. 0he total cost for local tra#el is @(>+A.BC:?A1BD.(>.

?. %u$get Summar&
?ine 1tem 9 dget: Complete the line item budget table below to present an o#erall line item budget for the entire outreach plan. Summarize the information presented in the budget detail tables for each pro$ect to complete this table. 0he table rows and columns are labeled and include math formulas to help you calculate the budget. If you ha#e no contracts, lea#e row q blan3. M ltiple year plans: Provide a 3 dget s mmary &or eac" year o& t"e plan and &or t"e plan as a w"ole# Complete Section Beac" year#
"on/Fe$eral Fun$s #;penses -a. Pu,lic Cash -,. Pu,lic In/<in$ -c. Private Cash -$5a7,7c. Total -e. Fe$eral Fun$s -f5$7e. Total Fun$s

:I"# IT#M %9D!#T S9MMA @

(g) Personnel (Salary and 9ene&its) (t"er Direct Costs (") Copying:Printing:Materials (i) 1nternet:+elep"one (') $< ipment and (t"er Capital $%pendit res (*) S pplies and -on Capital $%pendit res (l) 9 ilding:Space (m) (t"er (n=">i>'>*>l>m) S 3total (t"er Direct Costs +ravel (n) ?ong Distance (o) ?ocal (p=n>o) S 3total +ravel (<) Contract al -r5g7n7p7=. Total Personnel> Direct Costs> Travel> an$ Contractual (s = indirect cost rate @ r) 1ndirect Costs -t5r7s. TOTA:

A. Assurances
Chec< to In$icate @ou 0ave ea$ an$ 9n$erstan$ the Assurance Statement Assurance Statement

+"e State &ood stamp agency is acco nta3le &or t"e content o& t"e State o treac" plan and will provide oversig"t o& any s 3,grantees# +"e State &ood stamp agency is &iscally responsi3le &or o treac" activities & nded nder t"e plan and is lia3le &or repayment o& nallowa3le costs# ( treac" activities are targeted to t"ose potentially eligi3le &or 3ene&its# Cas" or in,*ind donations &rom ot"er non,Federal so rces "ave not 3een claimed or sed as a matc" or reim3 rsement nder any ot"er Federal program# 1& in,*ind goods and services are part o& t"e 3 dget6 only p 3lic in,*ind services are incl ded# -o private in,*ind goods or services are claimed# Doc mentation o& State agency costs6 payments6 and donations &or approved o treac" activities are maintained 3y t"e State agency and availa3le &or CSDA review and a dit# Contracts are proc red t"ro g" competitive 3id proced res governed 3y State proc rement reg lations# Program activities are cond cted in compliance wit" all applica3le Federal laws6 r les6 and reg lations incl ding Civil Rig"ts and (M9 reg lations governing cost iss es# Program activities do not s pplant e%isting o treac" programs6 and w"ere operating in con' nction wit" e%isting programs6 en"ance and s pplement t"em# Program activities are reasona3le and necessary to accomplis" o treac" goals and o3'ectives# 9y signat re on t"e cover page o& t"is doc ment6 t"e State &ood stamp agency director (or Commissioner) and &inancial representative certi&y t"at t"e a3ove ass rances are met#

B. Attachments
F-S,DAAA (9 dget Pro'ection) 1ndirect Cost Rate Agreement Add others as needed