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Nevada 2-1-1
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Forms, Exhibits and Other Program Information
Description
Exhibit 1-Solutions Grant Reimbursement Request Form
Exhibit 2- ESG Housing Status - Homeless Prevention
Exhibit 3- ESG Income Verification for Employers and Other Income Providers
Exhibit 3a- Solutions Grant Time Sheet
Exhibit 3b- Solutions Salary Coversheet
Exhibit 4- ESG Self-Declaration of Household Income
Exhibit 4a- Solutions Grant Budget Form
Exhibit 5- ESG Documentation Checklist Financial Assistance Housing Unit
Exhibit 6- ESG Documentation Checklist - Eligibility
Exhibit 7- Rent Reasonableness Checklist and Certification
Exhibit 8- Staff Certification of Eligibility for ESG Financial and Housing Relocation and Stabilization Assistance
Exhibit 9a- Lead Screening Worksheet for ESG Clients
Exhibit 9b- Lead Paint Checklist
Exhibit 9c- Lead-Based Paint Requirements
Exhibit 10- ESG Client File Checklist (corrected 4-13-13)
Exhibit 11- ESG Housing Status-Homeless
Exhibit 12 - Semi-Annual Certification of Employee Costs Charged to Federal Grants
Exhibit 13- Grant Close Out Report
Exhibit 13a- 2015 ESG Annual Performance and Matching Report
Exhibit 13b- Annual Performance Evaluation
Exhibit 14- Sample Landlord MOU
Exhibit 15a- Housing Standards Checklists
Exhibit 20- Solutions Grant Monitoring Checklist 03-13
Exhibit 21- Self-Assessment Survey
Exhibit 22- HMIS Project Management Tool - Agency Compliance Self Assessment
Exhibit A(1)- Salary Table
Exhibit A(2)- Salary Table-Shelters
Exhibit A(2a)- Time Sheet-Financial Assistance Activities
Exhibit A(2b)- Time Sheet-Shelter and Street Outreach
ESG Homeless Prevention and Rapid Re-Housing Program Summary
Written Standards Checklist
Termination and Grievance Policy
Conflict of Interest Policy-Version 1.0
Emergency Solutions Grant Interim Rule
Emergency Solutions Grant Program Guidelines-revised 4-2015
ESG Policies and Procedures Manual revised 4-2015
ESG Privacy Policy Notice-Version 2.0
ESG & RNCoC Written Standards rev 04-15
2015 RNCOC and ESG Performance Evaluation