§ 51d.4 What information is required in the application?

(a) Application for Immediate awards: The application is to contain the following information: (1) A certification by the State's chief executive officer, or, for the purposes of a Federally recognized Indian tribal government, the principal elected official, or such officer's or official's designee, that a mental health or substance abuse emergency exists, as well as a written statement setting out the basis for the certification; (2) A brief program plan describing needs; (3) An estimate of the number of people to be served and the geographical area to be served; (4) A description of the types of services to be provided; (5) A budget justifying the amount of the request; (6) Required certifications; and (7) Such other pertinent information as the Secretary may require. (b) Application for Intermediate awards: The application is to be submitted on an OMB-approved application form and contain the following: (1) If the applicant has not applied previously for an Immediate award, a certification by the State's chief executive officer, or, for the purposes of a Federally recognized Indian tribal government, the principal elected official, or such officer's or official's designee, that a mental health or substance abuse emergency exists, as well as a written statement setting out the basis for the certification; (2) An application submission date within three months of the date of the event that precipitated the mental health or substance abuse emergency, as certified in accordance with 51d.4(a)(1) or (b)(1), except that upon the request of a State, the Secretary may provide a waiver of this application submission deadline if the Secretary determines there is good cause to justify the waiver; (3) A detailed and comprehensive assessment of need; (4) Demographics specific to the estimated number of people to be served; (5) A description of the services that were provided up to the date of the submission of the Intermediate award application; (6) The geographical area to be served; (7) A detailed implementation program plan and related time line, including a description of outreach to special population groups affected by the crisis; (8) A budget justifying the amount of the request for personnel, equipment, supplies, travel, training, data collection and any technical assistance required; the budget shall include an identification of the resources the applicant is able to commit to the project, if any, including any in-kind contributions; (9) Any information that has changed since an Immediate application was submitted, if one was submitted; and (10) such other pertinent information as the Secretary may require. (c) Signature on Award Applications. The application must be signed by an individual authorized to act for the applicant and to assume on behalf of the applicant the obligations imposed by the statute, all applicable regulations, and any additional conditions of the grant.