EFSP Application

Agency Information
Funding Request
$
Shelter/Housing

Shelter Application

Only complete this section if your program is applying for emergency shelter funds.

Eligible program costs:

  • Rent/Mortgage assistance: one month’s rent or mortgage payment for individuals and families when payment is in arrears and the client is a resident of the home, is responsible for the rent/mortgage, and all other resources have been exhausted.  Note: Payment must guarantee an additional 30 days of service.
  • First month’s rent for individuals/families who are transient and plan to stay in Payne County for an extended period of time; are moving from a temporary shelter to more permanent housing; or are being evicted because one-month payment will not forestall eviction in current housing.  Note: Payment must guarantee 30 days of service.
  • Off site emergency lodging in a hotel or motel when no other appropriate shelter is available.  Note: Payment must not be more than 30 days of service.

Ineligible costs:

  • Late fees, legal fees, deposits, and condo fees.

Please complete all information below if you are applying for funds to supplement current shelter programs.

Shelter/Housing Funding Application
$
Describe the program's current rent/mortgage assistance program, including the type of service provided, income eligibility criteria, geographical restrictions, how often service is provided, tracking of participants and the number of households assisted in the previous calendar year.
Describe the proposed use of EFSP funding.
Mass Shelter Expenses

Mass Shelter Expenses Application

Only complete this section if your program is applying for mass shelter funds.

Eligible program costs:

  • Reimbursement of actual direct eligible costs for supplies/equipment essential to the operation of the mass shelter (e.g., cots, mattresses, soap, linens, blankets, cleaning supplies, etc.).
  • Per diem allowance of exactly $12.50 per person per night for mass shelter providers (five beds or more in one location). 
  • Cost related to the operation of the mass shelter is not limited to otherwise eligible items. The per diem allowance may be used to cover costs such as shelter rent, shelter utilities, and shelter staff salaries if necessary to provide a night of shelter.

Please complete all information below if you are applying for funds for mass shelter programs.

Mass Shelter Funding Application
$
Describe the program's current mass shelter use.
Describe the proposed use of EFSP funding.
Utility

Utility Application

Only complete this section if your program is applying for emergency utility assistance funds.

Eligible program costs:

  • Metered utility assistance (includes gas, electricity, water and sewer service): one month’s costs for each utility for individuals or households when payment is in arrears, and the client is a resident of the home and is responsible for the utility billing, and all other resources have been exhausted.  Note: Payment must guarantee an additional 30 days of service.
  • Non-metered utility assistance (includes oil, firewood, and coal) for individuals and families: payment is limited to a one-time delivery (minimum amount of delivery).  Note: The intent of non-metered utility assistance is to provide 30 days of service.

Ineligible costs:

  • Payments for utilities exceeding one month’s costs, late fees, deposits, cable TV bills, and phone bills.

Please complete all information below if you are applying for funds to supplement current utility programs:

Utility Application
$
Describe the program’s current utility assistance program, including the type of service provided, income eligibility criteria, geographical restrictions, how often service is provided, tracking of participants and the number of households assisted in the previous calendar year.
Describe the proposed use of EFSP funding.
Food

FOOD APPLICATION

Only complete this section if your program is applying for emergency food assistance funds.

Eligible program costs:

  • Food items in the form of served meals or groceries;
  • Purchase of consumable supplies essential to mass feeding (plastic cups, plates, utensils, detergent, etc.);
  • Purchase of consumable supplies essential to mass shelters (i.e. hygiene products, cleaning supplies, limited first aid supplies);
  • Purchase of consumable supplies essential to the distribution of food (i.e., bags, boxes, etc.);
  • Purchase of small equipment not exceeding $300 per item and essential to mass feeding (i.e., pots, pans, utensils, and small appliances).

 
Ineligible costs:

  • Tobacco, alcohol, food for special events/holiday events.

Please complete all information below if you are applying for funds to supplement current feeding programs:
 

Food Application
Describe the program’s current food assistance program, including the type of service provided, income eligibility criteria, geographical restrictions, how often service is provided, tracking of participants and the number of households assisted in the previous calendar year.
Describe the proposed use of EFSP funding.
The Emergency Food and Shelter National Board Program (EFSP) is a restricted federal grant. All federal grants have terms and conditions that apply to all parties participating in the grant.  By submitting this application I agree to follow all EFSP terms and conditions.