Community Capacity Building Funds Application Readiness Questionnaire

The purpose of this survey is to help your organization assess readiness to begin the Community Capacity Building Fund application and help determine areas for capacity building for your organization. This is NOT the application and questionnaire responses will not alter your chances of receiving funding.

If you need help, please reach out to HRSNQuestions@eocco.com

Submitter Name*

Organization Name*

Submitter Email Address*

Is your organization capable of providing or supporting the provision of one or more HRSN services to Medicaid beneficiaries within the state of Oregon?*

Yes

Does your organization intend on contracting with EOCCO and/or other CCOs or with fee-for-service to serve as an HRSN provider for at least one HRSN service?*

Yes

For which of the following do you intend on contracting with EOCCO (check all that apply)?*

Climate

Housing

Nutrition

Do you serve at least one county in Oregon?*

Yes

Can your organization demonstrate a history of responsible financial administration via recent annual financial reports, an externally conducted audit, experience receiving other federal funding or other similar documentation?*

Yes

Does your organization employ or partner with case management providers, THWs or organizations that work with children, women and families?*

Yes

Does your organization have capacity to speak and write in languages other than English?*

Yes

Does your organization have resources to have member materials translated to languages or formats other than English?*

Yes

Does your organization undergo trauma informed care training at least once per calendar year?*

Yes

Does your organization have experience providing or distributing climate services (air conditioner, space heater, mini-refrigerator, portable power supply, air filtration devices etc)?*

Yes

Does your organization have experience providing housing services?*

Yes

Does your organization have experience providing nutrition services?*

Yes

Does your organization have experience providing outreach and education services?*

Yes

Does your organization have access to secure email?*

Yes

Does you organization have access to basic Microsoft office program (word, excel, PowerPoint etc.)?*

Yes

Does your organization have access to adobe pdf?*

Yes

Does your organization have access to printers, fax and internet?*

Yes

Does your organization have any concerns with staffing and administrative support in order to apply for and participate in the HRSN network with EOCCO?*

Yes

Does your organization have needs for any of the following HRSN investment efforts*

Technology

Development of business or operational practices

Workforce Development

Outreach, education and convening

Is your organization currently using the UniteUS Connect Oregon platform?*

Yes

Have Questions?*

Would you like someone from Oregon Rural Practice-Based Research Network (ORPRN), the organization helping mange the application process to reach out to you?

Yes

Contact Email

Important information about SHARE

CCBF funds cannot be spent on the below. If you plan do so, you can apply for funding through SHARE.

(a) Activities for which other federal, state, or local funding is available and allocated for use for the same purposes

(b) Real estate investments, developments and other capital projects

(d) Ongoing lease or utilities payments

(e) Staff time devoted to non-HRSN related responsibilities or services

(f) Debt restructuring and bad debt

(g) Defense and prosecution of criminal and civil proceedings, and claims

(h) Donations and contributions

(i) Entertainment (e.g., receptions, parties, conferences, sporting events, etc.)

(j) Alcohol

(k) Fines and penalties

(l) Fundraising and investment management costs

(m) Goods or services for personal use

(n) Idle facilities or infrastructure

(o) Interest expense

(p) Marketing materials not otherwise related to HRSN

(q) Lobbying

(r) Memberships and subscription costs not related to HRSN

(s) Patent costs

(t) Insurance costs (e.g., liability insurance, rental insurance, etc.)

(u) Individual-level incentives

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