Download Application Form for Grant-in-Aid to Volunatry Organisations Working in the Field of Disabilities

Application Form For 2nd Installment (To be submitted in duplicate) 2. Grant-in-aid applied forRecurring Non-recurring i Applied in the current Yearii Received as Ist Installmentiii Applied for 2nd Instalmen3. Annual Report of the previous year whether enclosed 4. Audited statement of account of previous year of the organisation as whole and for the project i. Receipt and Payment Statement, ii. Income & Expenditure Statement iii. Balance Sheet iv. Audited utilisation certificate with Item wise/post wise expenditure as per the sanctioned items of grant 5. Assets acquired wholly or substantially out of Government grants under GFR 19 6. Any other information considered necessary by the organisation or as asked for 7. Whether the organisation is receiving or expecting to receive any grant from some other source for the project for which application is being made ? 8. I hereby certify that I have read the rules and regulations of the scheme and I undertake to abide by them. On behalf of the Management, I further agree to the following conditions :- a. All moneys given as Grant in Aid and all assets acquired wholly or substantially out of the central grant shall not be encumbered or disposed of or utilised for purposes other than those for which the grant is given. Should the organisation cease to exist at any time or violate the above condition at any time, such properties shall revert to the Government of India. b. The accounts of the project shall be properly and separately maintained. They shall always be open to check by an officer deputed by the Government of India or the State Government. They shall also be open to a test check by the Comptroller and Auditor General of India at his discretion. c. If the State or the Central Government have reasons to believe that the grant is not being utilised for approved purposes the Government of India may stop payment of further installments and recover earlier grant in such manner as they may decide. d. The institution shall exercise reasonable economy in its working in general and in particular in respect of expenditure on building. NOYESName of the Scheme/Project1. Organisation Name Address Office Project Location e. In the case of grant for buildings, the construction will be completed within a period of two years from the date of receipt of the first installment of grant unless further extension is granted by the Government of India. f. No change in the Plan of buildings, or of the construction or of project location will be made without the prior approval of Government of India. g. Progress reports on the project will be furnished at regular intervals as may be specified by the Government. h. The organisation will bear 10% of the estimated expenditure or the balance of the estimated expenditure on the projects as per the guidelines. i. The organisation agrees to make reservation for the Scheduled Castes/Schedule Tribe candidate/ Disabled persons for appointment against the posts required for the working of the organisation in accordance with instructions issued by the Government of India from time to time. j. It is hereby certified that no grant is being received for the same project from any other (Govt. private or foreign) sources. Yours faithfullyOffice Stamp NameDesignation Address DateSignature of the Authorised Signatory Annexe-IIAPPLICATION FORM FOR GRANT-IN-AID TO VOLUNTARY ORGANISATIONS WORKING IN THE FIELD OF DISABILITIES (for Ist installment and new cases) PART-A 1. Financial year for which grant-in-aid is applied 2. Name of the Organisation 3. (a) Nature of the project [See note 1 at the end of Part A] (b) Date of commencement of the Project (c) Year of Commencement of Grant-in- aid from G.O.I for the Project (d) Whether the Project is recognised by the state government.[see note 2 at the end of Part A] 4. (a) Date of Registration of the organization (b) Registration Valid Upto [With documentary Support.] 5. Address of Registered Office 6. (a) Complete Address of Location(s) / Location wherever Programme / Project / Scheme is being implemented. (b) Nearest Railway Station/Bus stand 7. Whether building is: [To be supported by appropriate documentary evidence such as rent agreement, lease deed etc] 8. (a) Is the building being utilized exclusively for this program ? YESNO(STD Code) Tel. No. Fax No.EmailON LEASEDONATEDRENTEDOWNESTD Code Tel. No: Fax No. 9. (a) Area of building (b) Total Number of rooms 10. Whether separate project-wise accounts for both Grants received and Expenditure incurred thereon have been maintained? 11. Whether Practice of joint operation of bank Accounts is being followed? 12. Details of bank accounts in which grant-in-aid released, during last three financial years, were deposited: Sl. No Grant-in- aid for financial year Sanction letter number and Date Recurring Amount Non- Recurring Amount Bank A/c No. and date of deposit Name and address of Bank Person Operating the joint Account Note : [One row may be used for each installment. In the case of new projects details of Bank A/c opened may be given] 13. Whether the statements of accounts both for the project and consolidated for the organisation submitted alongwith the application 14. The amount of support sought from the Ministry for grant-in-aid for the project: (Rs. in lacs) Cost Head Group Total Budget To be met from Ministry's Grant To be met by Management from their sources To be met from other sources (a) Recurring (b) Non- Recurring (c) TotalNote: The Budget Estimates should also give information under all the cost components under which assistance is sought, clearly giving justifications, wherever necessary for additional items/posts, new post/items in a separate annexure. A mere reference to the ceilings given under the cost norms would not be sufficient. 15. Whether Annual Report is enclosed NOYESAUDITEDUNAUDITED Sq. mtrs [The report should internally contain details of performance of each Component / Activity of the project in specific physical terms of persons benefited, special achievements, problems and difficulties faced etc, steps taken for resource mobilization through community] 16. Whether List of Beneficiaries added as per Form -I 17. Whether List of Managing Committee added as per Form-II 18. Whether the List of Employees added as per Form-III Notes : Refer to 3a and 3d above 1) A Separate Annexure may be added wherever required. Broad description of the project should interalia necessarily address the following: a. Category of Disability, viz, Orthopaedically Handicapped, Visually Handicapped, Hearing Handicapped, Mentally Handicapped, Multiple Handicapped, Leprosy Cured etc or a combination of them which the project intends to cater to b. Programmes covered by the project namely (one or combination of them) i. Centre Based Special School providing formal education for one or more categories of disabled. ii. Integrated School with or without residential facility, levels such as primary, secondary etc. iii. Centre Based Special School providing informal education and training in the form or in the combination with pre school intervention, skills of basic management encompassing inputs of personal care, self help skills, daily living skills, functional academics etc or such other interventions. iv. Illustrated in (iii) above or rehabilitative services envisaged in (v) below v. Centre Based intervention meeting the rehabilitation needs (para medical) of in-house beneficiaries or outpatients through the services of specialists such as Physiotherapists, Occupational Therapists, Audiologist, behavioral Psychologist, Psychiatrist etc. specialists, Pediatrician, Speech Therapist, Psychologist, Clinical Pre-Vocational training and Sheltered Workshop, Vocational Training for Adult Beneficiaries, placement and employment services, projects in the nature of production units such Braille press etc. vii. Projects for Man Power Development comprising Teachers Training Programmes viii.Projects for Leprosy Cured bringing out the components of services to be provided. Description should clearly being out if the specifically identified beneficiaries are under the exclusive care of the organisation or part of an ashram where only limited facilities are given. ix. Community Based Rehabilitation Programmes x. Awareness generation, identification, survey, research etc. c. The fact that a programme /activity /component is residential or non-residential should be clearly brought out. NOYES d. If the project contains one or more of the above components efforts to identify the number of beneficiaries associated with the components should be made. e. In the case of new projects or new proposals the date from which the project is in operation; need for the project extent and nature of problem proposed to be addressed, existing projects or facilities available in the area; experience of the Organisation / Members of the management committee etc should be explained. f. In the case of proposals for construction of building the information provided should cover the following: i. Whether the Building is new one or expansion of existing structure ii. In case of expansion whether the original structure was financed with the assistance from the Ministry and details of sanction etc. vide which assistance extended. iii. Blue Print (site Plan) of the proposed building or expansion iv. Detailed structural estimates of the construction v. Total cost of Construction, Amount already spent, Sources of finance for the total cost. vi. Certificate to the effect that proposed cost of construction is not more than the prevailing PWD rates vii. Proof of possession of land in the name of the organisation and permission from the local authorities to construct the building viii. The purpose for which the building will be put to use This refers to recognition by State Govt. or its agencies in respect of schools, State Health Agencies in the case of Leprosy projects, RCI in the case of Man Power Development Programmes, Registration with respective Commissioner with Disability whichever is applicable. 2. List of Attachments PART-B19. Details related to beneficiaries to be given for each of the programmes /activities for which assistance has been applied for, preferably in separate annexures A. Abstract of Beneficiaries Category of Disability No. of Beneficiaries OH M F MR M FVHHHM F LCP Multiple Disabled Others (Specify) Total i. At the start of the previous year ii. Additions during the previous year iii.Dropouts /Left outs iv. Successfully completed (those who have left the institution after completion) v. At the end of the previous year [(i+ii)-(iii+iv)] vi.Out of (v) above a. Residential: b. Non - Residentialvii. No of Benefic iaries as on the date of application for the current year viii. Out of (vii) above: a. Residential b. Non - ResidentiaNote: The list of beneficiaries will be given as per format contained in Form -I . The total number in the list should normally be equal to totals of row (i) Plus Row (ii). In respect of previous years and Row (vii) In respect of the current year. In the case of Vocational Training Centres / Sheltered Workshops the information as required above and associated list in Form I may be provided Tradewise / Vocationwise. Previous year means the immediately preceding financial year to the year for which the grant is applied for. B. Classification of period of stay with the organisation (With reference to the information given in row A (v) above) [i] Skill Development component( For VTCs) Category of Disability No. of years stay OH MR VH HH LCP Multiple HandicappedOthers (to be Specified Total Up to 1year1-2 years2-3 yearMore than 3years [ii] Schools/ training components other than (i) above [iii] For Teachers Training/ Man Power Development Programs Name of the course, duration, batch size and no of batches OH MR VH HH LCP Multiple Up to 5yearFrom 5-10 yearsMore than10years Note: B (i) to B(iii) to be given where applicable C. Information on Process and Procedure of selection of beneficiaries Prev. Year Current yeara. Number of Applications Received b. Number selected during the relevant year c No of beneficiaries for whom Disability Certificate Obtained (out of (b) above) d. If VTC whether an undertaking has been obtained from all beneficiaries that they have not availed of similar vocational training earlier e. Mode of Selection and broad criterion adopted D. Community Based Rehabilitation Programme (Only if there is a component in the project) a. Inputs on Coverage of the Programme i. In terms of number of villages ii. In terms of area in Sq Kms. iii. In terms of number of Beneficiaries b. Core area of rehabilitative services: i. Awareness Creation ii. Education iii. Training iv. Rehabilitation (Details of activities undertaken, phasing of components in the area of awareness creation, education, training and rehabilitation may be added as separate annexure clearly indicating the financial year, no. of beneficiaries covered in that year etc.). c. Details of strategies and time frame for BOT of the Programme to the community 1E . Whether the NGO is networking with other institutions to obtain the benefits of services which it cannot provide Internally ? If so details, thereof 20. ANNUAL IMPACT ASSESSMENT AT THE END OF THE PREVIOUS YEAR During Upto Prev. Year End of PrevYear 4. Total of beneficiaries Out of the above:- (i) Those passed out of the Institution successfully Build Operate and Transfer Sq mtrs.NOYES (ii) Promoted to next grade in the same organization (iii) Pursuing further studies/care in other organizations (iv) No. of dropouts(B) Total No. of Beneficiaries successfully trained and have left the Center during the last three years (For Vocational / Skill Development Projects only) Out of the above:- (i) Those who got employed/ placements (ii) Those who are self-employed Details on remuneration from placements: (Ref (B(i)) above) Details on remuneration from Self-Employment: (Ref (B (ii)) above) Community Based Rehabilitation Programme: (Add separate Sheets if necessary) i. Details of extent of involvement of community Groups: a) Through financial support: b) Participation in the project as resource Persons: c) Through other means Indicate the No. of Employed under each range of earnings from gainful employment / placements in Govt. or Private Sector below Rs.1000 p.m. Rs.1000 to Rs 4000 Above Rs 4000 Total beneficiariesIndicate the No. of Self-employed under each range of earnings accruing from Self-employment Preceding Three Years (e.g. entered) 97-9898-9999-00 ii. Details of achievements in terms of making the local community take over and operate the project: Name of the Activity % of activity taken over by community Details of Activities taken over by the community. % VERIFICATION Certified that above information is in accordance with the records and accounts audited / to be audited and is correct to the best of knowledge and belief of the office-bearers of the organization, and after its perusal and satisfaction, they have authorized the undersigned by a resolution dated (copy enclosed) to verify and submit the statement of information for purposes of monitoring the scheme for which rants-in-aid was received from the Ministry of Social Justice & empowerment, Govt. of India. 2. I also hereby certify that I have read the rules and regulations of the scheme and I undertake to abide by them. On behalf of the Management. I further agree to the following condition:- a. All moneys given as Grant in Aid and all assets acquired wholly or substantially out of the central grant shall not be encumbered or disposed of or utilised for purposes other than those for which the grant is given. Should the organisation cease to exist or violate the above condition at any time, such properties shall revert to the Government of India. b. The accounts of the project shall be properly and separately maintained. They shall always be open to check by an officer deputed by the Government of India or the State Government. They shall also be open to a test check Comptroller and Auditor General of India at his discretion. c. If the State or the Central Government have reasons to believe that the grant is not being utilised for approved purposes; the Government of India may stop payment of further installments and recover earlier grant in such manner as they may decide. d. The institution shall exercise reasonable economy in its working in general and particularly in respect of expenditure on building. e. In the case of grant for buildings, the construction will be completed within a period of two years from the date of receipt of the first instalment of grant unless further extension is granted by the Government of India. f. No change in the Plan of buildings, the construction or of the project location will be made without the prior approval of the Government of India. g.Progress reports on the project will be furnished at regular intervals as may be specified by the Government. h. The organisation will bear 10% of the estimated expenditure or the balance of the estimated expenditure on the project as per the guidelines i. The organisation agrees to make reservation for the Scheduled Castes / Schedule Tribe candidate / Disabled persons for appointment against the posts required for the working of the organisation in accordance with instructions issued by the Government of India from time to time. j. It is hereby certified that no grant is being received for the same project from any other (Govt., Private or foreign) source . Yours faithfullySignature of the Authorised Signatory Name Designation Address Date Office Stamp List of Documents to be submitted alongwith Application for Ist instalment or new case. a. Accounts in 4 parts for the project for which grant-in-aid is sought and for the organisation as a whole and for the project for which Grant in aid applied for. (i). Income & Expenditure Statement (ii). Receipt & Payments Statement (iii). Balance Sheet (iv). Auditors Report b. Activity/ Annual Report of the Organisation for the previous year. c. Budget Estimates for the project for current year with detailed justifications for various cost items. d. Details of Beneficiaries on Form-I e. Details Managing Committee on Form-II f. Details of Employees on Form -III g. Copy of Registration Certificate h. Memorandum of Association/bye-laws/Articles. i. Utilisation Certificate in respect of grants released in the previous year in form IV j. Such other documents to substantiate submissions made in the application. NOTE i. In the case of new projects accounts should be audited and the accounts submitted for the last preceding) two years. Utilisation Certificate does not apply. ii. The term audited means accounts duly audited by the Chartered Accountant along with audit report and not mere compilation /preparation of reports on the basis of books produced. PART-C21. Organisations Funds FlowFOR THE ORGANISATION AS A WHOLE FOR THE PROJECTParticulars Previous Year actual Current budgeted/ actual actual I. Financial year II. Total Income of which (each major source within the group to be specified) (i) (a) funded by office-bearers (b) donations from private sector. (ii) funded by foreign contribution. (iii) funded by local bodies and public sector organization/State Govt. (iv) grant from Central Govt.( indicate from each Ministry/ Deptt/ CAPART separately.) (v) Beneficiaries contribution/User Charges (vi) Miscellaneous income (vii) Any Other sources not mentioned above (viz sale of products etc) (specify) III. Total Expenditure, of which: Recurring Non-recurring For the organistion as a whole for the project IV Detail of Expenditure on :(i) Honorarium etc. (ii) Rental : (a) Building (b) Furniture & fixture Year of comme ncement or financial year 1998-99 which ever is later Year of comme ncement or financial year 1998-99 which ever is later Year of comme ncement or financial year 1998-99 which ever is later (c) Plant & Machinery (d) Others (to specify) (iii) Direct expenses on beneficiaries (given in cash/cheque) a) Stipend b) Transport Allowance c) Others (to specify) (iv) Direct expenses incurred on beneficiaries (in kind) a) Food Charges b) Transport Allowance (if not directly disbursed) c) Medicines d) Excursions, Recreations e) Others (to specify)(v) Expenditure against contingencies (Printing and Stationery, telephone, conveyance, etc. items to be specified) (vi) Building Maintenance repairs (vii) Material costs incurred (for imparting Vocational Training etc. ) (viii) Others (to be specified) (V). Total Cost and Cost per beneficiary: