The Community Support Fund is a community-based package of financial and non-financial support for disabled people in the areas affected by the Remploy factory closures. Full details here: http://odi.dwp.gov.uk/communitysupportfund This is the application form. It can also be downloaded here (along with other alternative formats): http://dev.odi.gov.uk/odi-projects/community-support-fund/how-to-apply.php

1. July 2012 Our reference number:
Community Support Fund: Application Form
Thank you for considering applying to the Community Support
Fund.
To assist you in completing this form we have created some
guidance notes. Accessible versions of this form and the guidance
notes are also available. All of these can be found on our website:
http://odi.dwp.gov.uk/communitysupportfund
Please read the guidance notes before you complete this
application form. They contain useful information about the
Community Support Fund, including by when your application
should be submitted for consideration in each funding round.
If you have any questions about your application please contact us
by emailing odi.businessperformance@dwp.gsi.gov.uk.
Your contact details
Name of your organisation:
Name and position in the organisation of the person
completing this form:
Postal address:
Telephone number:
Mobile phone number:
Email address:
Organisation website:
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2. July 2012 Our reference number:
1. About your application
1.1 Is this a partnership/joint application?
Yes (see questions below) / No
(proceed to Section 2)
Please note: Applications to the Community Support Fund from
organisations working in collaboration – that can develop and
demonstrate effective partnership working, especially with disabled
people and their organisations – will be particularly encouraged.
See Section 9.2 – Area 3 of the Guidance Notes.
1.2 Are you the lead contact/organisation?
Yes / No
Please note only the lead organisation can make the
application
1.3 List the name(s) of the organisation(s) who you are working
with you in this project/activity
1.3 Is/Are the organisation(s) you are working in partnership with
one or more of the following:
• A Disabled People’s User-Led Organisation (DPULO)
Yes / No
• A Voluntary and Community Sector Organisation
Yes / No
• A
Yes / No
• A Social Enterprise
Yes / No
• A Community Interest
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3. July 2012 Our reference number:
Yes / No
• A Non-Profit Organisation
Yes / No
• An employee- or member-owned organisation
Yes / No
• Other (please specify
Yes / No
• Working in collaboration with another organisation (Please
provide details
Yes / No
2. About the lead organisation
2.1 Are you:
• A DPULO
Yes / No
• A Voluntary and Community Sector Organisation
Yes / No
• A Charity
Yes / No
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4. July 2012 Our reference number:
• A Social Enterprise
Yes / No
• A Community Interest Company
Yes / No
• A Non-Profit
Yes / No
• Other (please specify
Yes / No
3. Your location
3.1 Are you:
• In one or more local community/communities affected by a
Remploy Factory closure?
(A list of geographical areas is included in the Guidance
Notes.) Yes / No
Please state which area(s):
• 3.2 If not, can you demonstrate a clear understanding of the
needs of the local community/communities affected by the
Remploy Factory closure?
Please supply supporting evidence.
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5. July 2012 Our reference number:
4. Funding
4.1a Can you confirm that your organisation has not received
funding for this particular project/activity from UK Government or
the Devolved Administrations
Yes/ No
4.1b Can you confirm that this project/activity is over and above
what your organisation is delivering with any funding from central
government or the Devolved Administrations
Yes/ No
4.1c Have you received or applied for funding from either the
Community Support Fund or Strengthening DPULOs Programme
Facilitation Fund1 before?
Yes / No
If yes, please provide your reference number(s):
4.2 Please provide confirmation that you are applying for the
funding as the lead officer for the organisation and have regularly
audited accounts that could be made available on request
Yes / No
4.3 Please confirm you can receive payment of any award made
through the Community Support Fund
Yes / No
4.4 Please provide confirmation that you have read and
understand your obligations with regards to de minimis awards
received, detailed in Schedule 3
Yes / No
1
Question only applicable to England-only organisations pre-July 2012
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6. July 2012 Our reference number:
4.5 What is the total amount of de minimis aid your organisation
has already been granted during the previous two fiscal years and
the current fiscal year?
4.6 Please confirm that the amount of grant applied for will not
result in the total amount of de minimis aid received during the
previous two fiscal years and the current fiscal year exceeding
€200,000
Yes / No
4.7 Please confirm that you will retain details of this grant and
produce it on any request by the UK public authorities or the
European Commission
Yes / No
5. About your proposed activity / project
5.1 What is the name of your proposed activity / project?
5.2 How much you are applying for?
5.3 Please summarise your proposed activity / project (150
words max)
5.4 Please use the Project Plan template contained at Schedule
1 to tell us your proposed key activities, outputs and associated
timescales
5.5 For each activity and associated output(s) please use the
Budget Breakdown template contained at Schedule 2 to tell us
what money you require
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7. July 2012 Our reference number:
6. Delivering the outcomes of the Community Support
Fund
6 How will your proposed activity / project make a positive
difference to the lives of disabled people affected by the
Remploy Factory closure?
To do so, it should cover one or both of the following bullets:
• Support individuals to become actively involved in their
local communities
or/and
• Support individuals to make the move from sheltered to
mainstream employment. (100 words)
(See Sections 2 and 3 of the Guidance notes for more
information about the the aim and objectives of the
Community Support Fund)
7. Developing Communities and working in partnership
• Important note: you must clearly demonstrate how disabled
people affected by the Remploy Factory closure have been
involved in developing the proposed activity / project. See
Area 2 of the Essential Criteria in the Guidance Notes.
7.1 What individuals or groups have you engaged with to
develop your proposed activity / project? Please list all of them
here.
For example:
• Ex-Remploy employees?
• Remploy factory?
• A DPULO Ambassador/National Lead?
• Other local organisations?
• Local Authorities?
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8. July 2012 Our reference number:
• Local employers?
• Anyone else?
7.2 How have you engaged these individuals / groups to develop
your proposed activity / project? (100 words)
7.3 How will you be taking forward the partnership working to
meet the objectives of this project/activity? (100 words)
7.4 How will your activity / project develop, or strengthen links
within the local community? (100 words)
7.5 If you haven’t discussed this activity / project with anyone
else, please tell us why (100 words)
Please enclose any relevant letters of support with your application
as this will strengthen your application.
8. Capturing impact, sustaining involvement and sharing
learning
• 8.1 How will you capture and understand the impact the
proposed project / activity has to ensure it makes a positive
difference to the lives of people affected by the a Remploy
Factory closure? (100 words)
• 8.2 Where possible, we would like to see the impact of the
Community Support Fund extend beyond the funding period.
How will you try to sustain the involvement of people affected
by the Remploy Factory closure in your work beyond the
time of the formal project? (100 words) Please note: This
question is for information only. It will not be marked.
8.3 How will you capture the wider learning from your activity /
project for the benefit of DPULOs and VCS organisations more
generally, especially in working with disabled people? (100 words)
Please note: This question is for information only. It will not be
marked.
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9. July 2012 Our reference number:
9.Confirmation
I confirm that if my application is successful I am happy for details
of my award and my organisations name and any partner names to
be published on the ODI website and used in press releases to
publicise the fund.
Yes / No
This application form has been completed and authorised by:
Signature:
Print name:
Position:
Organisation:
Date:
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10. July 2012 Our reference number:
10. Sending us your Community Support Fund application
Your completed application form for the Community Support Fund
should include all of the following:
• This application form
• Letters of support
• A completed project plan (Schedule 1)
• A completed budget breakdown (Schedule 2)
Once you have completed your Community Support Fund
application form, please send it to the Making a Difference team at:
• Email: odi.businessperformance@dwp.gsi.gov.uk
• Post: Office for Disability Issues, Ground Floor, Caxton House,
6-12 Tothill Street, London SW1H 9NA
You will receive confirmation from us that we have received your
Community Support Fund application within 7-14 working days.
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11. July 2012 Our reference number:
Community Support Fund Application: Schedule 1 – Your project plan
Name of your organisation:
Please complete this project plan template to tell us more about your proposed activity / project in more
detail (to answer Question 5.4 of the application form).
Activity Output Timescale
1.
2.
3.
4.
5.
Please add further rows as
necessary
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12. July 2012 Our reference number:
Community Support Fund Application:
Schedule 2 – Budget breakdown
Name of your organisation:
Please provide a breakdown of the costs you think will be covered
by any funding awarded (to answer Question 5.5 of the application
form).
Activity number
this relates to Budget (UK
Item of expenditure
(from your project sterling)
plan)
1.
2.
3.
4.
5.
Please add further
rows as necessary
Total:
This budget breakdown has been completed and authorised by:
Signature:
Print name:
Position:
Organisation:
Date:
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13. July 2012 Our reference number:
Community Support Fund Application: Schedule 3 –
State Aid requirements
What is State aid?
Where a public body provides financial support to an organisation
engaged in commercial and economic activity, it is necessary to
consider whether such support constitutes State aid.
State aid applies if:
• Aid is granted by a Member State or through its resources;
• It favours certain undertakings or the production of certain
goods
• It distorts threatens to distort competition ; and
• It affects trade between Member States.
Key questions to consider if a payment will fall within the
state aid regulations:
1. Is the support provided granted by the State?
This includes all public and private bodies controlled by the state to
distribute public funds. For example, Lottery, tax exemptions, grants,
subsidies.
2. Does the support confer a selective advantage to an
undertaking?
A benefit which is granted for free or on favorable (non-commercial)
terms to some selected organisations (but not others), could be state
aid.
Definitions:
Advantage: An advantage can take the form of direct payment of
state resources in the form of grants and subsidies as well as
indirect benefits that affect the public budget such as tax breaks, rate
rebates, low interest loans, sale of public land below market value
and the provision of services for free or at below-market rates.
Selectivity: Support that targets particular businesses, regions or
types of firm e.g. SMEs or particular sectors and not others is
selective.
Organisations - do not have to be profit-making as long as the
activity carried out is one which, in principle, has commercial
competitors. This can include voluntary and non-profit-making public
or public authorities when they are engaged in economic activity.
Charities, universities, research institutions, voluntary entities, social
enterprises and public sector bodies will be considered when they
are engaged in economic activity.
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14. July 2012 Our reference number:
Economic activity: Offering goods or services on a given market
and which could, at least in principle, be carried out by private actors
in order to make profits.
3. Does the support distort or have the potential to distort
competition?
If the funding has the potential to strengthen the position of the
organisation relative to other competitors then this criteria is likely to
be met.
The potential to distort competition does not need to be substantial
or significant, and this criterion can apply to relatively small amounts
of financial support and firms with little market share.
4. Does the support affect trade between Member States?
Commission's interpretation of this is broad - it is sufficient that a
product or service is tradeable between member states, even if the
recipient of support does not itself export to other EU markets. This
test is not met only in very limited circumstances.
If all four questions are met State Aid applies.
Additional information about de minimis aid previously
received
You are being considered for assistance under the De minimis
Regulation (Regulation 1998/2006). This may allow an enterprise
to receive up to €200,000 de minimis aid over any period of three
fiscal years.
To establish whether you are eligible to receive de minimis aid you
must declare the full amount of de minimis aid which you have
already been granted during the previous two fiscal years and the
current fiscal year.
Any assistance you may have received from a public body could
potentially be de minimis aid. This might include assistance
received from central, regional, or devolved governments, as well
as from other agencies or local councils.
You should have received a letter informing you if you were given
assistance under the de minimis regulation. If you are unsure as to
whether or not any public assistance you have received is de
minimis aid, please contact the granting body to clarify.
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15. July 2012 Our reference number:
Please provide information about any public assistance under
€200,000 you have received in the last three years in question 6 of
the application form.
The following is not a comprehensive list of all possible forms of
aid. However, it should provide an indication of some of the most
common forms of de minimis aid which you may have been
awarded over the past three years.
Forms of possible aid:
• State grants;
• Interest rate relief;
• Tax relief;
• Tax credits;
• State guarantees or holdings;
• State provision of goods or services on preferential terms;
• Direct subsidies;
• Tax exemptions;
• Preferential interest rates;
• Guarantees of loans on especially favourable terms;
• Acquisition of land or buildings either gratuitously or on
favourable terms;
• Provision of goods and services on preferential terms;
• Indemnities against operating losses;
• Reimbursement of costs in the event of success;
• State guarantees, whether direct or indirect, to credit operations
preferential re-discount rates;
• Dividend guarantees;
• Preferential public ordering;
• Reduction of, or exemption from, charges or taxes, including
accelerated depreciation and the reduction of social
contributions;
• Deferred collection of fiscal or social contributions;
• Assistance financed by special levies;
• Capital transfers;
• Certain State holdings in the capital of undertakings.
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