[]{.mark}

**U.S. Department of Health and Human Services**

**Health Resources and Services Administration**

*HIV/AIDS Bureau*

*Special Projects of National Significance (SPNS)*

**Innovations in Oral Health Care Initiative:**

**(1) Demonstration Models and (2) Evaluation and Support Center**

*Announcement Type: New Competition*

*Announcement Number: HRSA-06-042*

**Catalog of Federal Domestic Assistance (CFDA) No. 93.928**

[]{.mark}

**PROGRAM GUIDANCE**

Fiscal Year *2006*

**Application Due Date: March 31, 2006**

**Release Date: January 24, *2006***

**Date of Issuance: January 24*, 2006***

*Lois Eldred, DrPH, MPH, Chief, Demonstration and Evaluation Branch*

*Division of Science and Policy*

*Telephone: 301/443-3327*

*Fax: 301/594-2511*

*E-mail: <Lois.Eldred@hhs.hrsa.gov>*

Authority: Section 2691 of the Public Health Service Act, 42 U.S.C. §
300ff-101.

[]{#__RefHeading___Toc124234576 .anchor}**TABLE OF CONTENTS**

[TABLE OF CONTENTS 2](#__RefHeading___Toc124234576)

[I. Funding Opportunity Description
2](#i.-funding-opportunity-description)

[1. Purpose 2](#purpose)

[2. Background 2](#background)

[3. Program Requirements and Expectations
2](#program-requirements-and-expectations)

[II. Award Information 2](#ii.-award-information)

[1. Type of Award 2](#type-of-award)

[2. Summary of Funding 2](#summary-of-funding)

[III. Eligibility Information 2](#iii.-eligibility-information)

[1. Eligible Applicants 2](#eligible-applicants)

[2. Cost Sharing/Matching 2](#cost-sharingmatching)

[3. Other 2](#other-eligibility-information)

[IV. Application and Submission Information
2](#iv.-application-and-submission-information)

[1. Address to Request Application Package
2](#__RefHeading___Toc124234589)

[Application Materials 2](#application-materials)

[2. Content and Form of Application Submission
2](#content-and-form-of-application-submission)

[Application Format Requirements 2](#application-format-requirements)

[Application Format 2](#application-format)

[i *Application Face Page* 2](#i.-application-face-page)

[*ii. Table of Contents* 2](#ii.-table-of-contents)

[*iii. Application Checklist* 2](#iii.-application-checklist)

[*iv. Budget* 2](#iv.-budget)

[*v. Budget Justification* 2](#v.-budget-justification)

[*vi. Staffing Plan and Personnel Requirements*
2](#vi.-staffing-plan-and-personnel-requirements)

[*vii. Assurances* 2](#vii.-assurances)

[*viii. Certifications* 2](#viii.-certifications)

[Demonstration Site Applications 2](#demonstration-site-applications)

[*ix. Project Abstract* 2](#ix.-project-abstract)

[*x. Program Narrative* 2](#x.-program-narrative)

[*xi. Appendices* 2](#xi.-appendices)

[Evaluation and Support Center Applications
2](#evaluation-and-support-center-applications)

ix\. [Project Abstract 2](#project-abstract)

x\. [Program Narrative 2](#program-narrative)

xi\. [Appendices 2](#appendices)

[3. Submission Dates and Times 2](#submission-dates-and-times)

[4. Intergovernmental Review 2](#__RefHeading___Toc124234611)

[5. Funding Restrictions 2](#funding-restrictions)

[6. Other Submission Requirements 2](#other-submission-requirements)

[V. Application review information
2](#v.-application-review-information)

[1. Review Criteria 2](#review-criteria)

[2. Review and Selection Process 2](#review-and-selection-process)

[3. Anticipated Announcement and Award Dates
2](#anticipated-announcement-and-award-dates)

[VI. Award Administration Information
2](#vi.-award-administration-information)

[1. Award Notices 2](#award-notices)

[2. Administrative and National Policy Requirements
2](#administrative-and-national-policy-requirements)

[3. Reporting 2](#__RefHeading___Toc124234621)

[4. Performance Review 2](#performance-review)

[VII. Agency Contacts 2](#vii.-agency-contacts)

[IX. Tips for Writing a Strong Application
2](#ix.-tips-for-writing-a-strong-application)

[ADDENDUM 2](#addendum)

[APPLYING THROUGH GRANTS.GOV 2](#applying-through-grants.gov)

[Background References 2](#background-references)

# I. Funding Opportunity Description

## 1. Purpose

The Special Projects of National Significance (SPNS) Program is
authorized by Section 2691 of the Public Health Service Act (The Ryan
White Comprehensive AIDS Resources Emergency Act of 1990, as amended by
the Ryan White CARE Act amendments of 1996 (PL 104-146) and amendments
of 2000 (PL 106-345)). The program is authorized to award direct grants
to public and nonprofit private entities to carry out the objectives of
the law. This SPNS Program Competitive Application Guidance is provided
to assist applicants in preparing a request for funding to implement the
fiscal year (FY) 2006 Oral Health Care Initiative. This funding
initiative will support organizations using innovative models of care to
provide oral health care to HIV-positive, underserved populations.

This Guidance contains instructions for completing a comprehensive
application response. It provides background on the SPNS Oral Health
Initiative. It also provides information on completing the application
form, preparing the budget, and developing the narrative sections of the
application. Applicants must use the enclosed Public Health Service
(PHS) Application Form 5161-1 to prepare the application. Additional
copies of the form may be downloaded from the Internet at
<http://www.hhs.gov/forms> and click on Public Health Service.

## 2. Background

The human immunodeficiency virus (HIV) epidemic continues to pose
enormous challenges in the United States, both for the communities most
affected and for health care professionals who serve these communities.
Inadequate oral health care is but one of those challenges as its
consequences can undermine the success of treatment by exacerbating
existing medical conditions, compromising adherence to antiretroviral
treatment regimens, and diminishing quality of life (New York State
Department of Health, 2004). Thus, access to oral health care, both for
the person at risk for HIV infection and for the individuals with HIV,
is critical (CDC, 2005).

Oral health and medical services have increasingly important and
interrelated roles in the management of HIV disease. According to some
estimates, more than 90 percent of HIV patients will have at least one
oral manifestation in the course of the disease (McCarthy, 1992, Weinert
et al, 1996). Problems in the mouth may be the first symptom of HIV
infection and may also signify clinical regression. Few studies have
assessed the use of oral health services by persons with HIV, although
one of the earliest findings of the HIV epidemic was identification of
oral health as a common problem among HIV-infected individuals. The
availability of effective treatments and prophylactic regimens to combat
HIV-related opportunistic infections, including oral health conditions,
makes access to medical care essential for HIV-infected patients
(Shiboski et al, 1999). Such is the case, for example, with periodontal
disease in the HIV patient, where the absence of early and adequate oral
health care can lead to serious infections.

Studies of oral health among the various income groups in the U.S.
document that low-income people generally suffer from dental disease at
a higher rate than people of higher incomes. Medicaid, the source of
health care financing for those in poverty in this country, is a
mechanism for helping to close the gap. However, studies have found that
while preventive and therapeutic oral health services are covered by
State Medicaid programs for children, utilization rates are very low. At
the same time, only emergency oral health care is covered for adult
beneficiaries by most State Medicaid programs. The low utilization rates
for oral health care by children, and no coverage for those services for
adults, has resulted in several generations of Medicaid beneficiaries
with little or no oral health care.

***Access to Oral health Care Among Adults with HIV Infection***

Despite the importance of access to quality oral care, large numbers of
people with HIV reportedly have unmet need for oral health care. Several
articles have used data from the HIV Cost and Services Utilization Study
(HCSUS) to study oral health care access and utilization. HCSUS is the
first comprehensive U.S. survey of health care use among a nationally
representative sample of HIV-positive persons who were in care for their
HIV. Coulter and colleagues estimated that only 42% of respondents had
seen an oral health professional in the preceding six months (Coulter et
al., 2000). Reports indicated that individuals most likely to have unmet
oral health care needs included Medicaid beneficiaries in states without
dental benefits, individuals with no dental insurance, the very poor
(with incomes under \$5,000), and individuals with less than a high
school education (Marcus et al., 2000). Stage of HIV infection was not a
significant predictor of perceived unmet oral health care needs.

HCSUS findings also have underscored the important link between access
to oral health care and use of those services (Weinert et al., 1996).
While this is a logical point, the disparity in access to and actual use
of oral health services is remarkable. According to HCSUS, use of oral
health care was reported to be greatest among patients obtaining oral
health care from an AIDS clinic (74%) and lowest among individuals with
no usual source of oral health care (12%). In a more recent article,
HCSUS data were used to study the relationship between the provision and
use of oral health and medical care (Heslin et al., 2001). This article
found that oral infections, mouth ulcers, and other severe dental
conditions associated with HIV infection are more than twice as likely
to go untreated as other HIV-related health problems. Uninsured people
with HIV were reported to be three times more likely to have untreated
oral health and medical needs than those with private insurance.
Medicaid enrollees reported significantly more unmet needs for oral
health care than those with private insurance.

The perception of unmet oral health care needs was greatest among
participants who lacked dental insurance. Participants in the HCSUS who
reported unmet needs for oral health care were more than twice as likely
to lack dental insurance when compared to those with dental insurance.
Those lacking dental insurance included the uninsured or those with
private health insurance but no dental coverage (RAND Health Research,
2000).

***Financing Oral Health Care for HIV-Infected Persons***

As described in several studies, the availability and extent of third
party dental insurance and government funding for oral health care can
significantly reduce barriers to access to oral health care for people
with HIV. Additionally, the extent of funding for HIV-specific oral
health care has been instrumental in supporting innovative oral health
projects. Medicaid is the largest single payer of direct medical
services for HIV positive persons. States operate their Medicaid
programs within broad Federal requirements. They can elect to cover a
range of optional populations and services, thereby creating programs
that differ substantially from State to State. Oral health care is an
optional service for adults under Medicaid. In 1996, among adults
enrolled in Medicaid, only 29% visited a dentist in the preceding year,
which was less than one-half the rate of oral health care among
higher-income adults.

Researchers have examined barriers to Medicaid participation by
dentists. Reports indicate that dentists are unwilling to participate in
the Medicaid program because of administrative complexities and
extremely low reimbursement rates. The Federal Medicaid program is
offering incentives to states to expand oral health and other Medicaid
benefits to more children, as well as increased oversight of State
Medicaid programs to assure that oral health services mandated by law
are being provided. Barriers to organizing and financing HIV oral care
were reported by agencies and oral care professionals.

The Ryan White CARE Act has a number of programs that support oral
health services for HIV-infected persons. Oral health services are
supported with Title I, II, III, and IV funding. Additionally, the
Dental Reimbursement Program retrospectively compensates dental schools
and post-doctoral dental programs for providing oral health treatment to
people with HIV. This program assists accredited dental schools and
post-doctoral education programs to cover their non-reimbursed costs of
providing oral health care to people with HIV.

In September 2005, the Department of Health and Human Services awarded
66 grants totaling \$9.3 million to reimburse dental education programs
including schools and hospitals toward the costs of providing oral
health services to patients with HIV/AIDS. These grants support the
provision of comprehensive, primary and specialty oral health services
such as diagnostic and preventive care, oral health education, oral
medicine, oral surgery, and comprehensive restorative care (American
Dental Association, 2005).

***Addressing Barriers to Oral Health Care***

The need to train clinically and culturally competent primary oral
health practitioners who can work in an integrated, multidisciplinary
primary care setting is vital because they are needed in underserved
areas with high rates of HIV infection (Oral Health, 2000). An example
of an oral health training program is the WE CARE program that was
established in 1999. WE CARE consisted of a mobile dental team that
emphasized prevention, early intervention, and linkage to comprehensive
care. Cultural competency training was also provided to all members of
the dental team to improve communication between patients and providers
(Zabos et al, 2001).

Many approaches have been identified to increase access to oral health
services and to decrease identified barriers. These include:
streamlining administrative and reimbursement procedures to encourage
providers to participate in publicly-funded programs; development of
coalitions between local and State public health departments and
professional organizations and advocacy groups, to, for example, provide
training of providers; identifying and utilizing underutilized and
excess capacity of private and public dental providers; mobile care;
increasing the capacity and efficiency or safety-net providers; mobile
dental and other care services to enhance access of services to clients;
and using existing case management and patient-support networks to
identify oral health service needs and resources and to assist with
compliance with appointments and adherence to oral health treatment
plans. Within rural and frontier communities, geographic barriers have
been addressed by providing patient and provider transportation,
developing satellite clinics, and forging partnerships with the private
sector, dental training programs and local and state health departments.
These different approaches have been used in various States in hope of
improving access to dental services and improving patient outcomes.

**The SPNS Oral Health Initiative**

This funding initiative will award grants of up to five years to support
organizations using innovative models of care to provide oral health
care to HIV-positive, underserved populations in both urban (Category A)
and non-urban (Category B) settings. Applicants must specify which
category for which they wish to be considered for funding. Applications
must include plans for reaching underserved populations in communities
where oral health services do not exist or are inadequate to meet
current needs. Applicants must also include plans for disseminating
their models and findings locally to planning councils and nationally to
wider Ryan White CARE Act and other audiences working with HIV-positive
individuals. Applications will need to incorporate a local program
evaluation plan.

In addition, an Evaluation and Support Center (Center) will be provided
under this initiative to assist funded projects in evaluating their
models locally as well as in a multi-site study.

## 3. Program Requirements and Expectations

**Demonstration Sites**

Demonstration sites are expected to design, implement, and evaluate an
innovative and replicable intervention under the five-year grant that
provides oral health services to underserved HIV-positive individuals in
communities where public HIV oral health services do not exist or are
inadequate to meet current needs. Study design will assess the
effectiveness of the selected model(s) in providing appropriate oral
health services to the target population, in integrating these services
within the community's HIV continuum of care, and in maximizing
reimbursement for oral health services, when available. Awardees are
expected to work collaboratively with SPNS staff and the SPNS-funded
Evaluation and Support Center to conduct local and national evaluation
and dissemination of findings. Awardees will be expected to attend at
least two grantee meetings each year and host at least one site visit
conducted by the Center each year of the initiative. The grantee
meetings will most likely be held in the Washington, DC metropolitan
area and the grantee should allocate funds for the Project Director,
local evaluator, and one other key staff person to attend this two to
three day meeting.

Demonstration site applicants should carefully read the requirements for
the Center to better understand the importance of the local and national
evaluation requirements. The Center will also serve as a source for
policy, program, and clinical technical assistance for demonstration
sites as they develop and implement their programs.

**Demonstration Site Service Expectations**

1.  Develop innovative models of care that provide oral health services
    to HIV-positive individuals. Oral health services to be provided
    should be comprehensive and include: restorative, diagnostic,
    preventive, periodontic, prosthodontic, endodontic, oral
    medications, oral surgery, emergency care and oral health
    education/health promotion. Oral health services should be provided
    in accordance with professional practice guidelines. Individualized
    treatment plans are to be developed for each patient receiving
    service. If oral health providers do not have the capacity to
    provide after-hours emergency services directly, then the applicant
    should establish alternative access to after-hours emergency
    services for its patients.

> Applicants that are current providers of oral health care must propose
> to provide SPNS-funded services to a target population and/or a
> geographic area that is different from their existing services. A
> SPNS-supported initiative should not be a continuation of currently
> existing oral health service programs.

2.  Develop innovative models that maximize reimbursement of care from
    all potential payment sources, especially Medicaid when coverage of
    oral health services is available, and to effectively utilize
    existing resources. Demonstration sites may also have as a goal the
    development of methods for increasing community support for
    resources for and access to oral health care in order to sustain
    services established by this demonstration beyond the term of
    federal funds.

3.  Ensure linkages and referrals with HIV medical management and social
    and support services, where indicated, to ensure a continuum of
    community-based care.

4.  Ensure that clinical staff have the appropriate training and
    expertise to provide oral health services to HIV-positive patients
    and ensure that clinical and support staff have access to ongoing
    training and clinical education in HIV care management.

**Demonstration Site Evaluation Expectations**

1.  Collect, manage and report data that will assess and describe the
    demonstration project's delivery of oral health services and its
    effectiveness in meeting the oral health needs of HIV-positive
    individuals.

2.  Demonstration site's staffing plan should include, at a minimum, a
    0.25 FTE local evaluator to design and oversee the implementation of
    the local evaluation plan and the multi-site evaluation plan
    developed by the Evaluation and Support Center.

3.  Conduct a local evaluation of services and disseminate findings to
    local, state and national audiences.

4.  Participate in the multi-site evaluation of the SPNS oral health
    initiative led by the Evaluation and Support Center. Demonstration
    sites are expected to track and collect core data elements on the
    enrolled patient population and report, on an ongoing basis, client,
    provider, organizational setting and interventional characteristics
    as well as core service and quality measures. Data will be collected
    at baseline and throughout the initiative. All data must be
    electronically maintained and electronically transferable to the
    Center's Internet-based data collection system. Only coded data,
    without patient identifiers, are to be submitted and must be
    provided in a standardized method defined by the Center.
    Demonstration sites must implement or have in place a comprehensive
    client-level tracking system for such data collection. Demonstration
    sites must ensure that site staff has the appropriate experience in
    collecting data to complete the above named activities.

5.  Demonstration sites must provide requested materials for inclusion
    on the initiative's Web site maintained by the Center.

6.  Demonstration sites must participate in formative research conducted
    by the Center during year one to assess needs and capacity at each
    site. Demonstration sites must conduct their own local formative
    evaluation during the first project year to describe the development
    and first stage implementation of the program model.

7.  Demonstration sites, on an annual basis, will present a program
    chronology to provide a contextual reference for the implementation
    and evaluation of the model. This will include local program
    milestones such as policy development, implementation, staff
    training and turnover, collaborations, financing, development or
    adaptation of site-specific practice guidelines, clinical
    challenges, organizational structure, system influences and other
    contextual factors.

8.  Demonstration sites will collaborate with the Center and SPNS to
    propose applicability of findings to other Ryan White CARE Act and
    other HIV primary care settings.

Successful applicants will be required to submit their proposed studies
to their respective Institutional Review Boards for review and approval
within six months of funding. Proposals should address the capacity of
the applicant to undertake these core required evaluation activities. In
addition, applicants are encouraged to propose additional activities
specific to their local sites and interests. The Center will make
available technical assistance providers over the course of the project
years. This network will serve as a resource for demonstration sites
requesting assistance with all aspects of evaluation design and
delivery.

**Evaluation and Support Center**

The Evaluation and Support Center is expected to lead and facilitate the
work of the demonstration sites in developing and refining their
interventions and local evaluations. The Center will provide technical
support and training, communication, and dissemination activities. The
Center must follow their local Institutional Review Board requirements
for conducting a multi-site evaluation.

The planning of grantee meetings, site visits, and conference calls will
also be the responsibility of the Center. This will include, at a
minimum, one annual site visit with each demonstration site, and two
overall grantee meetings per year involving all of the demonstration
sites. Grantee meetings will most likely be held in the Washington, DC
metropolitan area.

In addition to providing technical assistance on evaluation-related
issues, the Center is expected to have the capacity to provide clinical
and technical assistance to demonstration sites in a range of issues
including, but not limited to, the development of clinical protocols,
patient education, operational policies and procedures, integration and
collaboration with primary care and other providers, third party
reimbursement and other financing-related issues, public/private
partnerships, and the development of coalitions and networks to provide
and/or advocate for oral health services.

The Center will also be responsible for conducting focused evaluation
studies, which are different from the multi-site evaluation. These
studies will address topics that are generated by the Center, and will
not necessarily involve all of the demonstration sites. Such studies may
include, but are not limited to, case studies, cost effectiveness
studies, or qualitative studies which focus on issues relating to the
clinical, administrative, financing or public policy aspects of the
provision of oral health services to HIV positive persons.

**Evaluation and Support Center Program Requirements**

During the first year of funding, the Center, in collaboration with SPNS
and the funded demonstration sites, will analyze and revise local
interventions, refine local evaluation plans and logic models, develop a
plan for multi-site evaluations and provide data collection training and
support to demonstration sites. Implementing the multi-site evaluation
plan, providing technical assistance to demonstration sites, and data
collection will be the major activities during the second and subsequent
years of the initiative. During the third and fourth years of the
initiative, the Center will be expected to continue with data collection
activities, conduct a preliminary multi-site evaluation, conduct special
evaluation studies, and continue dissemination and technical assistance
activities. During the fifth year, the Center will work with SPNS and
the demonstration sites to produce final planned papers, reports and
presentations. This will include a report of the applicability of
findings to other Ryan White CARE Act settings, and identification and
description of successful models for the provision of oral health care
to HIV positive persons. The Center will be expected to convene two
grantee meetings per year, as well as schedule conference calls with
demonstration sites and evaluators, as needed.

The Center will provide technical assistance to demonstration sites.
SPNS expects to support a diverse group of demonstration sites, so the
technical assistance needs are expected to be wide ranging. The Center
should have the capacity to provide this technical assistance as
identified by the demonstration sites, SPNS, or the Center. The Center's
staffing plan must include a dentist with clinical expertise in the
provision of care to HIV positive persons at a minimum of 0.25 FTE. This
clinician will provide client-level consultation to the demonstration
sites; in addition, this clinician, or other Center personnel, will also
be expected to provide consultation on issues relating to the
administration of oral health services.

The Center will develop a Web-based data reporting system for the
collection of core client-level output and outcome data elements
developed in collaboration with the demonstration sites. The Center must
assure the security and confidentiality of all data. The Center will
establish a Web site on the initiative to be used by the demonstration
sites and interested members of the public.

The Center will collect multi-site data describing the roles and
characteristics of the clients and providers. The Center will also
describe the process of implementation of the grantees' interventions,
with a focus on clinical, programmatic, and structural issues addressed
by the demonstration sites.

The Center will conduct focused evaluation studies involving sub groups
of demonstration sites. The topic of these studies will be initiated by
the Center in collaboration with the demonstration sites and SPNS.

# II. Award Information

[]{.mark}

## 1. Type of Award

Funding will be provided in the form of a grant.

[]{.mark}

## 2. Summary of Funding

[]{.mark}

The SPNS Program will provide funding beginning Federal fiscal year (FY)
2006, with project periods beginning September 1, 2006. Funding beyond
the first year is dependent on the availability of appropriated funds
for the SPNS Program in FY 2007 and future fiscal years, satisfactory
grantee performance, and a decision that funding is in the best interest
of the Federal government.

Funds are expected to be available to fund demonstration site grantees
in two categories: urban settings (Category A) and non-urban settings
(Category B). Up to 15 demonstration grantees will be funded, with at
least five being funded in each of the two geographic categories. Awards
will be for a five year grant period, with a maximum grant award of
\$400,000 per year. Applicants should apply for a five-year project
period.

Funds are expected to be available to fund one Evaluation and Support
Center for a five year grant period, with a maximum grant award of
\$550,000 per year. Applicants should apply for a five-year project
period.

# III. Eligibility Information

## 1. Eligible Applicants

Demonstration sites in Urban Setting (Category A): For purposes of this
grant, this is defined as cities with a population equal to or greater
than 100,000 and/or cities with more than 2,500 reported HIV/AIDS cases.
Public and non-profit private entities are eligible to apply, including
faith-based and community-based organizations with experience in
delivering oral health services to HIV-positive, underserved
individuals.

Demonstration sites in Non-Urban Settings (Category B): For purposes of
this grant, this is defined as cities with a population of fewer than
100,000 and/or cities with fewer than 2,500 reported HIV/AIDS cases.
Public and non-profit private entities are eligible to apply, including
faith-based and community-based organizations with experience in
delivering oral health services to HIV-positive, underserved
individuals.

Evaluation and Support Center: Public and non-profit private entities,
including faith-based and community-based organizations with experience
with HIV and/or oral health as well as experience providing technical
assistance and evaluation support to organizations.

## 2. Cost Sharing/Matching

There are no cost sharing or matching requirements.

## 3. Other Eligibility Information

Applications that exceed the ceiling amount will be considered
non-responsive and will not be considered for funding under this
announcement.

Any application that fails to satisfy the deadline requirements
referenced in *Section IV.3* will be considered non-responsive and will
not be considered for funding under this announcement

Eligible applicants may not submit applications in more than one grant
category. Only one application may be submitted per applicant. Requested
funds must comply with Funding Restrictions (see Section IV.5 below).
Demonstration site applicants must demonstrate significant experience
with provision of oral health care to HIV positive persons. Applications
that fail to show such experience will not be considered.

# IV. Application and Submission Information

## 1. Address to Request Application Package

### Application Materials

> Applicants must submit proposals using the appropriate form: Public
> Health Service (PHS) Application Form 5161-1. This form contains
> additional general information and instructions for grant
> applications, proposal narratives, and budgets. This form may be
> obtained from the following sites by:
>
> []{.mark}

(1) Downloading from <http://www.hrsa.gov/grants/forms.htm>

> Or

\(2\) Contacting the HRSA Grants Application Center at:

> The Legin Group, Inc.
>
> 901 Russell Avenue, Suite 450
>
> Gaithersburg, MD 20879
>
> Telephone: 877-477-2123
>
> <HRSAGAC@hrsa.gov>
>
> []{.mark}
>
> Instructions for preparing portions of the application that must
> accompany Application Form 5161-1 appear in the "Application Format"
> section below.

## 2. Content and Form of Application Submission

### Application Format Requirements

The total size of all uploaded files **may not exceed the equivalent of
80 pages when printed by HRSA, approximately 10 MB.** **This 80-page
limit includes the abstract, project and budget narratives, attachments,
appendices and letters of commitment and support.** Standard forms are
NOT included in the page limit. Pages must be numbered consecutively.

**Applications that exceed the specified limits (approximately 10 MB, or
that exceed 80 pages when printed by HRSA) will be deemed non-compliant.
All non-compliant applications will be returned to the applicant without
further consideration.**

a.  Type of Submission

> []{.mark}
>
> HRSA, in providing the grant community a single site to Find and Apply
> for grant funding opportunities, is ***requiring*** applicants for
> this funding opportunity to apply electronically through Grants.gov.
> By using Grants.gov you will be able to download a copy of the
> application package, complete it off-line, and then upload and submit
> the application via the Grants.gov site. You may not e-mail an
> electronic copy of a grant application to us.
>
> **NOTE:** All applicants ***must*** submit in this manner unless the
> applicant is granted a written exemption from this requirement in
> advance by the Director of HRSA's Division of Grants Policy. Grantees
> must request an exemption in writing from <DGPClearances@hrsa.gov>,
> and provide details as to why they are technologically unable to
> submit electronically though the Grants.gov portal. Make sure you
> specify the announcement number you are seeking relief for. As
> indicated in this guidance, HRSA and its Grants Application Center
> (GAC) will only accept paper applications from applicants that
> received prior written approval.

b.  Font

> []{.mark}
>
> Please use an easily readable serif typeface, such as Times Roman,
> Courier, or CG Times. The text and table portions of the application
> must be submitted in not less than 12 point and 1.0 line spacing.
> Applications not adhering to 12 point font requirements may be
> returned. Do not use colored, oversized or folded materials.  Please
> do not include organizational brochures or other promotional
> materials, slides, films, clips, etc. For charts, graphs, footnotes,
> and budget tables, applicants may use a different pitch or size font,
> not less than 10 pitch or size font. However, it is vital that when
> scanned and/or reproduced, the charts are still clear and readable.
>
> []{.mark}

c.  Paper Size and Margins

> For duplicating and scanning purposes, please ensure that the
> application can be printed on 8 ½" x 11" white paper. Margins must be
> at least one (1) inch at the top, bottom, left and right of the paper.
> Please left-align text.

[]{.mark}

d.  Numbering

> Please number the pages of the application sequentially from page 1
> (face page) to the end of the application, including charts, figures,
> tables, and appendices.

e.  Names

> Please include the name of the applicant on each page.

f.  Section Headings

> Please put all section headings flush left in bold type.

### Application Format

Applications for funding must consist of the following documents in the
following order:

#### i*. Application Face Page* 

Public Health Service (PHS) Application Form 5161-1 is provided with the
application package. Prepare this page according to instructions
provided in the form itself. For information pertaining to the Catalog
of Federal Domestic Assistance, the Catalog of Federal Domestic
Assistance Number is 93.*928.*

**DUNS Number**

All applicant organizations are required to have a Data Universal
Numbering System (DUNS) number in order to apply for a grant from the
Federal Government. The DUNS number is a unique nine-character
identification number provided by the commercial company, Dun and
Bradstreet. There is no charge to obtain a DUNS number. Information
about obtaining a DUNS number can be found at
[http://www.hrsa.gov/grants/preview/dunsccr.htm](http://www.hrsa.gov/grants/preview/dunsccr.htm )
or call 1-866-705-5711. Please include the DUNS number next to the OMB
Approval Number on the application face page. Applications ***will
not*** be reviewed without a DUNS number.

Additionally, the applicant organization is required to register with
the Federal Government's Central Contractor Registry (CCR) in order to
do electronic business with the Federal Government. Information about
registering with the CCR can be found at
[http://www.hrsa.gov/grants/preview/dunsccr.htm](http://www.hrsa.gov/grants/preview/dunsccr.htm ).

#### *ii. Table of Contents*

Provide a Table of Contents for the remainder of the application
(including appendices), with page numbers.

#### *iii. Application Checklist* 

Application Form 5161-1 provided with the application package.

#### *iv. Budget*

Application Form 5161-1 provided with the application package.

#### *v. Budget Justification*

Provide a narrative that explains the amounts requested for each line in
the budget. The budget justification should specifically describe how
each item will support the achievement of proposed objectives. The
budget period is for ONE year. However, the applicant must submit
one-year budgets for each of the subsequent project period years
(usually one to three years or more) at the time of application. Line
item information must be provided to explain the costs entered in
appropriate form, Application Form 5161-1. **The budget justification
must clearly describe each cost element and explain how each cost
contributes to meeting the project's objectives/goals.** Be very careful
about showing how each item in the "other" category is justified. The
budget justification MUST be concise. Do NOT use the justification to
expand the project narrative.

> []{.mark}

This announcement is inviting applications for project periods up to
five years. Awards, on a competitive basis, will be for a one‑year
budget period, expected to begin on September 1, 2006 and end on August
31, 2007, although project periods may be for five years.

Applications for continuation grants funded under these awards beyond
the initial one-year budget period but within the five-year project
period will be entertained in subsequent years on a noncompetitive
basis, subject to availability of funds, satisfactory progress of the
grantee and a determination that continued funding would be in the best
interest of the Government.

With this proposal, applicants must submit additional line-item one-year
budgets for each of the subsequent four project periods (initiative
years two through five) on Application Form 5161-1.

[]{.mark}

Include the following in the Budget Justification narrative:

> Personnel Costs: Personnel costs should be explained by listing each
> staff member who will be supported from funds, name (if possible),
> position title, percent full time equivalency, annual salary, and the
> exact amount requested for each project year which mainly covers
> indirect cost.
>
> Indirect Costs: Indirect costs are those costs incurred for common or
> joint objectives which cannot be readily identified but are necessary
> to the operations of the organization, e.g., the cost of operating and
> maintaining facilities, depreciation, and administrative salaries. For
> institutions subject to OMB Circular A-21, the term "facilities and
> administration" is used to denote indirect costs. If an organization
> applying for an assistance award does not have an indirect cost rate,
> the applicant may wish to obtain one through HHS's Division of Cost
> Allocation (DCA).  Visit DCA's website at: 
> [http://rates.psc.gov](http://rates.psc.gov/)/ to learn more about
> rate agreements, the process for applying for them, and the regional
> offices which negotiate them.
>
> Fringe Benefits: List the components that comprise the fringe benefit
> rate, for example health insurance, taxes, unemployment insurance,
> life insurance, retirement plan, tuition reimbursement. The fringe
> benefits should be directly proportional to that portion of personnel
> costs that are allocated for the project.
>
> Travel: List travel costs according to local and long distance travel.
> For local travel, the mileage rate, number of miles, reason for travel
> and staff member/consumers completing the travel should be outlined.
> The budget should also reflect the travel expenses associated with
> participating in meetings and other proposed trainings or workshops.
>
> Equipment: List equipment costs and provide justification for the need
> of the equipment to carry out the program's goals. Extensive
> justification and a detailed status of current equipment must be
> provided when requesting funds for the purchase of computers and
> furniture items. Equipment means tangible nonexpendable personal
> property, including exempt property, charged directly to the award
> having a useful life of more than one year and an acquisition cost of
> \$5,000 or more per unit.
>
> Supplies: List the items that the project will use. In this category,
> separate office supplies from medical and educational purchases.
> Office supplies could include paper, pencils, and the like; medical
> supplies are syringes, blood tubes, plastic gloves, etc., and
> educational supplies may be pamphlets and educational videotapes.
> Remember, they must be listed separately.
>
> Subcontracts: To the extent possible, all subcontract budgets and
> justifications should be standardized, and contract budgets should be
> presented by using the same object class categories contained in the
> Standard Form 424A. Provide a clear explanation as to the purpose of
> each contract, how the costs were estimated, and the specific contract
> deliverables.
>
> []{.mark}
>
> Other: Put all costs that do not fit into any other category into this
> category and provide and explanation of each cost in this category. In
> some cases, grantee rent, utilities and insurance fall under this
> category if they are not included in an approved indirect cost rate.

#### *vi. Staffing Plan and Personnel Requirements*

Applicants must present a staffing plan and provide a justification for
the plan that includes education and experience qualifications and
rationale for the amount of time being requested for each staff
position. Position descriptions that include the roles,
responsibilities, and qualifications of proposed project staff must be
included in Appendix B. Copies of biographical sketches for any key
employed personnel that will be assigned to work on the proposed project
must be included in Appendix C.

#### *vii. Assurances*

(SF 424B, PHS 5161-1) Complete this page according to PHS instructions
provided with the application package. Application Form 5161-1 provided
with the application package.

#### *viii. Certifications*

(PHS 5161-1 pages 17-19) Complete these pages according to PHS
instructions provided with the application package. Application Form
5161-1 provided with the application package.

### Demonstration Site Applications

#### *ix. Project Abstract*

Provide a summary of the application. Because the abstract is often
distributed to provide information to the public and Congress, please
prepare this so that it is clear, accurate, concise, and without
reference to other parts of the application. It must include a brief
description of the proposed grant project including the needs to be
addressed, the proposed services, and the population group(s) to be
served.

**Please place the following at the top of the abstract:**

Project Title

Submission Category: Demonstration Category (A-Urban Settings) or
Demonstration Category (B-Non-Urban Settings)

Applicant Name

Address

Contact Phone Numbers (Voice, Fax)

E-Mail Address

Web Site Address, if applicable

**The Project Abstract must have the following four subheadings:**

1\. Summary of intervention: A brief overview of the proposed
intervention describing the proposed services, specific sites where they
will be provided, and collaborators, if applicable. If applicable,
provide a summary of start-up activities that may be required prior to
the beginning of service delivery, the anticipated time frame for
beginning of service delivery.

2\. Target Population(s): A brief description of the geographic area(s)
to be served by the proposed project and the demographic characteristics
of the target population to be served by the project. Provide a brief
description of the current oral health resources available to the target
population and how the proposed project will address the unmet oral
health needs of the target population.

3\. Goals and Objectives: Present the goals and objectives for the
project as described in the Work Plan.

The project abstract must be single-spaced and limited to one page in
length.

#### *x. Program Narrative*

This section of the proposal provides a description of all aspects of
the proposed program. It must be directly responsive to the Program
Requirements and Expectations described above in Section 1. The Program
Narrative should be succinct, self-explanatory and well organized so
that reviewers can understand the proposed program. Follow the program
narrative requirements specific to the grant for which you are applying
(e.g., Demonstration projects or Evaluation and Support Center).

Use the following section headers for the Narrative:

[]{.mark}

**Introduction:**

This section should provide the reviewers with a brief description of
your demonstration project and outline the innovative methods chosen to
provide services. Describe the target population and the problem of
unmet oral health need in the target population. Describe what methods
you will utilize to meet the oral health needs of the target population.
Briefly describe the applicant organization and any collaborators.

Include in this introductory section evidence for the demonstration site
category under which you are applying (i.e., urban or non-urban
setting).

**Needs Assessment**

This section should help reviewers understand the population and
community that will be served by the proposed project in terms of needs
(current oral health services available compared to barriers to care and
gaps/unmet needs not currently being addressed) and characteristics of
the target audience.

Clearly identify the populations and the geographic community that the
project will serve and provide the rationale for selecting this
population and/or geographic community to serve. To the extent possible,
your presentation of the target population(s) should include the
distribution by race/ethnicity, gender, age, mode of transmission/risk
factor, and insurance coverage. The statistics you use should be
specific to the area from which the majority of the proposed clients
will be drawn. Statistics from the larger service area or community may
be cited for purposes of comparison or contrast. You should also include
a description of other relevant characteristics of the target population
that affect their access to oral health and other medical services. Data
used should be cited to support the information provided.

Clearly describe the oral health services provided in your community
that may/may not be available to your target population. Indicate what
oral health services, primary medical care services and/or social and
support services are available to HIV-positive persons in your
community, identifying the funding sources. Describe both the public and
private entities that provide oral health services to HIV-positive
persons, including other Ryan White CARE Act supported services.
Describe the Medicaid oral health benefits available in your service
area including gaps and/or limitations in terms of oral health benefits.
Describe the role of State and local professional dental organizations,
public health and advocacy organizations, state and local health
departments and local, state and regional oral health training programs
and institutions in the provision of oral health services and
advocacy/education relating to oral health services. Describe other
barriers to the provision of oral health care to HIV-positive persons
and barriers to accessing available oral health services by the target
population.

If you are currently providing oral health services, describe how the
proposed target population and/or geographic area differs from or is
similar to your current patient population/geography. A discussion of
your experiences with providing oral health services to the target
population/geography and what changes you are proposing based on
assessment of these experiences should also be included in this section.

[]{.mark}

**Methodology**

This section should describe your proposed methods that will be used to
meet each of the previously described program requirements and
expectations of this grant announcement. The rationale for the selection
of your methods should be discussed.

This section should clearly describe how your proposed intervention
addresses the barriers to care and unmet need of the target
population/geography identified in the needs assessment section. It
should clearly describe the types of oral health services that will be
provided. This should include patient education, the plan for providing
referral services to link patients to HIV medical management and social
and support services to ensure a continuum of community-based care, the
plan for maintaining oral health services clients in care, the plan for
providing after-hours and weekend coverage for urgent or emergency oral
health needs, and the plan for outreach to the provider and patient
communities. This should also include the plan for multi-site and local
evaluation of the initiative---including a quality management plan.
Issues of financing of services, creation of new administrative
structures, creation of networks of care and referral mechanisms, etc.
should be clearly described.

The evaluation plan should outline how the achievement of program
objectives and outcomes will be measured as part of the local
evaluation. Demonstration sites should also outline their methods for
disseminating information about the project and its findings to local,
State, and national audiences. All SPNS demonstration sites will
participate in the multi-site evaluation developed and implemented by
the Evaluation and Support Center.

> []{.mark}

**Work Plan**

This section should include a work plan that delineates your steps to
implement and assess the progress of your project. It is to be used as a
tool to actively manage your program by measuring progress, identifying
necessary changes, and quantifying your accomplishments. For example,
include estimates of numbers of patients to be served, number of
procedures to be provided, number of referrals to be made, number of
collaborative relationships to be established, etc. The work plan should
directly relate to the methods described in the Methodology section and
the program requirements and timelines outlined in Section 1.

[]{.mark}

The work plan should include: 1) goals; 2) objectives, specific,
time-framed, and measurable; 3) action steps; and 4) staff responsible
for each action step and by what date.

The work plan should clearly indicate the anticipated start date of the
provision of oral health services to patients and should clearly outline
the action steps planned during a planning or start-up period prior to
the delivery of oral health services to patients.

[]{.mark}

Goals are to be written for your entire proposed five-year project
period. Work plan objectives should be written for one year. Objectives
and key action steps should describe activities that will be undertaken
to provide oral health services to people with HIV and to conduct the
multi-site and local evaluations. Objectives and key action steps should
be written in time-framed and measurable terms providing numbers for
targeted outcomes where applicable, not only percentages.

You may want to use a table format to present this information.

[]{.mark}

[]{.mark}

**Resolution of Challenges**

This section should briefly discuss challenges that are likely to be
encountered in designing and implementing the activities described in
the work plan, and approaches that could be used to resolve such
challenges and how these challenges and responses will be documented as
part of the evaluation process.

**Evaluation and Technical Support Capacity**

This section should describe your (and any consultant's and/or
subcontractor's) experience, skills and knowledge with conducting
program evaluation and with quality management. Include, as appropriate
a discussion of individuals on staff, materials published, and previous
work of a similar nature.

**Organizational Information**

This section should briefly describe your current mission and structure,
scope of activities, and a description of how all of these contribute to
your ability to carry out the planned project and to meet the program
requirements and expectations. If subcontractors will be used to provide
services, then similar information should be provided for these
entities. An organizational chart and any letters of agreement and/or
descriptions of proposed or existing contracts should be included in the
appendices.

#### *xi. Appendices*

Please provide the following items to complete the content of the
application. Please note that these are supplementary in nature and are
not intended to be a continuation of the project narrative. Be sure each
appendix is clearly labeled.

Appendix A: Tables, Charts, etc.

Provide any additional tables or charts that give further details about
the proposal.

Appendix B: Job Descriptions for Key Personnel

Keep each to one page in length. Item 6 in the Program Narrative section
of the PHS 5161-1 Form provides some guidance on items to include in a
job description.

Appendix C: Biographical Sketches of Key Personnel

Include biographical sketches for persons occupying the key positions
described in Appendix B, not to exceed two pages in length. In the event
that a biographical sketch is included for an identified individual who
is not yet hired, please include a letter of commitment from that person
with the biographical sketch.

Appendix D: Letters of Agreement and/or Description(s) of
Proposed/Existing Contracts

Provide any documents that describe working relationships between the
applicant agency and other agencies and programs cited in the proposal.
Documents that confirm actual or pending contractual agreements should
clearly describe the roles of the subcontractors and any deliverable.
Letters of agreements must be dated and be project specific.

Appendix E: Project Organizational Chart

Provide a one-page figure that depicts the organizational structure of
the project, including subcontractors and other significant
collaborators.

Appendix F: Other Relevant Documents

Include here any other documents that are relevant to the application,
including letters of supports. Letters of support must be dated.

Include only letters of support which specifically indicate a commitment
to the project/program (in-kind services, dollars, staff, space,
equipment, etc.) Letters of agreement and support must be dated. List
all other support letters on one page.

### Evaluation and Support Center Applications

#### Project Abstract

Provide a summary of the application. Because the abstract is often
distributed to provide information to the public and Congress, please
prepare this so that it is clear, accurate, concise, and without
reference to other parts of the application. It must include a brief
description of the proposed grant project including the needs to be
addressed, the proposed services, and the population group(s) to be
served.

Please place the following at the top of the abstract:

Project Title

Submission Category: Evaluation and Support Center

Applicant Name

Address

Contact Phone Numbers (Voice, Fax)

E-Mail Address

Web Site Address, if applicable

The Project Abstract must have the following four subheadings:

1\. Summary of the applicant. Briefly describe the applicant and its
experiences and expertise of the project team.

2\. Summary of the evaluation and support activities. Briefly describe
the planned evaluation and support activities.

3\. Goals and Objectives: Present the goals and objectives for the
project as described in the Work Plan.

The project abstract must be single-spaced and limited to one page in
length.

[]{.mark}

#### Program Narrative

[]{.mark}

Use the following section headers for the Narrative:

[]{.mark}

**Introduction**

This section should provide the reviewers with a brief description of
your proposed project. Briefly describe the evaluation and support
services that the Center will provide. Briefly describe the applicant
organization and any collaborators.

**Needs Assessment**

This section should briefly include a literature review that
demonstrates an understanding of oral health services and providing
these services to underserved persons. Also include a brief discussion
of policy, financial, structural and clinical issues relating to
providing oral health care to persons with HIV disease. This section
should also discuss anticipated evaluation questions.

[]{.mark}

**Methodology**

This section should fully describe the proposed methods that will be
used to meet each of the previously described program and evaluation
requirements in this announcement and the needs and challenges
identified by the applicant in the needs assessment section. This
section must include:

-   A draft plan for conducting an overall evaluation of this
    initiative.

-   A draft plan for providing technical assistance to demonstration
    sites, which includes assistance in the development of agency
    policies, clinical protocols, referral and network development,
    dissemination of state-of-the art information to demonstration
    sites.

-   A draft plan for the Web-based data reporting system.

-   A draft plan for the intervention Web site for demonstration
    projects and the interested public.

-   A draft plan for providing training of and support to demonstration
    site staff in data collection.

-   A draft plan for addressing patient confidentiality.

-   A draft plan to disseminate the process and results of the
    initiative.

This section must also include a brief outline of how the following
items could be measured in the multi-site evaluation design:

-   Demonstration sites' inputs and resources utilized to implement
    their interventions.

-   Demonstration sites' outputs, including client-level service
    utilization and quality of care.

-   Demonstration sites' client-level and systems-level outcomes.

-   Barriers to effective implementation of the planned intervention.

-   Characteristics of demonstration sites' interventions for the
    purposes of replication in other communities or settings, which
    address the structural, policy and financing issues.

[]{.mark}

**Work Plan**

This section should include a work plan that delineates your steps to
implement and assess the progress of your project. It is to be used as a
tool to actively manage your program by measuring progress, identifying
necessary changes, and quantifying your accomplishments. For example,
include estimates of numbers of patients to be served, number of
procedures to be provided, number of referrals to be made, number of
collaborative relationships to be established, etc. The work plan should
directly relate to the methods described in the Methodology section and
include the program requirements and timelines outlined in Section 1.

[]{.mark}

The work plan should include: 1) goals; 2) objectives, specific,
time-framed, and measurable; 3) action steps; and 4) staff responsible
for each action step by what date.

[]{.mark}

Goals are to be written for your entire proposed five-year project
period. Work plan objectives should be written for one year. Objectives
and key action steps should describe activities that will be undertaken
to provide oral health services to people with HIV and to conduct the
multi-site and local evaluations. Objectives and key action steps should
be written in time-framed and measurable terms providing numbers for
targeted outcomes where applicable, not only percentages.

You may want to use a table format to present this information.

[]{.mark}

[]{.mark}

**Resolution of Challenges**

This section should briefly discuss challenges that are likely to be
encountered in designing and implementing the activities described in
the work plan, and approaches that could be used to resolve such
challenges and how these challenges and responses will be documented as
part of the evaluation process.

**Evaluation and Technical Support Capacity**

This section should describe your (and any consultant's and/or
subcontractor's) experience, skills and knowledge with conducting
program evaluation and with quality management. Include, as appropriate
a discussion of individuals on staff, materials published, and previous
work of a similar nature.

**Organizational Information**

This section should briefly describe your current mission and structure,
scope of activities, and a description of how all of these contribute to
your ability to carry out the planned project and to meet the program
requirements and expectations. If subcontractors will be used to provide
services, then similar information should be provided for these
entities. An organizational chart and any letters of agreement and/or
descriptions of proposed or existing contracts should be included in the
appendices.

[]{.mark}

#### Appendices

Please provide the following items to complete the content of the
application. Please note that these are supplementary in nature and are
not intended to be a continuation of the project narrative. Be sure each
appendix is clearly labeled.

Appendix A: Tables, Charts, etc.

Provide any additional tables or charts that give further details about
the proposal.

Appendix B: Job Descriptions for Key Personnel

Keep each to one page in length. Item 6 in the Program Narrative section
of the PHS 5161-1 Form provides some guidance on items to include in a
job description.

Appendix C: Biographical Sketches of Key Personnel

Include biographical sketches for persons occupying the key positions
described in Appendix B, not to exceed two pages in length. In the event
that a biographical sketch is included for an identified individual who
is not yet hired, please include a letter of commitment from that person
with the biographical sketch.

Appendix D: Letters of Agreement and/or Description(s) of
Proposed/Existing Contracts

Provide any documents that describe working relationships between the
applicant agency and other agencies and programs cited in the proposal.
Documents that confirm actual or pending contractual agreements should
clearly describe the roles of the subcontractors and any deliverable.
Letters of agreements must be dated and be project specific.

Appendix E: Project Organizational Chart

Provide a one-page figure that depicts the organizational structure of
the project, including subcontractors and other significant
collaborators.

Appendix F: Other Relevant Documents

Include here any other documents that are relevant to the application,
including letters of supports. Letters of support must be dated.

Include only letters of support which specifically indicate a commitment
to the project/program (in-kind services, dollars, staff, space,
equipment, etc.) Letters of agreements and support must be dated. List
all other support letters on one page.

[]{.mark}

## 3. Submission Dates and Times

**Application Due Date**

The due date for applications under this grant announcement is *March
31, 2006 at 5:00 P.M. Eastern Time (ET)*.

Applications will be considered as meeting the deadline if they are E
marked on or before the due date.

The Chief Grants Management Officer (CGMO) or a higher level designee
may authorize an extension of published deadlines when justified by
circumstances such as acts of God (e.g. floods or hurricanes),
widespread disruptions of mail service, or other disruptions of
services, such as a prolonged blackout. The authorizing official will
determine the affected geographical area(s).

Applications must be submitted by 5:00 P.M. ET. **To ensure that you
have adequate time to follow procedures and successfully submit the
application, we recommend you start [submission]{.underline} no later
than noon on the due date.** Applications submitted electronically will
be time/date stamped electronically, which will serve as receipt of
submission. After you electronically submit your application, you will
receive an automatic acknowledgement from Grants.gov that contains a
Grants.gov tracking number. HRSA will retrieve your application from
Grants.gov.

**Please refer to the Addendum for important specific information on
registering and applying through Grants.gov.**

**Late applications:**

Applications which do not meet the criteria above are considered late
applications. Health Resources and Services Administration (HRSA) shall
notify each late applicant that its application will not be considered
in the current competition.

## 4. Intergovernmental Review

SPNS Program is a program subject to the provisions of Executive Order
12372, as implemented by 45 CFR 100. Executive Order 12372 allows States
the option of setting up a system for reviewing applications from within
their States for assistance under certain Federal programs. Application
packages made available under this guidance will contain a listing of
States which have chosen to set up such a review system, and will
provide a State Single Point of Contact (SPOC) for the review.
Information on states affected by this program and State Points of
Contact may also be obtained from the Grants Management Officer listed
in the AGENCY Contact(s) section, as well as from the following Web
site: <http://www.whitehouse.gov/omb/grants/spoc.html>.

All applicants other than federally recognized Native American Tribal
Groups should contact their SPOC as early as possible to alert them to
the prospective applications and receive any necessary instructions on
the State process used under this Executive Order.

Letters from the State Single Point of Contact (SPOC) in response to
Executive Order 12372 are due sixty days after the application due date.

## 5. Funding Restrictions

Applicants submitting applications for Demonstration Site awards must
request funding for a project period of up to five (5) years, at no more
than \$400,000 per year and applicants submitting applications for the
Evaluation and Support Center must request funding for a project period
of up to five (5) years, at no more than \$550,000 per year. Awards to
support projects beyond the first budget year will be contingent upon
Congressional appropriation, satisfactory progress in meeting the
project's objectives, and a determination that continued funding would
be in the best interest of the government.

Under current OMB regulations, funds under this announcement may not be
used for the following purposes:

-   Charges that are billable to third party payers (e.g., private
    health insurance, prepaid health plans, Medicaid, Medicare, other
    CARE Act funding including ADAP).

-   Construction of new facilities or capital improvements to existing
    facilities.

-   Purchase of or improvement to land.

-   Cash payments to intended service recipients, as opposed to various
    non-cash incentives to encourage participation in evaluation
    activities.

-   Fundraising expenses.

-   Lobbying activities and expenses.

-   Pre-award costs.

-   Foreign travel.

The Evaluation and Support Center and Demonstration Sites may allocate
no more than 25 percent of total expected grant funds received over the
life of the project (i.e., five years) for the purchase of equipment
necessary to carry out the project's activities.

Grantees may spend grant funds for alternation and renovation of
physical space that is necessary to carry out the project's activities.
In such cases previous written authorization must be obtained.
Applicants should consult the PHS guidelines on use of grant funds for
alternation and renovation, located at
[http://grants.nih.gov/grants/policy/gps/7costs.htm#costs](http://grants.nih.gov/grants/policy/gps/7costs.htm%23costs)

## 6. Other Submission Requirements 

Except in rare cases (please refer back to IV.2.a for specifics), HRSA
will no longer accept applications for grant opportunities in paper
form. Applicants submitting for this funding opportunity are
***required*** to submit ***electronically*** through Grants.gov. To
submit an application electronically, please use the
[http://www.Grants.gov](http://www.Grants.gov/) apply site. When using
Grants.gov you will be able to download a copy of the application
package, complete it off-line, and then upload and submit the
application via the Grants.gov site.

As soon as you read this, whether you plan on applying for a HRSA grant
later this month or later this year, it is incumbent that your
organization ***immediately register*** in Grants.gov and become
familiar with the Grants.gov site application process. If you do not
complete the registration process you will be unable to submit an
application. The registration process can take up to one month, so you
need to begin immediately.

To be able to successfully register in Grants.gov, it is necessary that
you complete all of the following required actions:

> • Obtain an organizational Data Universal Number System (DUNS) number
>
> • Register the organization with Central Contractor Registry (CCR)
>
> • Identify the organization's E-Business POC (Point of Contact)
>
> • Confirm the organization's CCR "Marketing Partner ID Number (M-PIN)"
> password
>
> • Register an Authorized Organization Representative (AOR)
>
> • Obtain a username and password from the Grants.gov Credential
> Provider

Instructions on how to register, tutorials and FAQs are available on the
Grants.gov web site at [www.grants.gov](http://www.grants.gov/).
Assistance is also available from the Grants.gov help desk at
<support@grants.gov> or by phone at 1-800-518-4726.

More specific information, including step-by-step instructions on
registering and applying, can be found in the Addendum to this guidance.

Please understand that **we will not consider additional information
and/or materials submitted after your initial application.** You must
therefore ensure that all materials are submitted together.

Online applications are still required to submit ONE form in signed hard
copy: the SF-424/5161 Face Sheet, since all other elements of the
application have been captured and transmitted electronically. 

**Formal submission of the electronic application:** Applications
completed online are considered formally submitted when the Authorizing
Official electronically submits the application to HRSA. However, to
complete the submission requirements, a hard-copy of the SF-424/5161
Face Sheet must be printed, signed, and submitted to the HRSA Grants
Application Center. The SF-424/5161 can be printed from the online
application.

For an online application, the signed SF-424/5161 must be sent to the
HRSA GRANTS APPLICATION CENTER at the following address and received by
HRSA by no later than five days after the application due date:

> The HRSA Grants Application Center
>
> The Legin Group, Inc.
>
> Attn: SPNS Innovations in Oral Health Care Initiative
>
> Program Announcement No. HRSA-06-042
>
> CFDA No. 93.*928*
>
> 901 Russell Avenue, Suite 450
>
> Gaithersburg, MD 20879
>
> Telephone: 877-477-2123

In addition, please scan the signed Face Sheet and include it as an
Attachment in your electronic submission.

Applications will be considered as having met the deadline if: (1) the
application has been successfully transmitted electronically by your
organization's Authorizing Official through Grants.gov on or before the
deadline date and time, and (2) the signed SF-424/5161 Face Sheet is
received by HRSA no later than five days after the deadline date.

Note that it is incumbent on applicants to ensure that the AO is
available to submit the application to HRSA by the application due date.
We will NOT accept submission or re-submission of incomplete, rejected,
or otherwise delayed applications after the deadline.

# V. Application review information

## 1. Review Criteria

Procedures for assessing the technical merit of grant applications have
been instituted to provide for an objective review of applications and
to assist the applicant in understanding the standards against which
each application will be judged. Critical indicators have been developed
for each review criterion to assist the applicant in presenting
pertinent information related to that criterion and to provide the
reviewer with a standard for evaluation. Review criteria are outlined
below with specific detail and scoring points.

Reviewers will use only the information you include in your application.
Therefore, it is important that you write clearly and be specific. You
should assume that the reviewers will know nothing about your
organization or the work you do. The reviewers will make recommendations
to HAB regarding the strengths and weaknesses of your application.

Your Project Proposal will be evaluated section by section using the
following general criteria:

Review Criteria are used to review and rank applications. The SPNS Oral
Health Care Initiative has six review criteria:

[]{.mark}

**Review Criteria: Demonstration Site Applications**

[]{.mark}

**Criterion 1: Need (15 Points)**

The extent to which the application describes the target population and
community that will be served by the project, identifies the barriers
and associated contributing factors to these barriers, and demonstrates
the need for the proposed project to serve the selected target
population and community.

This corresponds to the Introduction and Needs Assessment sections of
the Narrative.

**i. Introduction (2 Points)**

a.  Does the application provide a clear, succinct description of the
    proposed demonstration project?

b.  Does the application state the demonstration site category (i.e.,
    urban or non-urban) to which it is applying and present the
    epidemiology and demographic evidence, with citation, for the
    selection of this category?

**ii. Needs Assessment (13 Points)**

a.  Does the application clearly identify the target population to be
    served as well as provide a clear description of the social and
    demographic characteristics?

b.  Does the application clearly identify the location of where the oral
    health services will be provided?

c.  If the applicant currently provides oral health services, does the
    application clearly describe how the proposed SPNS initiative
    differs---in terms of target population and/or geography---from its
    current services?

d.  Does the application provide a clear description of oral health
    services provided in the community?

e.  Does the application provide a clear description of the oral health,
    primary medical and social support services that are available to
    HIV-positive persons?

f.  Does the application provide a description of how public oral health
    services are funded?

g.  Does the application identify the unmet oral health needs of the
    target population and/or geographic area to be served by the SPNS
    initiative?

**Criterion 2: Response (35 Points)**

The extent to which the application responds to the Purpose section of
the Program Guidance; the clarity of the proposed goals and objectives
and their relationship to the proposed project; the extent to which the
methodology proposed is justified by the needs assessment.

This corresponds to the Methodology, Work Plan and Resolution of
Challenges sections of the Narrative.

**i. Methodology (15 Points)**

a.  Does the application present an innovative and replicable approach
    to providing oral health services to underserved HIV-positive
    individuals in their local communities?

b.  Is the proposed intervention a reasonable approach to address the
    unmet needs and other difficulties with the delivery and
    availability of oral health services identified in the needs
    assessment section of the application?

c.  Does the application clearly describe the types of oral health
    services it will provide, to whom they will be provided, and who
    will provide the services?

d.  If the applicant currently provides oral health services, does the
    application clearly describe an expansion of its services to a
    different target population and/or geography?

e.  If the applicant currently provides oral health services, does the
    application clearly describe how the proposed SPNS initiative
    differs---in terms of target population and/or geography---from its
    current services?

f.  If the application identifies collaborators, including
    subcontractors, are the roles and responsibilities of all of the
    parties clearly described?

g.  Does the application contain an appropriate evaluation plan that
    will measure the achievement of the project's objectives and
    outcomes?

h.  Does the application contain an appropriate plan to participate in
    the multi-site evaluation and to collaborate with the Evaluation and
    Support Center?

[]{.mark}

**ii. Work Plan (17 Points)**

a.  Does the work plan contain specific, measurable, and time-framed
    goals and objectives?

b.  Does the work plan contain goals and objectives which address each
    of the program expectations and timelines?

c.  Do the objectives relate directly to goals?

d.  Do the key action steps contribute directly to meeting their
    corresponding objectives?

e.  Do the objectives and key action steps have target dates or specific
    milestones?

f.  Does the workplan clearly identify the start date for oral health
    services and clearly identify the start-up activities? Is the start
    date and start up activities reasonable and realistic?

**iii. Resolution of Challenges (3 points)**

a.  Does the applicant clearly describe challenges it may face in
    implementing the activities described in the work plan?

b.  Does the applicant identify appropriate responses to these
    challenges?

**Criterion 3: Evaluative Measures (15 Points)**

The extent to which the application demonstrates an understanding of the
importance of evaluation and dissemination and demonstrates the capacity
and expertise to carry out the evaluation and dissemination requirements
of SPNS.

This corresponds to the Evaluation and Technical Support Capacity
section of the Narrative.

a.  Do the project director and/or other key staff have experience in
    conducting evaluation projects as well as the ability to collect
    data and disseminate project results?

b.  Does the applicant demonstrate the capacity (including the
    identification of and allocation of new resources) and expertise to
    carry out evaluation activities?

c.  Does the application describe the applicant's capacity/capability
    to:

    -   Collect client-level data, including patient demographics and
        services provided and systems-level data, where indicated

    -   Measure outcomes of the intervention

    -   Measure duration and intensity of the intervention

    -   Assess the cost of the intervention with assistance from the
        Evaluation Center

    -   Identify and provide the training required to implement and
        sustain the intervention

d.  Does the application contain an appropriate dissemination plan?

**Criterion 4: Impact (10 Points)**

The extent to which the plans for dissemination of project results and
the degree to which the project activities are replicable.

This corresponds to the Evaluation and Technical Support Capacity
section of the Narrative.

a.  Do the principal investigator, project director and other key staff
    have demonstrated ability to produce and disseminate project
    results?

b.  Does the dissemination plan identify other HIV care providers and
    oral health providers, including in their local community, as a key
    target audience?

c.  Are the methods described in the dissemination plan appropriate to
    facilitate replication of the project, or components, by other oral
    health providers?

**Criterion 5: Resources/Capabilities (15 Points)**

The extent to which project personnel are qualified by training and/or
experience to implement and carry out the project. The capabilities of
the applicant organization, and quality and availability of facilities
and personnel to provide the identified oral health services.

This corresponds to the Organizational Information section of the
Narrative.

a.  Does the application describe and demonstrate that the principal
    investigator and other key staff have the capacity to carry out and
    evaluate demonstration projects, to collect data as part of a
    multi-site evaluation and to disseminate project results?

b.  Does the identified clinical staff have adequate experience in the
    provision of oral health services to HIV-positive persons?

c.  Does the applicant describe its MIS capacity and its adequacy to
    conduct the local and multi-site evaluation?

d.  Are the roles and responsibilities of any subcontractors clearly
    described?

**Criterion 6: Support Requested (10 Points)**

The extent to which project personnel are qualified by training and/or
experience to implement and carry out the project. The capabilities of
the applicant organization, and quality and availability of facilities
and personnel to provide the identified oral health services.

This corresponds to the Budget, Budget Justification and Staffing Plan
sections.

**i. Budget and Budget Justification (6 Points)**

a.  Does the application present a budget that is appropriate to the
    proposed program plan?

b.  Does the application provide a clearly presented budget
    justification that fully supports each line item?

c.  Does the budget adhere to limitations on the purchase of equipment
    to no more than 25% of the total anticipated grant award?

d.  Does the budget allocate adequate funding to attend the twice yearly
    grantee meetings?

e.  Does the application clearly relate the budget to the work plan?

f.  Are budgets for project years 2 through 5 included and are
    significant changes to subsequent years' budgets identified and a
    rationale for these changes provided?

g.  Are contracts for subcontractors and consultants clearly identified
    and described, in terms of contract purposes, how costs were
    derived, payment mechanisms and deliverables?

**ii. Staffing Plan (4 Points)**

a.  Does the application clearly describe the staffing plan for the
    proposed project?

b.  Does the proposal describe a staffing plan that is consistent with
    the project description?

c.  Is the time allocated for clinical staff consistent with their
    expected workload and goals and objectives of the project?

d.  Does the staffing plan include at a minimum a 0.25FTE evaluator? Is
    staff for data entry clearly identified?

e.  Does the application provide job descriptions for key staff as
    Appendix A?

f.  Does the application provide biographical sketches for key staff as
    Appendix B?

**Review Criteria: Evaluation and Support Center Applications**

**Criterion 1: Need (10 Points)**

The extent to which the application provides a literature review that
addresses the major issues relating to providing oral health services to
underserved and HIV positive persons.

This corresponds to the Introduction and Needs Assessment sections of
the Narrative.

**i. Introduction (3 Points)**

a.  Does the application provide a clear, succinct description of the
    proposed demonstration project?

**ii. Needs Assessment (7 Points)**

Does the application provide a literature review that demonstrates an
understanding of the issues relating to providing oral health services
to underserved and HIV positive persons.?

Does the application identify and discuss anticipated evaluation
questions?

**Criterion 2: Response (35 Points)**

The extent to which the application responds to the Purpose section of
the Program Guidance; and the clarity of the proposed goals and
objectives and their relationship to the proposed project.

This corresponds to the Methodology, Work Plan and Resolution of
Challenges sections of the Narrative.

**i. Methodology (10 Points)**

a.  Does the application present a discussion of the rationale for the
    proposed Evaluation and Support Center in terms of its theoretical
    framework, methods, components, and quality assurance activities in
    conducting evaluation and support activities?

[]{.mark}

**ii. Work Plan (22 Points)**

a.  Does the work plan contain specific, measurable, and time-framed
    goals and objectives?

b.  Does the work plan contain goals and objectives which address each
    of the program expectations and timelines?

c.  Do the objectives relate directly to each goal?

d.  Do the key action steps contribute directly to meeting each of the
    objectives?

e.  Do the objectives and key action steps have target dates or specific
    milestones?

**iii. Resolution of Challenges (3 points)**

a.  Does the application clearly describe challenges it may face in
    implementing the activities described in the work plan?

b.  Does the application identify appropriate responses to these
    challenges?

**Criterion 3: Evaluative Measures (20 Points)**

The extent to which the application demonstrates an understanding of the
importance of evaluation and dissemination and demonstrates the capacity
and expertise to carry out the evaluation and dissemination requirements
of SPNS and the technical assistance and support activities of the
Center..

This corresponds to the Evaluation and Technical Support Capacity
section of the Narrative.

a.  Do the project director and other key staff have experience in
    conducting evaluation projects as well as the ability to collect
    data and disseminate project results?

b.  Does the applicant demonstrate the capacity (including the
    identification of and allocation of new resources) and expertise to
    carry out evaluation activities?

c.  Does the application describe the applicant's capacity/capability
    to:

    -   Coordinate a multi-site evaluation among demonstration sites of
        varied project design and capacities?

    -   Provide direction and support to demonstration sites on the
        multi-site and local evaluations?

d.  Does the application describe appropriate and effective methods for
    ensuring data security and quality?

**Criterion 4: Impact (5 Points)**

The extent to which the plans for dissemination of project results.

This corresponds to the Evaluation and Technical Support Capacity
section of the Narrative.

a.  Does the application describe time and creative approaches for
    disseminating "lessons learned" and "best practices" identified
    through the multi-site evaluation?

b.  Does the application describe a plan for the release of various
    types of dissemination products, with an emphasis on products for
    use by HIV oral health providers?

c.  Are the methods described in the dissemination plan appropriate to
    facilitate replication of the project, or components, by other oral
    health providers?

**Criterion 5: Resources/Capabilities (20 Points)**

The extent to which project personnel are qualified by training and/or
experience to implement and carry out the project. The capabilities of
the applicant organization, and quality and availability of facilities
and personnel to provide the identified oral health services.

This corresponds to the Organizational Information section of the
Narrative.

a.  Does the application describe and demonstrate that the principal
    investigator and other key staff have experience in designing,
    implementing, and conducting multi-site, multi-model health program
    evaluations, which includes, but not limited to:

    -   Evaluating the effectiveness of HIV service delivery programs

    -   Providing technical assistance on evaluation methods and
        implementation

    -   Publication and dissemination

    -   Organizing collaborative meetings and conferences; and

    -   Implementing, analyzing, and reporting project operations?

b.  Does the staffing plan include a minimum of a 0.25 FTE dentist with
    clinical expertise in providing oral health services to HIV positive
    persons? Additionally, does the staffing plan include expertise in
    areas for which technical assistance is likely to be requested and
    provided to the demonstration sites?

c.  Is the applicant's staffing plan adequate to provide the required
    evaluation and support activities?

d.  Does the applicant describe its MIS capacity and its adequacy to
    conduct the multi-site evaluation?

e.  Are the roles and responsibilities of any subcontractors clearly
    described?

**Criterion 6: Support Requested (10 Points)**

The extent to which the proposed budget is appropriate and justified in
relation to the objectives, the complexity of the activities and the
anticipated results.

This corresponds to the Budget, Budget Justification and Staffing Plan
sections.

**i. Budget and Budget Justification (5 Points)**

a.  Does the application present a budget that is appropriate to the
    proposed program plan?

b.  Does the application provide a clearly presented budget
    justification that fully supports each line item?

c.  Does the budget contain adequate levels of support for the grantee
    meetings, site visits and on-going demonstration site
    communications?

d.  Does the budget adhere to limitations on the purchase of equipment
    to no more than 20% of the total anticipated grant award?

e.  Does the application clearly relate the budget to the work plan?

f.  Are budgets for project years 2 through 5 included and are
    significant changes in subsequent years' budgets identified and a
    rationale for these changes provided?

g.  Are contracts for subcontractors and consultants clearly identified
    and described, in terms of contract purposes, how costs were
    derived, payment mechanisms and deliverables?

**ii. Staffing Plan (5 Points)**

a.  Does the application clearly describe the staffing plan for the
    proposed project?

b.  Does the proposal describe a staffing plan that is consistent with
    the project description?

c.  Is the time allocated for clinical staff consistent with their
    expected workload and goals and objectives of the project?

d.  Does the application provide job descriptions for key staff as
    Appendix A?

e.  Does the application provide biographical sketches for key staff as
    Appendix B?

## 2. Review and Selection Process

The Division of Independent Review is responsible for managing objective
reviews within HRSA. Applications competing for federal funds receive an
objective and independent review performed by a committee of experts
qualified by training and experience in particular fields or disciplines
related to the program being reviewed. In selecting review committee
members, other factors in addition to training and experience may be
considered to improve the balance of the committee, e.g., geographic
distribution. Each reviewer is screened to avoid conflicts of interest
and is responsible for providing an objective, unbiased evaluation based
on the review criteria noted above. The committee provides expert advice
on the merits of each application to program officials responsible for
final selections for award.

Applications that pass the initial HRSA eligibility screening will be
reviewed and rated by a panel based on the program elements and review
criteria presented in relevant sections of this program announcement.
The review criteria are designed to enable the review panel to assess
the quality of a proposed project and determine the likelihood of its
success.  The criteria are closely related to each other and are
considered as a whole in judging the overall quality of an application.

[]{.mark}

## 3. Anticipated Announcement and Award Dates

A final funding decision will be made by the HAB Associate
Administrator. You will receive results of the review and award process
on or before September 1, 2006 in writing.

# VI. Award Administration Information

## 1. Award Notices

Each applicant will receive written notification of the outcome of the
objective review process, including a summary of the expert committee's
assessment of the application's merits and weaknesses, and whether the
application was selected for funding. Applicants who are selected for
funding may be required to respond in a satisfactory manner to
Conditions placed on their application before funding can proceed.
Letters of notification do not provide authorization to begin
performance.

The Notice of Grant Award sets forth the amount of funds granted, the
terms and conditions of the grant, the effective date of the grant, the
budget period for which initial support will be given, the non-Federal
share to be provided (if applicable), and the total project period for
which support is contemplated. Signed by the Grants Management Officer,
it is sent to the applicant agency's Authorized Representative, and
reflects the only the authorizing document. It will be sent prior to the
start date of September 1, 2006.

## 2. Administrative and National Policy Requirements

Successful applicants must comply with the administrative requirements
outlined in 45 CFR Part 74 (non-governmental) or 45 CFR Part 92
(governmental), as appropriate.

**PUBLIC POLICY ISSUANCE**

[]{.mark}

**HEALTHY PEOPLE 2010**

**Healthy People 2010** is a national initiative led by HHS that sets
priorities for all HRSA programs. The initiative has two major goals:
(1) To increase the quality and years of a healthy life; and (2)
Eliminate our country's health disparities. The program consists of 28
focus areas and 467 objectives. HRSA has actively participated in the
work groups of all the focus areas, and is committed to the achievement
of the Healthy People 2010 goals.

Applicants must summarize the relationship of their projects and
identify which of their programs objectives and/or sub-objectives relate
to the goals of the Healthy People 2010 initiative.

Copies of the Healthy People 2010 may be obtained from the
Superintendent of Documents or downloaded at the Healthy People 2010
website: [http://www.health.gov/healthypeople/document]{.underline}/.

The Public Health Service strongly encourages all award recipients to
provide a smoke-free workplace and to promote the non-use of all tobacco
products. Further, Public Law 103-227, the Pro-Children Act of 1994,
prohibits smoking in certain facilities (or in some cases, any portion
of a facility) in which regular or routine education, library, day care,
health care or early childhood development services are provided to
children.

[]{.mark}

## 3. Reporting

The successful applicant under this guidance must:

a.  Comply with audit requirements of Office of Management and Budget
    (OMB) Circular A-133. Information on the scope, frequency, and other
    aspects of the audits can be found on the Internet at
    [www.whitehouse.gov/omb/circulars](http://www.whitehouse.gov/omb/circulars);

b.  Submit a Payment Management System Quarterly Report. The reports
    identify cash expenditures against the authorized funds for the
    grant. Failure to submit the report may result in the inability to
    access grant funds. Submit report to the:

> Division of Payment Management
>
> DPM/FMS/PSC/ASAM/HHS
>
> PO Box 6021
>
> Rockville, MD 20852
>
> Telephone: (301) 443-1660;

c.  Submit a Financial Status Report. A financial status report is
    required within 90 days of the end of each grant year. The report is
    an accounting of expenditures under the project that year;

d.  Submit a Progress Report(s).

## 4. Performance Review

HRSA's Office of Performance Review (OPR) serves as the agency's focal
point for reviewing and enhancing the performance of HRSA funded
programs within communities and States. On a regularly scheduled basis,
HRSA grantees are required to participate in a performance review of
their HRSA funded program(s) by a review team from one of the ten OPR
regional divisions. Grantees should expect to participate in a
performance review at some point during their project period. When a
grantee receives more than one HRSA grant, each of the grantee's HRSA
funded programs will be reviewed during the same performance review.

The purpose of performance review is to improve the performance of HRSA
funded programs. Through systematic pre-site and on-site analysis, OPR
works collaboratively with grantees and HRSA Bureaus/Offices to measure
program performance, analyze the factors impacting performance, and
identify effective strategies and partnerships to improve program
performance, with a particular focus on outcomes. Upon completion of the
performance review, grantees are expected to prepare an Action Plan that
identifies key actions to improve program performance as well as
addresses any identified program requirement issues. Performance reviews
also provide direct feedback to the agency about the impact of HRSA
policies on program implementation and performance within communities
and States.

For additional information on performance reviews, please visit:
<http://www.hrsa.gov/performancereview>.

# VII. Agency Contacts

Applicants may obtain additional information regarding business,
administrative, or fiscal issues related to this grant announcement by
contacting:

Neal I. Meyerson, MPA, CRA

Lead Grants Management Specialist

Government & Special Focus Branch

Division of Grants Management Operations/HRSA

5600 Fishers Lane, Room 11A-16

Rockville, Maryland 20857

Telephone: (301) 443-5906

Fax: (301) 594-6686

E-mail: <nmeyerson@hrsa.gov>

Additional information related to the overall program issues by
contacting:

Lois Eldred, DrPH

Branch Chief, Demonstration and Evaluation Branch

Division of Science and Policy

Health Resources and Services Administration

5600 Fishers Lane, Room 7C-07

Rockville, MD 20857

Telephone: 301-443-3327

Fax: 301-443-8486

E-mail: <LEldred@hrsa.gov>

# IX. Tips for Writing a Strong Application

**Include DUNS Number.** You must include a DUNS Number to have your
application reviewed. Applications ***will not*** be reviewed without a
DUNS number. To obtain a DUNS number, access
[www.dunandbradstreet.com](http://www.dunandbradstreet.com/) or call
1-866-705-5711. Please include the DUNS number next to the OMB Approval
Number on the application face page.

**Keep your audience in mind.** Reviewers will use only the information
contained in the application to assess the application. Be sure the
application and responses to the program requirements and expectations
are complete and clearly written. Do not assume that reviewers are
familiar with the applicant organization. Keep the review criteria in
mind when writing the application.

**Start preparing the application early.** Allow plenty of time to
gather required information from various sources.

**Follow the instructions in this guidance carefully.** Place all
information in the order requested in the guidance. If the information
is not placed in the requested order, you may receive a lower score.

**Be brief, concise, and clear.** Make your points understandable.
Provide accurate and honest information, including candid accounts of
problems and realistic plans to address them. If any required
information or data is omitted, explain why. Make sure the information
provided in each table, chart, attachment, etc., is consistent with the
proposal narrative and information in other tables.

**Be organized and logical.** Many applications fail to receive a high
score because the reviewers cannot follow the thought process of the
applicant or because parts of the application do not fit together.

**Be careful in the use of appendices.** Do not use the appendices for
information that is required in the body of the application. Be sure to
cross-reference all tables and attachments located in the appendices to
the appropriate text in the application.

**Carefully proofread the application.** Misspellings and grammatical
errors will impede reviewers in understanding the application. Be sure
pages are numbered (including appendices) and that page limits are
followed. Limit the use of abbreviations and acronyms, and define each
one at its first use and periodically throughout application.

**Print out and carefully review an electronic application**. If
submitting electronically, print out the application before submitting
it to ensure appropriate formatting and adherence to page limit
requirements.

# ADDENDUM 

## APPLYING THROUGH GRANTS.GOV

**Prepare to Apply through Grants.gov:**

HRSA, in providing the grant community a single site to Find and Apply
for grant funding opportunities, is [requiring]{.underline} applicants
for this funding opportunity to apply electronically through Grants.gov.
By using Grants.gov you will be able to download a copy of the
application package, complete it off-line, and then upload and submit
the application via the Grants.gov site. You may [no]{.underline}t
e-mail an electronic copy of a grant application to us.

Please understand that we will not consider additional information
and/or materials submitted after your initial application. You must
therefore ensure that all materials are submitted together.

**Note: Except in rare cases, paper applications will NOT be accepted
for this grant opportunity. If you believe you are technologically
unable to submit an on-line application you MUST contact the Director of
the Division of Grants Policy, at <DGPClearances@hrsa.gov> and explain
why you are technologically unable to submit on-line. . Make sure you
specify the announcement number you are requesting relief for. HRSA and
its Grants Application Center (GAC) will only accept paper applications
from applicants that received prior written approval.**

In order to apply through Grants.gov the Applicant must register with
Grants.gov. This is a three step process that must be completed by any
organization wishing to apply for a grant opportunity. The registration
process will require some time. Therefore, applicants or those
considering applying at some point in the future should register
**[immediately]{.underline}**. Registration in Grants.gov does not
require the organization to apply for a grant; it simply provides the
organization the required credentials so that the organization may apply
for a grant in the future. Registration is required only once.

**Get started now and complete the one-time registration process to
begin submitting grant applications as soon as you read this.**

You don't need to be registered to search or to begin selecting,
downloading and completing grant applications. Registration is required
to submit applications. Therefore, it is essential that your
organization be registered prior to attempting to submit a grant
application or your organization will not be able to do so. **Be sure to
complete the process early as the registration process may take some
time (anywhere from 5 days to 1 month)**.

**There are three steps to the registration process:**

**Step 1:** Register your organization

**Step 2:** Register yourself as an Authorized Organization
Representative

**Step 3:** Get authorized by your organization to submit grants

These instructions will walk you through the three basic registration
steps. Additional assistance is available at Grants.gov at
[www.grants.gov](http://www.grants.gov/). Individual assistance is
available at <http://www.grants.gov/Support> or 1-800-447-8477.
Grants.gov also provides a variety of support options through online
Help including Context-Sensitive Help, Online Tutorials, FAQs, Training
Demonstration, User Guide, and Quick Reference Guides.

Follow this checklist to complete your registration---

1\. Register Your Organization

\- Obtain your organization's Data Universal Number System (DUNS) number

\- Register your organization with Central Contractor Registry (CCR)

\- Identify your organization's E-Business POC (Point of Contact)

\- Confirm your organization's CCR "Marketing Partner ID Number (M-PIN)"
password

2\. Register Yourself as an Authorized Organization Representative (AOR)

\- Obtain your username and password

\- Register your username and password with Grants.gov

3\. Get Yourself Authorized as an AOR

\- Contact your E-Business POC to ensure your AOR status

\- Log in to Grants.gov to check your AOR status

The Grants.gov/Apply feature includes a simple, unified application
process to enable applicants to apply for grants online. The information
applicants need to understand and execute the steps is at
[http://www.grants.gov/GetStarted](../www.grants.gov/GetStarted).
Applicants should read the Get Started steps carefully. The site also
contains registration checklists to help you walk through the process.
HRSA recommends that you download the checklists and prepare the
information requested before beginning the registration process.
Reviewing information required and assembling it before beginning the
registration process will save you time and make the process faster and
smoother.

**REGISTER YOUR ORGANIZATION**

Before you can apply for a grant via Grants.gov, your organization must
obtain a Data Universal Number System (DUNS) number and register early
with the Central Contractor Registry (CCR).

**Obtain your organization's DUNS number**

A DUNS number is a unique number that identifies an organization. It has
been adopted by the Federal government to help track how Federal grant
money is distributed. Ask your grant administrator or chief financial
officer to provide your organization's DUNS number.

***-How do you do it?*** If your organization does not have a DUNS
number, call the special Dun & Bradstreet hotline at 1-866-705-5711 to
receive one free of charge.

***- How long will this take?*** You will receive a DUNS number at the
conclusion of the phone call.

**Register your organization with CCR**

The CCR is the central government repository for organizations working
with the Federal government. Check to see if your organization is
already registered at the CCR website. If your organization is not
already registered, identify the primary contact who should register
your organization.

When your organization registers with CCR, it will be required to
designate an E-Business Point of Contact (E-Business POC). The designee
authorizes individuals to submit grant applications on behalf of the
organization and creates a special password called a Marketing Partner
ID Number (M-PIN) to verify individuals authorized to submit grant
applications for the organization.

**-*How do you do it? ***Visit the CCR website at
[http://www.ccr.gov](http://www.ccr.gov/). Check whether your
organization is already registered or register your organization right
online. Be certain to enter an MPIN number during this process as this
is an optional field for the CCR registration but
[mandatory]{.underline} for Grants.gov.

***- How long will this take?*** It may take a few days for you to
collect the information needed for your organization's registration, but
once you finish the registration process, you can move on to Step 2 the
very next business day. Note it will take up to a month for the total
registration- therefore this should be done as soon as possible.

**GET AUTHORIZED as an AOR by Your Organization**

The registration process is almost complete. All that remains is the
final step ---getting authorized. Even though you have registered, your
E-Business POC must authorize you so Grants.gov will know that you are
verified to submit applications.

**- Obtain your E-Business POC authorization**

After your Authorized Organizational Representative (AOR) profile is
completed, your organization's E-Business POC will receive an email
regarding your requested AOR registration, with links and instructions
to authorize you as an AOR.

***- How do you do it?*** Instruct your E-Business POC to login to
Grants.gov at http://www.grants.gov/ForEbiz and enter your
organization's DUNS number and M-PIN. They will select you as an AOR
they wish to authorize and you will be verified to submit grant
applications.

***- How long will this take?*** It depends on how long it takes your
E-Business POC to log in and authorize your AOR status. You can check
your AOR status by logging in to Grants.gov at
http://www.grants.gov/ForApplicants.

**REGISTER YOURSELF as an Authorized Organization Representative (AOR)**

Once the CCR Registration is complete, your organization is finished
registering. You must now register yourself with Grants.gov and
establish yourself as an AOR, an individual authorized to submit grant
applications on behalf of your organization. There are two elements
required to complete this step --- both must be completed to move onto
Step 3.

**1. Obtain your username and password**

In order to safeguard the security of your electronic information, and
to submit a Federal grant application via Grants.gov, you must first
obtain a username and password from the Grants.gov Credential Provider.

***- How do you do it?*** Just register with Grants.gov's Credential
Provider at http://www.grants.gov/Register1. You will need to enter your
organization's DUNS number to access the registration form. Once you
complete the registration form you will be given your username and you
will create your own password.

***- How long will this take?*** Same day. When you submit your
information you will receive your username and be able to create your
password.

2\. **Register with Grants.gov**

Now that you have your username and password, allow about 30 minutes for
your data to transfer from the Credential Provider, then you must
register with Grants.gov to set up a short profile.

**\> *How do you do it? ***Simply visit http://www.grants.gov/Register2
to register your username and password and set up your profile.
Remember, you will only be authorized for the DUNS number which you
register in your Grants.gov profile.

**\> *How long will this take? ***Same day. Your AOR profile will be
complete after you finish filling in the profile information and save
the information at Grants.gov.

You have now completed the registration process for Grants.gov. If you
are applying for a [new or competing continuation]{.underline} you may
find the application package through Grants.gov FIND. If you are filling
out a [non-competing continuation]{.underline} application you
[must]{.underline} obtain the announcement number through your program
office, and enter this announcement number in the search field to pull
up the application form and related program guidance. Download the
required forms and enter your current grant number in the appropriate
field to begin the non-competing continuation application which you will
then upload for electronic submittal through Grants.gov. For
continuation applications which require submittal of performance
measures electronically, instructions are provided in the program
guidance on how to enter the HRSA electronic handbooks to provide this
information.

**How to submit an electronic application to HRSA via Grants.gov/Apply**

[a. Applying using Grants.gov.]{.underline} Grants.gov has a full set of
instructions on how to apply for funds on its website at
<http://www.grants.gov/CompleteApplication>. The following provides
simple guidance on what you will find on the Grants.gov/Apply site.
Applicants are encouraged to read through the page entitled, "Complete
Application Package" before getting started. Grants.gov allows
applicants to download the application package, instructions and forms
that are incorporated in the instructions, and work off line. In
addition to forms that are part of the application instructions, there
will be a series of electronic forms that are provided utilizing a
PureEdge reader. The PureEdge Reader is available free for download from
the Grants.gov/Get Started site. The PureEdge Reader allows applicants
to read the electronic files in a form format so that they will look
like any other Standard or HRSA form. The PureEdge forms have content
sensitive help. To use this feature you will need to click on the icon
at the top of the page that features an arrow with a question mark. This
engages the content sensitive help for each field you will need to
complete on the electronic form. The PureEdge forms can be downloaded
and saved on your hard drive, network drive(s), or CDs.

MacIntosh Users will need to use the Virtual PC emulator software, which
allows PC software to run on MacIntosh platforms.

[b. Mandatory Fields on PureEdge Forms.]{.underline} In the PureEdge
forms you will note fields that will appear with a yellow background
color on the data fields to be completed. These fields are mandatory
fields and they **must** be completed to successfully submit your
application.

[c. Completion of SF-424 Fields First.]{.underline} The PureEdge forms
are designed to fill in common required fields such as the applicant
name and address, DUNS number, etc., on all PureEdge electronic forms.
**To trigger this feature, an applicant must complete the SF-424
information first.** Once it is completed the information will transfer
to the other forms.

[d. Customer Support.]{.underline} The grants.gov website provides
customer support via (800) 518-GRANTS (this is a toll-free number) or
through e-mail at <support@grants.gov>. The customer support center is
open from 7:00 a.m. to 9:00 p.m. Eastern time, Monday through Friday,
except federal holidays, to address grants.gov technology issues. For
technical assistance to program related questions, contact the number
listed in the Program Section of the program you are applying for.

**Timely Receipt Requirements and Proof of Timely Submission**

a\. Electronic [Submission.]{.underline} All applications must be
received by [www.grants.gov/Apply](http://www.grants.gov/Apply) **by
5:00 P.M. Eastern Time** on the due date established for each program.

Proof of timely submission is automatically recorded by Grants.gov. An
electronic time stamp is generated within the system when the
application is successfully received by Grants.gov. The applicant will
receive an acknowledgement of receipt and a tracking number from
Grants.gov with the successful transmission of their application.
Applicants should print this receipt and save it, along with facsimile
receipts for information provided by facsimile, as proof of timely
submission. When HRSA successfully retrieves the application from
Grants.gov, Grants.gov will provide an electronic acknowledgment of
receipt to the e-mail address of the AOR. Proof of timely submission
shall be the date and time that Grants.gov receives your application.

Applications received by grants.gov, after the established due date and
time for the program, will be considered late and will not be considered
for funding by HRSA. [HRSA suggests that applicants submit their
applications during the operating hours of the Grants.gov Support Desk,
so that if there are questions concerning transmission, operators will
be available to walk you through the process.]{.underline} Submitting
your application during the Support Desk hours will also ensure that you
have sufficient time for the application to complete its transmission
prior to the application deadline. Applicants using dial-up connections
should be aware that transmission should take some time before
Grants.gov receives it. Grants.gov will provide either an error or a
successfully received transmission message. The Grants.gov Support desk
reports that some applicants abort the transmission because they think
that nothing is occurring during the transmission process. Please be
patient and give the system time to process the application. Uploading
and transmitting many files, particularly electronic forms with
associated XML schemas, will take some time to be processed.

Note the following additional information regarding submission of all
HRSA applications through Grants.gov:

• You must submit all documents electronically, including all
information typically included on the SF424 and all necessary assurances
and certifications.

• Your application must comply with any page limitation requirements
described in this program announcement.

• After you electronically submit your application, you will receive an
automatic acknowledgement from Grants.gov that contains a Grants.gov
tracking number. HRSA will retrieve your application from Grants.gov.

Online applications are required to submit ONLY one form in signed hard
copy: the SF-424/5161 Face Sheet, since all other elements of the
application have been captured and transmitted electronically. This face
page should be sent to HRSA's Grants Application Center at:

The HRSA Grants Application Center

> The Legin Group, Inc.
>
> Attn: *SPNS Innovations in Oral Health Care Initiative*
>
> Program Announcement No. HRSA-06-042
>
> CFDA No. 93.*928*
>
> 901 Russell Avenue, Suite 450
>
> Gaithersburg, MD 20879
>
> Telephone: 877-477-2123

**Formal Submission of the Electronic Application**

Applications completed online are considered formally submitted when the
Authorizing Official electronically submits the application to HRSA
through Grants.gov. However, to complete the submission requirements, a
hard-copy of the SF-424/5161 Face Sheet must be printed, signed, and
submitted to the HRSA Grants Application Center. The SF-424/5161 can be
printed from the online application.

For an online application, the signed SF-424/5161 must be sent to the
HRSA GRANTS APPLICATION CENTER at the above address and received by HRSA
by no later than five days after the due date.

Applications will be considered as having met the deadline if: (1) the
application has been successfully transmitted electronically by your
organization's Authorizing Official through Grants.gov on or before the
deadline date and time, and (2) the signed SF-424/5161 Face Sheet is
received by HRSA no later than five days after the deadline date.

# Background References

American Dental Association New Release, 2005.

*Access to HIV Care: Initial Results from the HIV Cost and Services
Utilization Study*, Santa Monica, California: RAND Corporation, RB-4530,
2000.

Coulter ID; Marcus M; Freed JR; Der-Martirosian C; Cunningham WE;
Andersen RM; Maas WR; Garcia I; Schneider DA; Genovese B; Shapiro MF;
Bozzette SA. Use of dental care by HIV-infected medical patients.
*Journal of Dental Research*. 79(6): 1356- 1361, 2000.

Elter JR, Strauss RP, Beck JD. Assessing dental anxiety, dental care use
and oral status in older adults. *Journal of American Dental
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Hayward RA, Bernard AM, Freeman HE, Corey CR. Regular source of
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Heslin KC, Cunningham WE, Marcus M. A comparison of unmet needs for
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Marcus M; Freed JR; Coulter ID: Der-Martirosian C; Cunningham W;
Andersen R; Garcia I; Schneider DA; Maas WR; Bozzette SA; Shapiro MF.
Perceived unmet need for oral treatment among a national population of
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McCarthy GM. Hose factors associated with HIV-related oral candidiasis.
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*Oral Health in America: A Report of the Surgeon General*. Rockville,
MD: National Institute of Dental and Craniofacial Research: 2000.

Oral Health: D*ental Disease Is a Chronic Problem Among Low-Income
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Publication HEHS-00-149.

Shiboski C, Palacio H, Neuhaus J, Greenblatt R. Dental Care Access and
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89(6). 834-839. 1999.

Weinert M, Grimes RM, Lynch DP. Oral manifestations of HIV infection.
*Annual Internal Medicine*: 125: 485-96. 1996.

Zabos G, and Trinh C. Bringing the Mountain to Mohammed: A Mobile Dental
Team Serves a Community-Based Program for People with HIV/AIDS.
*American Journal of Public Health*. 91(8). 1187-1189. 2001.