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

**Health Resources and Services Administration**

*Maternal and Child Health Bureau*

*Division of Services for Children with Special Health Needs*

> ***Medical Home Capacity Building for Children and Youth with***
>
> ***Special Health Care Needs***
>
> *New Announcement*
>
> *HRSA-08-025*
>
> **Catalog of Federal Domestic Assistance (CFDA) No. 93.110**

**PROGRAM GUIDANCE**

Fiscal Year 2008 []{.mark}

**Application Due Date: January 7, 2008**

**Release Date: *October 29, 2007***

**Date of Issuance*: October 29, 2007***

> Marie Y. Mann, MD, MPH
>
> Division of Services for Children with Special Health Needs
>
> Telephone: 301-443-1080

Fax: 310-443-8604

mmann@hrsa.gov

Authority: Section 501(a) (2) of the Social Security Act; (42 U.S.C.
701)

**Executive Summary**

The purpose of this grant activity is to support a national resource
center for medical home implementation. The primary goal is to provide
support to ongoing efforts directed toward improving children and
youths, particularly those with special health care needs, access to a
regular, ongoing source of health care in the community with appropriate
sources of routine and specialty health care and integrated with the
requisite community services.

It is anticipated that through the cooperative agreement, the successful
applicant will: (1) develop and implement policy initiatives related to
achieving medical homes for children and youth, particularly those with
special health care needs, building upon the operational definition of a
medical home and knowledge of best practices, and utilizing tools that
have been developed, such as the medical home index and continuous
quality improvement measures; (2) support and enhance the capacity of
community-based health care professionals, including those from diverse
populations and/or serving culturally/linguistically diverse
populations, in the implementation of the medical home, e.g. incentive
awards; (3) use quantitative and qualitative data to evaluate and
identify models of medical homes that work; (4) facilitate the
development of resources that increase access, awareness, and
implementation of the medical home; (5) address potential barriers to
achieving a medical home; (6) promote activities that establish medical
home as the standard of care for all community-based primary care
providers; (7) establish and implement with relevant stakeholders
strategies for coordination of primary care with specialty care and the
array of other services required for children and youth with special
health care needs (CYSHCN) and their families; (8) develop strategies
with relevant partners, including children, youth, and families of a
variety of backgrounds, health professional organizations, the Health
and Ready to Work National Center, insurers/third party payers, state
and national policy makers, to achieve successful transition from
pediatric practice to adult care settings for CYSHCN; and (9) assist
States in implementation, assessment, and evaluation of strategies to
promote Healthy People 2010 Goals and the President's New Freedom
Initiative around community based systems of care for CYSHCN.

One project will be funded for a period of up to five (5) years, during
Federal fiscal years 2008-2012. Funding beyond the first year is subject
to availability of funding, satisfactory grantee performance, and a
determination that continued funding is in the best interest of the
government. Approximately \$700,000 is expected to be available annually
to fund the one project. Funding will be provided in the form of a
cooperative agreement. The award is subject to adjustment after program
and objective review.

**Guidance Table of Contents**

[I. Funding Opportunity Description 6](#__RefHeading___Toc178485800)

[**1.** **Purpose** 6](#Funding_purpose)

[**2.** **Background** 7](#__RefHeading___Toc178485802)

[II. Award Information 10](#__RefHeading___Toc178485803)

[**1. Type of Award** 10](#__RefHeading___Toc178485804)

[**2. Summary of Funding** 11](#__RefHeading___Toc178485805)

[III. Eligibility Information 11](#__RefHeading___Toc178485806)

[**1. Eligible Applicants** 11](#Eligibility_who)

[**2. Cost Sharing/Matching** 11](#__RefHeading___Toc178485808)

[**3. Other** 12](#__RefHeading___Toc178485809)

[IV. Application and Submission Information
12](#__RefHeading___Toc178485810)

[**1.** **Address to Request Application Package**
12](#__RefHeading___Toc178485811)

[**2. Content and Form of Application Submission**
13](#__RefHeading___Toc178485812)

[**i.** ***Application Face Page*** 17](#__RefHeading___Toc178485813)

[**ii.** ***Table of Contents*** 17](#__RefHeading___Toc178485814)

[**iii.** ***Application Checklist*** 17](#__RefHeading___Toc178485815)

[**iv.** ***Budget*** 17](#__RefHeading___Toc178485816)

[**v.** ***Budget Justification*** 17](#__RefHeading___Toc178485817)

[**vi.** ***Staffing Plan and Personnel Requirements***
19](#__RefHeading___Toc178485818)

[**vii.** ***Assurances*** 19](#__RefHeading___Toc178485819)

[**viii.** ***Certifications*** 19](#__RefHeading___Toc178485820)

[**ix.** ***Project Abstract*** 19](#__RefHeading___Toc178485821)

[**x.** ***Program Narrative*** 19](#__RefHeading___Toc178485822)

[**xi.** ***Program Specific Forms*** 20](#__RefHeading___Toc178485823)

[**xii.** ***Attachments*** 21](#__RefHeading___Toc178485824)

[**3. Submission Dates and Times** 22](#__RefHeading___Toc178485825)

[**4. Intergovernmental Review** 22](#Application_materials)

[**5. Funding Restrictions** 22](#__RefHeading___Toc178485827)

[**6. Other Submission Requirements** 23](#__RefHeading___Toc178485828)

[V. Application Review Information 24](#__RefHeading___Toc178485829)

[**1. Review Criteria** 24](#__RefHeading___Toc178485830)

**2. Review and Selection
Process**\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....27

[VII. Agency Contacts 30](#__RefHeading___Toc178485831)

[VIII. Other Information 31](#__RefHeading___Toc178485832)

[ix. Tips for Writing a Strong Application
34](#__RefHeading___Toc178485833)

[APPENDIX A: HRSA's Electronic Submission User Guide
36](#__RefHeading___Toc178485834)

[1. Introduction 36](#introduction)

[1.1 Document Purpose and Scope 36](#document-purpose-and-scope)

[1.2 Document Organization and Version Control
36](#document-organization-and-version-control)

[2. Noncompeting Continuation Application
36](#noncompeting-continuation-application)

[2.1 Process Overview 36](#process-overview)

[2.2 Grantee Organization Needs to Register With Grants.gov (if not
already registered) -- See Appendix B
37](#grantee-organization-needs-to-register-with-grants.gov-if-not-already-registered-see-appendix-b)

[2.3 Project Director and Authorizing Official Need to Register with
HRSA EHBs (if not already registered)
37](#project-director-and-authorizing-official-need-to-register-with-hrsa-ehbs-if-not-already-registered)

[2.4 Apply through Grants.gov 38](#apply-through-grants.gov)

[2.4.1 Find Funding Opportunity 38](#find-funding-opportunity)

[2.4.2 Download Application Package 38](#download-application-package)

[2.4.3 Complete Application 39](#complete-application)

[2.4.4 Submit Application 39](#submit-application)

[2.4.5 Verify Status of Application 39](#verify-status-of-application)

[2.5 Verify in HRSA Electronic Handbooks
40](#verify-in-hrsa-electronic-handbooks)

[2.5.1 Verify Status of Application 40](#verify-status-of-application-1)

[2.5.2 Manage Access to Your Application
40](#manage-access-to-your-application)

[2.5.3 Check Validation Errors 40](#check-validation-errors)

[2.5.4 Fix Errors and Complete Application
40](#fix-errors-and-complete-application)

[2.5.5 Submit Application 40](#submit-application-1)

[3. Competing Application 41](#competing-application)

[3.1 Process Overview 41](#process-overview-1)

[3.2 Grantee Organization Needs to Register With Grants.gov (if not
already registered) -- See Appendix B
41](#grantee-organization-needs-to-register-with-grants.gov-if-not-already-registered-see-appendix-b-1)

[3.3 Apply through Grants.gov 42](#apply-through-grants.gov-1)

[3.3.1 Find Funding Opportunity 42](#find-funding-opportunity-1)

[3.3.2 Download Application Package 42](#download-application-package-1)

[3.3.3 Complete Application 42](#complete-application-1)

[3.3.4 Submit Application 42](#submit-application-2)

[3.3.5 Verify Status of Application 43](#verify-status-of-application-2)

[4. General Instructions for Application Submission
43](#general-instructions-for-application-submission)

[4.1 Narrative Attachment Guidelines
43](#narrative-attachment-guidelines)

[4.1.1 Font 43](#font)

[4.1.2 Paper Size and Margins 44](#paper-size-and-margins)

[4.1.3 Names 44](#names)

[4.1.4 Section Headings 44](#section-headings)

[4.1.5 Page Numbering 44](#page-numbering)

[4.1.6 Allowable Attachment or Document Types
44](#allowable-attachment-or-document-types)

[4.2 Application Content Order (Table of Contents)
44](#application-content-order-table-of-contents)

[4.3 Page Limit 45](#page-limit)

[5. Customer Support Information 45](#customer-support-information)

[5.1.1 Grants.gov Customer Support 45](#grants.gov-customer-support)

[5.1.2 HRSA Call Center 45](#hrsa-call-center)

[5.1.3 HRSA Program Support 45](#hrsa-program-support)

[6. FAQs 45](#faqs)

[6.1 Software 45](#software)

[6.1.1 What are the software requirements for using Grants.gov?
45](#what-are-the-software-requirements-for-using-grants.gov)

[6.1.2 Why can't I download PureEdge Viewer onto my machine?
46](#why-cant-i-download-pureedge-viewer-onto-my-machine)

[6.1.3 I have heard that Grants.gov is not Macintosh compatible. What do
I do if I use only a Macintosh?
46](#i-have-heard-that-grants.gov-is-not-macintosh-compatible.-what-do-i-do-if-i-use-only-a-macintosh)

[6.1.4 What are the software requirements for HRSA EHBs?
46](#what-are-the-software-requirements-for-hrsa-ehbs)

[6.1.5 What are the system requirements for using HRSA EHBs on a
Macintosh computer?
47](#what-are-the-system-requirements-for-using-hrsa-ehbs-on-a-macintosh-computer)

[6.2 Application Receipt 47](#application-receipt)

[6.2.1 What will be the receipt date\--the date the application is
stamped as received by Grants.gov or the date the data is received by
HRSA?
47](#what-will-be-the-receipt-date--the-date-the-application-is-stamped-as-received-by-grants.gov-or-the-date-the-data-is-received-by-hrsa)

[6.2.2 When do I need to submit my application?
47](#when-do-i-need-to-submit-my-application)

[6.2.3 What emails can I expect once I submit my application? Is email
reliable?
47](#what-emails-can-i-expect-once-i-submit-my-application-is-email-reliable)

[6.2.4 If a resubmission is required because of Grants.gov system
problems, will these be considered \"late\"?
48](#if-a-resubmission-is-required-because-of-grants.gov-system-problems-will-these-be-considered-late)

[6.3 Application Submission 48](#application-submission)

[6.3.1 How can I make sure that my electronic application is presented
in the right order for objective review?
48](#how-can-i-make-sure-that-my-electronic-application-is-presented-in-the-right-order-for-objective-review)

[6.4 Grants.gov 48](#grants.gov)

[Appendix B -- Registering and Applying Through Grants.gov
49](#__RefHeading___Toc178485894)

[APPENDIX C: MCHB Discretionary Grant Performance Measures
55](#__RefHeading___Toc178485895)

[APPENDIX D: Financial and Demographic Forms
71](#__RefHeading___Toc178485896)

[APPENDIX E: Additional Data Elements 86](#__RefHeading___Toc178485897)

[]{#__RefHeading___Toc178485800 .anchor}**I. Funding Opportunity
Description**

[]{#Funding_purpose .anchor}

1.  **Purpose**

> Social Security Act, Section 501 (a)(2); 42 U.S.C. 701. This
> announcement solicits applications for the Medical Home Capacity
> Building for Children with Special Health Care Needs (CSHCN) program.
>
> The purpose of this grant activity is to support a national resource
> center for medical home implementation. The primary goal is to provide
> support to ongoing efforts directed toward improving children and
> youths, particularly those with special health care needs, access to a
> regular, ongoing source of health care in the community with
> appropriate sources of routine and specialty health care and the
> integration of medical services with the requisite community services.
>
> Effective efforts to ensure access to quality, community-based,
> continuous, coordinated, and culturally effective primary and
> specialty care are to be maintained through collaborative partnerships
> between State Title V/CSHCN programs, relevant health care
> professionals, health professional organizations, insurers/third party
> payers, community service providers, CYSHCN and their families to
> assure universal access to medical homes, as well as support systems
> for the health care providers who serve children and youths.
>
> It is anticipated that through the cooperative agreement, the
> successful applicant will:

1)  develop and implement policy initiatives related to achieving
    medical homes for all children and youth, particularly those with
    special health care needs and medically underserved, building upon
    the operational definition of a medical home and knowledge of best
    practices, and utilizing tools that have been developed, such as the
    medical home index and continuous quality improvement measures;

2)  support and enhance the capacity of community-based health care
    professionals, including those from diverse populations and/or
    serving culturally/linguistically diverse populations, in the
    implementation of the medical home (e.g. use of incentive awards);

3)  use quantitative and qualitative data to evaluate and identify
    models of medical homes that work;

4)  facilitate the development of resources that increase access,
    awareness, and implementation of the medical home;

5)  address potential barriers to achieving a medical home (e.g.
    reimbursement, privacy/confidentiality);

6)  promote activities that establish medical home as the standard of
    care for all community-based primary care providers (e.g. policy
    statement development);

7)  establish and implement with relevant stakeholders strategies for
    coordination of primary care with specialty care and the array of
    other services required for CYSHCN and their families;

8)  develop strategies with relevant partners, including children, youth
    and families of a variety of backgrounds, health professional
    organizations, the Health and Ready to Work National Center, third
    party payers, state and national policy makers, to achieve
    successful transition from pediatric practice to adult care settings
    for CYSHCN; and

9)  assist states in implementation, assessment, and evaluation of
    strategies to promote Healthy People 2010 Goals and the President's
    New Freedom Initiative around community based systems of care for
    CYSHCN.

```{=html}
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```
2.  []{#__RefHeading___Toc178485802 .anchor}**Background**

> **The Maternal & Child Health Bureau**
>
> The Maternal and Child Health Bureau (MCHB) is a component of the
> Health Resources and Services Administration (HRSA) within the
> Department of Health and Human Services (DHHS). Since its inception,
> Maternal and Child Health (MCH) Services Grants through Title V of the
> Social Security Act have provided a foundation for ensuring the health
> of our Nation's mothers and children. The mission of the MCHB is to
> provide national leadership in partnership with key stakeholders, to
> reduce disparities, assure the availability of quality care, and
> strengthen the Nation's Maternal and Child Health (MCH) infrastructure
> in order to improve the physical and mental health, safety, and
> well-being of the MCH population -- *all* women, infants, children,
> adolescents and their families, including fathers and CYSHCN.
>
> **Division of Services for Children with Special Health Needs**
>
> The Omnibus Budget Reconciliation Act (OBRA) of 1989, Public Law
> 101-239 amended Title V of the Social Security Act to extend the
> authority and responsibility of MCHB to address core elements of
> community-based systems of services for children with special health
> care needs and their families. With this amendment, State Title V
> Programs for Children with Special Health Care Needs (CSHCN) under the
> Maternal and Child Health Services Block Grant were given the
> responsibility to "provide and promote family-centered,
> community-based, coordinated care for children with special health
> care needs, and facilitate the development of community-based systems
> of services for such children and their families." Children and youth
> with special health care needs are defined as "those children and
> youth who have or are at increased risk for a chronic physical,
> developmental, behavioral, or emotional condition and who also require
> health and related services of a type or amount beyond that required
> by children generally" (American Academy of Pediatrics, 1998).
>
> The Division's mission to assure access to care through systems
> improvement is reflected in both the *Healthy People 2010 Objectives*,
> and the *President's New Freedom Initiative*. Through these national
> initiatives, MCHB is specifically charged with developing and
> implementing a plan to achieve appropriate community-based systems of
> services for CYSHCN and their families.
>
> Components of the plan include:
>
> 1\. Family/professional partnership at all levels of decision-making.
>
> 2\. Access to comprehensive health and related services through the
> medical home.
>
> 3\. Early and continuous screening, evaluation and diagnosis.
>
> 4\. Adequate public and/or private financing of needed services.
>
> 5\. Organization of community services so that families can use them
> easily.
>
> 6\. Successful transition to all aspects of adult health care, work,
> and independence.
>
> Each of the following 6 program areas in the Division's Integrated
> Services Branch corresponds with one of the 6 core components
> mentioned previously. The program areas are:
>
> [Medical Home]{.underline}: This program improves (1) access to
> quality sources of ongoing primary health care, (2) appropriate
> referral to specialty care, and (3) integration of medical services
> with the community services required by CYSHCN and their families. The
> medical home defines care for CYSHCN as accessible, continuous,
> comprehensive, family-centered, coordinated, compassionate, and
> culturally effective. The program is a collaborative effort among
> child health professionals, CYSHCN, and their families to assure
> universal access to medical homes, as well as support systems for the
> providers who serve these children. Partnerships with families, State
> Title V programs and other national and State constituents have been
> established for the planning, development, and oversight of the
> medical home.
>
> [Family Professional Partnerships/Cultural Competence:]{.underline}
> The purpose of this program is to promote the integration of
> family-centered care, family/professional partnerships and cultural
> and linguistic competence into existing service systems to address
> issues related to quality of health care, access to services,
> disparities in heath care and health outcomes and the quality of life
> for CYSHCN and their families. Values, principles and practices
> supporting this effort should be the standard of practice for
> providers and the expectation of families with CYSHCN. This program
> area is accomplished through respectful partnerships between families
> with CYSHCN, health professionals, policy makers, programs and
> agencies at local, state and national levels and should be inclusive
> of these same entities who are and/ have expertise in, working with
> culturally and linguistically diverse populations.
>
> [Health Insurance and Financing]{.underline}: This program works to
> improve access to adequate, affordable health insurance of CYSHCN by
> employing 3 strategies: (1) expand insurance to include uninsured
> CYSHCN, (2) assure that currently insured CYSHCN have access to the
> full array of benefits and services they need, and (3) improve the
> financing and reimbursement of services. Grant activities are focused
> on promoting state and regional partnerships to develop strategies
> focused on improving access to health insurance for CYSHCN and
> cooperative agreements and contracts are awarded to provide support
> and assistance on special issues impacting health insurance.
>
> [Community Integrated Services]{.underline}: The purpose of this
> program is to: (1) identify barriers to coordinating, integrating and
> financing multiple and fragmented health and related services in
> community-based service systems, (2) implement community driven model
> solutions addressing barriers facing families in accessing community
> health and related services that are coordinated and easy to use, and
> (3) implement successful models state-wide with support from Title V
> programs and key partners and stakeholders. Strategies include
> developing private/public partnerships to implement community-based
> service integration initiatives; coordinating community and
> State/territory plans and activities with partners around the six core
> measures for CYSHCN in accordance with the *President's New Freedom
> Initiative*; and developing measurement and monitoring strategies to
> more accurately demonstrate community and states' progress on the six
> core measures.
>
> [Early and Continuous Screening]{.underline}: This program supports
> periodic developmental screening for all children in conjunction with
> the medical home. To achieve this goal, the program works through
> "Bright Futures Guidelines for Health Supervision of Infants, Children
> and Adolescents." and AAP policy statement "Identifying Infants and
> Young Children with Developmental Disorders in the Medical Home: An
> Algorithm for Developmental Surveillance and Screening" (AAP, June
> 2006). In addition, there is a national program to implement universal
> newborn hearing screening prior to hospital discharge and intervention
> by six months of age by linking all identified infants to a medical
> home, family-to-family support and early intervention; as well as a
> newborn bloodspot screening program. As noted by Kim et al (Kim,
> Lloyd-Puryear, & Tonniges, 2003) and Lloyd-Puryear, et al
> (Lloyd-Puryear, Tonniges, van Dyck, Mann, et al., 2006), newborn
> screening is a system involving initial screening, immediate follow-up
> evaluation of the screen-positive newborn, diagnosis confirmation,
> initial and long-term treatment and management, and evaluation of all
> components of the system. The Heritable Disorders Program, outlined in
> sections 1109 and 1110 of the Public Health Service (PHS) Act (42
> U.S.C. 300b-8 and 9) which were enacted in 2000, was established to
> enhance, improve, and/or expand the ability of State and local public
> health agencies to support such a system. 
>
> [Healthy and Ready to Work]{.underline}: The purpose of this program
> is to provide the necessary support systems to ensure that youth with
> special health care needs and their families make a successful
> transition to adulthood, including: (1) moving from the pediatric to
> the adult health care system; (2) from secondary to post-secondary
> education; and (3) to employment and self-sufficiency. The program
> implements the "Consensus Statement on Health Care Transition for
> Young Adults with Special Health Care Needs" developed by the American
> Academy of Pediatrics, American Academy of Family Physicians, and
> American College of Physicians-American Society of Internal Medicine
> (December 2002).
>
> The Division of Services for Children with Special Health Care Needs
> (DSCSHN) medical home program was initiated in 1997 as one of six
> outcomes to guide the development of comprehensive, coordinated,
> family-centered systems of care for children with special health care
> needs and their families. A major goal of DSCSHN, it aims to ensure
> that all CYSHCN receive appropriate health care through a medical
> home. Data from the 2001 National Survey of CSHCN demonstrates that
> approximately 52% of the nation's children with special health care
> needs receive comprehensive, coordinated care within the context of a
> medical home (CSHCN National Survey, 2001). Children and youth who are
> poor, minority or for whom their special health care needs impose a
> significant limitation on their activities of daily living are more
> significantly impacted by the absence of a medical home. Medical homes
> ensure that every child and youth with a special health care need has
> access to an ongoing, routine source of comprehensive health care that
> is accessible, family-centered, continuous, comprehensive,
> coordinated, compassionate, and delivered in a culturally effective
> environment.
>
> In February 2001, President Bush released the New Freedom Initiative,
> a comprehensive plan to tear down barriers facing people with
> disabilities which prevent them from participating fully in community
> life. This broad interagency initiative calls upon the Federal
> government to assist States and localities to implement the decision
> of the Supreme Court in Olmstead v L.C., which requires states to
> provide appropriate community-based services for persons with
> disabilities. As part of this initiative, HRSA was charged with
> "developing and implementing a plan to achieve appropriate
> community-based service systems for children and youth with special
> health care needs (CYSHCN) and their families". A core component of
> community systems is that every child with a special health care need
> must have access to a regular, ongoing source of health care in the
> community, i.e., a medical home.
>
> The medical home is included as a AHealthy People 2010 National Health
> Promotion and Disease Prevention Objective@, an integral part of the
> President's New Freedom Initiative for the nation, and is part of the
> MCHB Strategic Plan for all children. Each State Title V Maternal and
> Child Health Program reports annually on the extent to which children
> with special health care needs have access to a medical home. The need
> for including the medical home concept in pediatric education is
> addressed by the Futures of Pediatric Education (FOPE) II. The FOPE II
> Task Force recommends that A all children receive primary care
> services through a consistent medical home@ (American Academy of
> Pediatrics, 2000). With these and other resources the DSCHSN aims to
> ensure that all CYSHCN have access to a medical home by the year 2010.
>
> The medical home has been recognized as a model of care that not only
> benefits CYSHCN but all children, youth, and adults, particularly
> those in "safety net settings." (Commonwealth Fund, June 2007). In
> March 2007 the American Academy of Pediatrics, American Academy of
> Family Physicians, American College of Physicians, and the American
> Osteopathic Association released Joint Principles of the
> Patient-Centered Medical Home to describe the approach to providing
> comprehensive primary care for children, youth, and adults in a health
> care setting (American Academy of Pediatrics, March 2007).
>
> In June 2007 the Commonwealth Fund released findings from a 2006 study
> that showcased the medical home as a "promising model of care for
> narrowing health care disparities and providing patients with higher
> quality care in terms of prevention and chronic disease management."
> (Commonwealth Fund, June 2007)

[]{#__RefHeading___Toc178485803 .anchor}**II. Award Information**

[]{#__RefHeading___Toc178485804 .anchor}**1. Type of Award**

> Funding will be provided in the form of a **cooperative agreement**. A
> **cooperative agreement** is an award instrument of financial
> assistance where substantial involvement is anticipated between the
> HHS awarding agency and the recipient during performance of the
> contemplated project. This means that substantial MCHB scientific
> and/or programmatic involvement with the awardee is anticipated during
> the performance of this project. Under the terms of this cooperative
> agreement, in addition to the usual monitoring and technical
> assistance provided under grants,
>
> ***Federal responsibilities include:***

-   Participation, as appropriate, in meetings conducted during the
    period of the cooperative agreement;

-   Ongoing review of activities and procedures to be established and
    implemented for accomplishing the scope of work;

-   Review of project information prior to dissemination;

-   Review of information on project activities;

-   Assistance around establishing and facilitating effective
    collaborative relationships with State, Federal and non-Federal
    partners, MCHB grant projects, MCHB-funded resource centers, and
    other entities that may be relevant to the project's mission and
    necessary for carrying out the project; and

-   Provision of information resources.

> ***Awardee responsibilities include:***

-   Ongoing review of project activities and procedures to be
    established and implemented for accomplishing the scope of work;

-   Regular and ongoing communication and collaboration with the Federal
    granting agency, i.e. Federal project officer;

-   Provision to the Federal project officer opportunities to review
    project information prior to dissemination;

-   Collaboration with the Federal project officer to review information
    on project activities, budgets, contracts, and agreements;

-   Establishment of contacts with State, Federal and non-Federal
    partners, and other MCHB grant projects that may be relevant to the
    project's mission;

-   Completion of activities proposed in response to application review
    criteria listed in Section V of this application;

-   Maintenance of a website, provision of technical assistance, and
    training, and production and dissemination of relevant informational
    materials; and

-   Leadership, in collaboration with the Federal Office, in data
    collection and analysis of State/grantee HP 2010 and the
    *President's New Freedom Initiative* implementation activities.

> []{.mark}

[]{#__RefHeading___Toc178485805 .anchor}**2. Summary of Funding**

[]{.mark}

> This program will provide funding during Federal fiscal years 2008
> -2012. Approximately \$700,000 is expected to be available annually to
> fund one grantee. Funding beyond the first year is dependent on the
> availability of appropriated funds for *Medical Home Capacity Building
> for CSHCN* in subsequent fiscal years, grantee satisfactory
> performance, and a decision that funding is in the best interest of
> the Federal government.

[]{#__RefHeading___Toc178485806 .anchor}**III. Eligibility Information**

[]{#Eligibility_who .anchor}

**1. Eligible Applicants**

[]{.mark}

> As cited in 42 CFR Part 51a.3(a), any public or private entity,
> including an Indian tribe or tribal organization (as those terms are
> defined at 25 U.S.C. 450b) is eligible to apply for this Federal
> funding opportunity. Faith-based and community organizations are
> eligible to apply for this Federal funding opportunity. The applicant
> must be a national organization that has significant experience and
> expertise in implementing medical homes for children and youth,
> particularly those with special health care needs, and has the
> capability and capacity to coordinate activities among the relevant
> stakeholders and initiate activities at the state, regional, and
> national level. Applications that fail to show such experience and
> expertise will not be considered.

[]{#__RefHeading___Toc178485808 .anchor}**2. Cost Sharing/Matching**

> Cost sharing is not required; however, applicants are encouraged to
> indicate funds from other sources contributed to this effort,
> including in-kind resources.

[]{#__RefHeading___Toc178485809 .anchor}**3. Other**

> Applications that exceed the ceiling amount of \$700,000 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

[]{#__RefHeading___Toc178485810 .anchor}**IV. Application and Submission
Information**

1.  []{#__RefHeading___Toc178485811 .anchor}**Address to Request
    Application Package**

**Application Materials**

> The application and submission process has changed significantly. HRSA
> is ***requiring*** applicants for this funding opportunity to apply
> electronically through Grants.gov. 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
> <DGPWaivers@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 for which you
> are seeking relief. As indicated in this guidance, **HRSA and its
> Grants Application Center (GAC) will only accept paper applications
> from applicants that received prior written approval. Applicants
> technologically unable to scan the signed face page should also
> contact the DGPWaivers mailbox to provide information and request
> further instructions. However, the application must still be submitted
> under the deadline.**
>
> Refer to Appendix A for detailed application and submission
> instructions. Pay particular attention to Section 3, which provides
> detailed information on the competitive application and submission
> process.
>
> Applicants must submit proposals according to the instructions in
> Appendix A, using this guidance in conjunction with Public Health
> Service (PHS) Application Form 5161-1. These forms contain additional
> general information and instructions for grant applications, proposal
> narratives, and budgets. These forms 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.
>
> 910 Clopper Road
>
> Suite 155 South
>
> Gaithersburg, MD 20878
>
> 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.

[]{#__RefHeading___Toc178485812 .anchor}**2. Content and Form of
Application Submission**

**Application Format Requirements**

> See Appendix A, Section 4 for detailed application submission
> instructions. These instructions must be followed.
>
> 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, and letters of commitment and support.** Standard forms
> are NOT included in the page limit.
>
> **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.**
>
> **Application Format**
>
> Applications for funding must consist of the following documents in
> the following order:

**SF 424 Non Construction -- Table of Contents**

-   It is mandatory to follow the instructions provided in this section
    to ensure that your application can be printed efficiently and
    consistently for review.

-   Failure to follow the instructions may make your application
    non-compliant. Non-compliant applications will not be given any
    consideration and those particular applicants will be notified.

-   For electronic submissions, applicants only have to number the
    electronic attachment pages sequentially, resetting the numbering
    for each attachment, i.e., start at page 1 for each attachment. Do
    not attempt to number standard OMB approved form pages.

-   For electronic submissions no table of contents is required for the
    entire application. HRSA will construct an electronic table of
    contents in the order specified.

-   When providing any electronic attachment with several pages, add
    table of content page specific to the attachment. Such page will not
    be counted towards the page limit.

-   For paper submissions (when allowed), number each section
    sequentially, resetting the page number for each section. i.e.,
    start at page 1 for each section. Do not attempt to number standard
    OMB approved form pages.

-   For paper submissions ensure that the order of the forms and
    attachments is as specified below.

  ------------------------------------------------------------------------------
  **Application       **Form       **Instruction**          **HRSA/Program
  Section**           Type**                                Guidelines**
  ------------------- ------------ ------------------------ --------------------
  Application for     Form         Pages 1, 2 & 3 of the    Not counted in the
  Federal Assistance               SF-424 face page.        page limit
  (SF-424)                                                  

  Project             Attachment   Can be uploaded on page  Required attachment.
  Summary/Abstract                 2 of SF-424 - Box 15     Counted in the page
                                                            limit. Refer
                                                            guidance for
                                                            detailed
                                                            instructions.
                                                            Provide table of
                                                            contents specific to
                                                            this document only
                                                            as the first page

  Additional          Attachment   Can be uploaded on page  As applicable to
  Congressional                    2 of SF 424 - Box 16     HRSA; not counted in
  District                                                  the page limit

  HHS Checklist Form  Form         Pages 1 & 2 of the HHS   Not counted in the
  PHS-5161                         checklist.               page limit

  Project Narrative   Form         Supports the upload of   Not counted in the
  Attachment Form                  Project Narrative        page limit
                                   document                 

  Project Narrative   Attachment   Can be uploaded in       Required attachment.
                                   Project Narrative        Counted in the page
                                   Attachment form.         limit. Refer
                                                            guidance for
                                                            detailed
                                                            instructions.
                                                            Provide table of
                                                            contents specific to
                                                            this document only
                                                            as the first page

  SF-424A Budget      Form         Page 1 & 2 to supports   Not counted in the
  Information -                    structured budget for    page limit
  Non-Construction                 the request of Non       
  Programs                         construction related     
                                   funds                    

  SF-424B             Form         Supports assurances for  Not counted in the
  Assurances -                     non construction         page limit
  Non-Construction                 programs                 
  Programs                                                  

  Disclosure of       Form         Supports structured data Not counted in the
  Lobbying Activities              for lobbying activities. page limit
  (SF-LLL)                                                  

  Other Attachments   Form         Supports up to 15        Not counted in the
  Form                             numbered attachments.    page limit
                                   This form only contains  
                                   the attachment list      

  Attachment 1-15     Attachment   Can be uploaded in Other Refer to the
                                   Attachments form 1-15    attachment table
                                                            provided below for
                                                            **specific**
                                                            sequence. Counted in
                                                            the page limit
  ------------------------------------------------------------------------------

-   To ensure that attachments are organized and printed in a consistent
    manner, follow the order provided below. Note that these
    instructions may vary across programs.

-   Evidence of Non Profit status and invention related documents, if
    applicable, must be provided in the other attachment form.

-   Additional supporting documents, if applicable, can be provided
    using the available rows. Do not use the rows assigned to a specific
    purpose in the program guidance.

-   Merge similar documents into a single document. Where several pages
    are expected in the attachment, ensure that you place a table of
    content cover page specific to the attachment. Table of content page
    will not be counted in the page limit.

  -----------------------------------------------------------------------
  **Attachment        **Attachment Description (Program Guidelines)**
  Number**            
  ------------------- ---------------------------------------------------
  Attachment 1        Copy of signed SF-424/5161 face sheet

  Attachment 2        Tables, charts, etc.

  Attachment 3        Job descriptions for key personnel

  Attachment 4        Bio Sketches of key personnel

  Attachment 5        Letters of agreement and/or description(s) of
                      proposed/existing contracts

  Attachment 6        Project organizational chart

  Attachment 7        Other relevant documents not required elsewhere
  -----------------------------------------------------------------------

> Note the following specific information related to your submission.

i.  []{#__RefHeading___Toc178485813 .anchor}***Application Face Page***

Use Public Health Service (PHS) Application Form 5161-1 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 93.110.

> **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/dunsccr.htm> or call 1-866-705-5711.
> Please include the DUNS number in *item 8c* 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/dunsccr.htm>.

ii. []{#__RefHeading___Toc178485814 .anchor}***Table of Contents***

> The application should be presented in the order of the Table of
> Contents provided earlier. Again, for electronic applications no table
> of contents is necessary as it will be generated by the system. (Note:
> the Table of Contents will not be counted in the page limit).

iii. []{#__RefHeading___Toc178485815 .anchor}***Application Checklist***

Use Application Form 5161-1 provided with the application package.

iv. []{#__RefHeading___Toc178485816 .anchor}***Budget***

Use Application Form 5161-1 provided with the application package.
Please complete Sections A, B, E, and F, and then provide a line item
budget for each grant year using the budget categories in the SF 424A.

v.  []{#__RefHeading___Toc178485817 .anchor}***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 four (4) project period
> years 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.
>
> ***Budget for Multi-Year Grant Award***
>
> This announcement is inviting applications for project periods up to
> five (5) years. Awards, on a competitive basis, will be for an
> one‑year budget period, although project periods may be for up to five
> (5) years. Applications for continuation grants funded under these
> awards beyond the one-year budget period but within the five (5) 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.
>
> Include the following in the Budget Justification narrative:
>
> [Personnel Costs]{.underline}: 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, and annual
> salary.
>
> [Indirect Costs]{.underline}: 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/> to learn more about rate agreements, the
> process for applying for them, and the regional offices which
> negotiate them.
>
> [Fringe Benefits]{.underline}: 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]{.underline}: 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. [Annual travel to Washington, D.C. for two (2) staff
> members must be included.]{.underline}
>
> [Equipment:]{.underline} 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 that meet the definition of equipment (a
> unit cost of \$5000 and a useful life of one or more years).
>
> [Supplies]{.underline}: 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:]{.underline} 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]{.underline}: 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. []{#__RefHeading___Toc178485818 .anchor}***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 Attachment 3. Copies of biographical sketches for any key
> employed personnel that will be assigned to work on the proposed
> project must be included in Attachment 4.

vii. []{#__RefHeading___Toc178485819 .anchor}***Assurances***

> Use Application Form 5161-1 provided with the application package.

viii. []{#__RefHeading___Toc178485820 .anchor}***Certifications***

> Use Application Form 5161-1 provided with the application package.

ix. []{#__RefHeading___Toc178485821 .anchor}***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*

-   *Applicant Name*

-   *Address*

-   *Contact Phone Numbers (Voice, Fax)*

-   *E-Mail Address*

-   *Web Site Address, if applicable*

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

x.  []{#__RefHeading___Toc178485822 .anchor}***Program Narrative***

> This section provides a comprehensive framework and description of all
> aspects of the proposed program. It should be succinct,
> self-explanatory and well organized so that reviewers can understand
> the proposed project.

Use the following section headers for the Narrative:

-   *Introduction*

> This section should briefly describe the purpose of the proposed
> project and anticipated benefit.

-   *NEEDS ASSESSMENT*

> This section outlines the needs to be addressed. The target population
> and its unmet health needs must be described and documented in this
> section. Demographic data should be used and cited whenever possible
> to support the information provided. Please discuss any relevant
> barriers in the service area that the project hopes to overcome. This
> section should help reviewers understand the community and population
> that will be served by the proposed project.

-   *Methodology*

> Propose methods that will be used to meet each of the
> previously-described program requirements and expectations in this
> grant announcement. Identify target populations, if applicable, and
> steps to be taken to evaluative the proposed activities.

-   *Work Plan*

> Describe the activities or steps that will be used to achieve each of
> the activities proposed in the methodology section. Use a time line
> that includes each activity and identifies responsible staff,
> workgroups, etc, and measurable outcomes (e.g. Logic Model). The Work
> Plan should be a tool that will help to actively manage the project by
> measuring progress, identify barriers and necessary changes, and
> quantify accomplishments.

-   *Resolution of Challenges*

> Discuss challenges that are likely to be encountered in designing and
> implementing the activities described in the Work Plan, and approaches
> that will be used to resolve such challenges.

-   *Evaluation and Technical Support Capacity*

> Describe current experience, skills, and knowledge, including
> individuals on staff, materials published, and previous work of a
> similar nature.

-   *Organizational Information*

> Provide information on the applicant organization's current mission
> and structure, scope of current activities, and an organizational
> chart. Describe how these all contribute to the ability of the
> organization to conduct the program requirements and meet program
> expectations. Demonstrate that organizational and administrative
> structures and processes are in place to allow for effective
> collaboration with the relevant stakeholders and partners and service
> as a national center for medical home implementation.
>
> []{.mark}

xi. []{#__RefHeading___Toc178485823 .anchor}***Program Specific Forms***

> []{.mark}
>
> *1) Performance Standards for Special Projects of Regional or National
> Significance (SPRANS) and Other MCHB Discretionary Projects*
>
> The Health Resources and Services Administration (HRSA) has modified
> its reporting requirements for SPRANS projects, CISS projects, and
> other grant programs administered by the Maternal and Child Health
> Bureau (MCHB) to include national performance measures that were
> developed in accordance with the requirements of the Government
> Performance and Results Act (GPRA) of 1993 (Public Law 103-62). This
> Act requires the establishment of measurable goals for Federal
> programs that can be reported as part of the budgetary process, thus
> linking funding decisions with performance. Performance measures for
> States have also been established under the Block Grant provisions of
> Title V of the Social Security Act, the MCHB's authorizing
> legislation. Performance measures for other MCHB-funded grant programs
> have been approved by the Office of Management and Budget and are
> primarily based on existing or administrative data that projects
> should easily be able to access or collect. An electronic system for
> reporting these data elements has been developed and is now available.
>
> *2) Performance Measures for the **Medical Home Capacity Building for
> Children with Special Health Care Needs program** and Submission of
> Administrative Data*
>
> To prepare applicants for reporting requirements, administrative data
> collection requirements are presented in the appendices of this
> guidance.

xii. []{#__RefHeading___Toc178485824 .anchor}***Attachments***

> 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 attachment is clearly labeled.

1)  *Attachment 1 : Copy of Siogned SF-424/5161 Face Sheet*

2)  *Attachment 2: Tables, Charts, etc.*

> To present visually details and additional information about the
> proposal.

3)  *Attachment 3: Job Descriptions for Key Personnel*

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

4)  *Attachment 4: Biographical Sketches of Key Personnel*

> Include biographical sketches for persons occupying the key positions
> described in Attachment 3, 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.

5)  *Attachment 5: Letters of Agreement and/or Description(s) of
    Proposed/Existing* Contracts (project specific) 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.

6)  *Attachment 6: Project Organizational Chart*

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

7)  *Attachment 7: Other Relevant Documents*

> Include here any other documents that are relevant to the application,
> including letters of supports.
>
> **Include [only]{.underline} 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.**

[]{#__RefHeading___Toc178485825 .anchor}**3. Submission Dates and
Times**

**Application Due Date**

The due date for applications under this grant announcement is
***January 7, 2008** at 8:00 P.M. ET*. Applications will be considered
as meeting the deadline if they are E marked on or before the due date.
Please consult Appendix A, Section 3 for detailed instructions on
submission requirements.

> 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 8:00 P.M. ET. **To ensure that you
> have adequate time to follow procedures and successfully submit the
> application, we recommend you register immediately in Grants.gov (see
> Appendix B) and complete the forms as soon as possible, as this is a
> new process and may take some time.**
>
> **Please refer to Appendix B for important specific information on
> registering, and Appendix A, Section 3 for important information on
> applying through Grants.gov.**
>
> [**Late applications:**]{.underline}
>
> 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.

[]{#Application_materials .anchor}**4. Intergovernmental Review**

> []{.mark}
>
> Medical Home Capacity Building for Children with Special Health Care
> Needs is not a program subject to the provisions of Executive Order
> 12372, as implemented by 45 CFR 100.

[]{#__RefHeading___Toc178485827 .anchor}**5. Funding Restrictions**

> []{.mark}
>
> Applicants responding to this announcement may request funding for a
> project period of up to five (5) years, at no more than \$700,000 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.

[]{.mark}

[]{#__RefHeading___Toc178485828 .anchor}**6. Other Submission
Requirements**

> As stated in Section IV.1, except in rare cases 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 Appendix B of this guidance.
>
> **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. You must, however, ensure that copy of the
> SF-424/5161 Face Sheet is printed, [signed,]{.underline} scanned, and
> included with your application as Attachment 1. The face page **must**
> be printed from Grants.gov.
>
> 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 included in the electronic application submission.
>
> **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]{.underline} accept submission or re-submission of incomplete,
> rejected, or otherwise delayed applications after the deadline.**
>
> **Again, 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.
> Further information on the HRSA electronic submission policy can be
> obtained at <http://www.hrsa.gov/grants/electronicsubmission.htm>.**

[]{#__RefHeading___Toc178485829 .anchor}**V. Application Review
Information**

> The MCHB has developed key strategies that are the broad,
> cross-cutting approaches the Bureau uses in order to reach its
> five-year goals in the Bureau Strategic Plan (2003-2007). Goal 4 of
> the Strategic Plan is, **"Improve the Health Infrastructure and
> Systems of Care".** One key strategy used to support this goal is**,
> "Using the best available evidence, develop and promote guidelines and
> practices that improve services and systems of care**." In support of
> this strategy, DSCSHN has developed specific review criteria requiring
> approaches/activities that are based on the current best evidence for
> making decisions on how to implement the six core outcomes for a
> system of services for CYSHCN. For an explanation and summary of the
> evidence based practices relevant to this guidance, see Appendix F.
> The following review criteria are based upon these practices.

[]{#__RefHeading___Toc178485830 .anchor}**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.
>
> Review Criteria are used to review and rank applications. The Medical
> Home Capacity Building for CSHCN Program has 7 review criteria:

[]{.mark}

> **[Criterion 1: Need (5 points)]{.underline}**
>
> The extent to which the application describes the problem and
> associated contributing factors.
>
> Each application will be reviewed on the extent it:
>
> a)defines the population of CYSHCN according to the MCHB definition as
> "those children and youth who have or are at risk for a chronic
> physical, developmental, behavioral, or emotional condition and who
> also require health and related services of a type and or amount
> beyond that required by children generally" (American Academy of
> Pediatrics, 1998);
>
> b)identifies the challenges in obtaining an usual source of health
> care for these children and youth, particularly those transitioning
> from pediatric to adult health care; c)recognizes the needs of diverse
> populations and underserved populations due to geographic,
> socioeconomic, and other barriers; and
>
> d)outlines the necessary requirements for health professionals to
> implement medical homes.
>
> **[Criterion 2: Response (35 points)]{.underline}**
>
> The extent to which the proposed project responds to the "Purpose"
> included in the program description, the clarity of the proposed goals
> and objectives and their relationship to the identified project, and
> the plan for attaining project objectives.
>
> Each application will be reviewed on the extent to which the proposal:
> (a) includes a clear, practical and viable work plan including
> timeframes and proposed outcomes; and (b) clearly links project
> activities to the project objectives and outcomes.
>
> Each application will be reviewed on the extent to which the proposal
> addresses:
>
> \(a\) the development and implementation of policy initiatives related
> to achieving medical homes and facilitating transition for children
> and youth, particularly those with special health care needs;
>
> \(b\) establishment and implementation of innovative strategies that
> enhance interactive communication and collaboration among primary care
> physicians, allied health professionals, the educational and early
> intervention system, community leaders, insurers, and policy-makers
> towards the goals of increased access, appropriateness, and
> coordination of primary care with specialty care and the array of
> other services required for CYSHCN and their families;
>
> \(c\) the promotion and marketing of the medical home concept and
> activities to relevant stakeholders, including families of a variety
> of backgrounds, health professionals, insurers, and policy makers;
>
> \(d\) expansion of the current body of evidence-based data on outcomes
> of medical homes;
>
> \(e\) serving as a national resource center that facilitates the
> development and dissemination of resource materials and products;
> maintenance of a website, development of a technical assistance
> process that fosters a "community of learners and mentors", linkage
> with and learning from other MCHB funded national centers,
> professional and family support organizations, state and local
> MCH/CSHCN programs, and other relevant MCHB grant programs;
>
> \(f\) the training/strategies and tools to improve the
> family-centeredness and cultural competence of medical home providers
> and care systems;
>
> \(g\) the support and enhancement for community-based health care
> professionals in the implementation of medical home;
>
> \(h\) strategies to be employed in enhancing the inclusion of
> culturally and linguistically diverse health care professionals and
> families in educational and policy development activities; and
>
> \(i\) assisting States in implementation, assessment, and evaluation
> of strategies to promote the Healthy People 2010 Goals and the
> President's New Freedom Initiative around community based systems of
> care for children with special health care needs through medical
> homes.
>
> **[Criterion 3: Evaluative Measures (10 points)]{.underline}**
>
> The effectiveness of the method(s) proposed to monitor and evaluate
> the project results.
>
> Each application will be reviewed on the extent to which the proposal:
>
> \(a\) articulates a well-conceived evaluation plan that measures all
> planned goals and objectives and provides evidence based outcomes for
> each; and
>
> \(b\) includes outcome-based measurements which determine the extent
> to which primary care providers implement medical homes nationally and
> children with special health care needs have access to a medical home.
>
> **[Criterion 4: Impact (20 points)]{.underline}**
>
> The extent to which project results are national in scope and/or
> degree to which the project activities are replicable, and/or the
> sustainability of the project beyond the Federal funding.
>
> Each application will be reviewed on the extent to which the proposal:
>
> \(a\) details the mechanism(s) by which national implementation of the
> medical home will occur, to include the requisite partnerships and
> collaborations;
>
> \(b\) describes leadership activities on a national level on medical
> home and related issues for CYSHCN and their families, including
> transition and cultural competency;
>
> \(c\) outlines a plan to develop and maintain up-to-date resources,
> tools, and models on national and local medical home activities; and
>
> \(d\) identifies potential strategies and resources for sustaining the
> project beyond the Federal funding.

**[Criterion 5: Resources/Capabilities (15 points)]{.underline}**

The extent to which project personnel are qualified by training and/or
experience to implement and carry out project activities; the
capabilities of the applicant organization, and quality and availability
of facilities and personnel to fulfill the needs and requirements of the
proposed project.

> Each application will be reviewed on the extent to which the proposal:
>
> \(a\) describes the experience, titles, and appropriateness of the
> listed personnel to perform project activities;
>
> \(b\) clearly indicates where personnel listed in the application are
> utilized in the work plan and their specific tasks;
>
> \(c\) indicates, where applicable, the name of contracting entities
> and the entity's credentials for performing the designated tasks;
>
> \(d\) includes position descriptions for all primary personnel listed
> for the project which highlight experience relevant to this project;
> and
>
> \(e\) documents the organization's qualifications for completing the
> proposed project, including facilities and needed resources necessary
> to the project but not being requested in the application.

**[Criterion 6: Support Requested (10 points)]{.underline}**

The reasonableness of the proposed budget in relation to the objectives,
the complexity of the activities, and the anticipated results.

Each application will be reviewed on the extent to which the proposal:

\(a\) presents a clear, complete, and reasonable budget to address the
scope and planned impact of the project;

\(b\) provides an adequate budget narrative detailing the items listed
in the budget and addressed in the project work plan;

\(c\) adheres to the budget guidelines defined in the application
materials; and

\(d\) identifies in-kind resources provided through other programs or
projects and describes how these resources will be leveraged to
accomplish the goals of the project.

Funding should be adequate to support family involvement; required
travel, including attendance at relevant national meetings and
conferences; collaboration with key partners; and the organization
structures and processes necessary for the applicant to serve as an
effective national resource center for medical home implementation.

**[Criterion 7: Achieving the President's New Freedom Initiative (5
points)]{.underline}**

The extent to which the project will be integrated with the
administration of the Maternal and Child Health Services Block Grant,
State primary care plans, public health, and prevention programs, and
other related national programs.

Each application will be reviewed on the extent to which the proposal:

\(a\) describes how the project will be coordinated and integrated with
the ongoing Title V activities related to medical home; and

\(b\) details coordination strategies for integrating the President's
New Freedom Initiative 6 outcome areas into medical home activities
(e.g. adequate insurance, family/professional partnerships, transition,
early and continuous screening, etc.).

> **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}

**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 authorizing document. It will be
> sent prior to the start date of **July 1, 2008****.**
>
> **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.
>
> HRSA grant awards are subject to the requirements of the HHS Grants
> Policy Statement (HHS GPS) that are applicable to the grant based on
> recipient type and purpose of award. This includes, as applicable, any
> requirements in Parts I and II of the HHS GPS that apply to the award,
> as well as any requirements of Part IV. The HHS GPS is available at
> <http://www.hrsa.gov/grants/>. The general terms and conditions in the
> HHS GPS will apply as indicated unless there are statutory,
> regulatory, or award-specific requirements to the contrary (as
> specified in the Notice of Award).

**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}/.

[]{.mark}

> *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 comply with the
following reporting and review activities:

a.  **Audit Requirements**

> 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.  **Payment Management Requirements**

> Submit a quarterly electronic PSC-272 via the Payment Management
> System. The report identifies cash expenditures against the authorized
> funds for the grant. Failure to submit the report may result in the
> inability to access grant funds. The PSC-272 Certification page should
> be faxed to the PMS contact at the fax number listed on the 272 form,
> or it may be submitted to the:
>
> Division of Payment Management
>
> HHS/ASAM/PSC/FMS/DPM
>
> PO Box 6021
>
> Rockville, MD 20852
>
> Telephone: (877) 614-5533;

c.  **Status Reports**

> 1\. Submit a **Financial Status Report**. A financial status report is
> required within 90 days of the end of each budget period. The report
> is an accounting of expenditures under the project that year. More
> specific information will be included in the award notice;
>
> 2\. Submit a **Progress Report**(s). Further information will be
> provided in the award notice.
>
> d\. **Performance Standards for Special Projects of Regional or
> National Significance (SPRANS) and Other MCHB Discretionary Projects**
>
> The Health Resources and Services Administration (HRSA) has modified
> its reporting requirements for SPRANS projects, CISS projects, and
> other grant programs administered by the Maternal and Child Health
> Bureau (MCHB) to include national performance measures that were
> developed in accordance with the requirements of the Government
> Performance and Results Act (GPRA) of 1993 (Public Law 103-62). This
> Act requires the establishment of measurable goals for Federal
> programs that can be reported as part of the budgetary process, thus
> linking funding decisions with performance. Performance measures for
> States have also been established under the Block Grant provisions of
> Title V of the Social Security Act, the MCHB's authorizing
> legislation. Performance measures for other MCHB-funded grant programs
> have been approved by the Office of Management and Budget and are
> primarily based on existing or administrative data that projects
> should easily be able to access or collect. **\
> **
>
> **1. Performance Measures and Program Data**
>
> To prepare applicants for these reporting requirements, the designated
> performance measures for this program and other program data
> collection are presented in the appendices of this guidance.

**2. Performance Reporting**

> Successful applicants receiving grant funds will be required, within
> 120 days of the Notice of Grant Award (NGA), to register in HRSA's
> Electronic Handbooks (EHBs) and electronically complete the program
> specific data forms that appear in the appendices of this
> guidance.** **This requirement entails the provision of budget
> breakdowns in the financial forms based on the grant award amount, the
> project abstract and other grant summary data as well as providing
> objectives for the performance measures.
>
> Performance reporting is conducted for each grant year of the project
> period. [Grantees will be required, within 120 days of the NGA, to
> enter HRSA's EHBs and complete the program specific
> forms.]{.underline} This requirement includes providing expenditure
> data, finalizing the abstract and grant summary data as well as
> finalizing indicators/scores for the performance measures.
>
> **3. Final Year Performance Reporting**
>
> Successful applicants receiving grant funding will be required, within
> 120 days from the end of the project period, to electronically
> complete the program specific data forms that appear in the appendices
> of this guidance. The requirement includes providing expenditure data
> for the final year of the project period, the project abstract and
> grant summary data as well as final indicators/scores for the
> performance measures.
>
> e\. **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. As part of this agency-wide
> effort, HRSA grantees will be required to participate, where
> appropriate, in an on-site 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 will
> be required to prepare an Action Plan that identifies key actions to
> improve program performance as well as addresses any identified
> program requirement issues. In addition, performance reviews also
> provide an opportunity for grantees to offer 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>.

[]{#__RefHeading___Toc178485831 .anchor}**VII. Agency Contacts**

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

Donna Giarth

Grants Management Specialist

Attn.: Medical Home Capacity Building for CSHCN

HRSA Division of Grants Management Operations, OFAM

Parklawn Building, Room 11A-02

5600 Fishers Lane

Rockville, MD 20857

Telephone: 301-443-9142

Fax: 301-443-6686

Email: <Donna.Giarth@hrsa.hhs.gov>

> Additional information related to the overall program issues and
> technical assistance may be obtained by contacting:

Marie Y. Mann MD, MPH

Genetic Services Branch

Attn: Medical Home Capacity Building for CSHCN

MCHB, HRSA

Parklawn Building, Room 18A-19

5600 Fishers Lane

Rockville, MD 20857

Telephone: 301-443-1080

Fax: 301-443-8604

Email: <mmann@hrsa.gov>

[]{#__RefHeading___Toc178485832 .anchor}**VIII. Other Information**

**Helpful HRSA/ and MCHB Web Sites**

[www.hrsa.gov](http://www.hrsa.gov/) and
[www.mchb.hrsa.gov](http://www.mchb.hrsa.gov/)

HRSA's MCHB is the federal agency responsible for assuring the
availability of quality health care to low-income, uninsured, vulnerable
and special needs populations. Its web site contains fact sheets and
links to all HRSA programs, including the Maternal and Child Health
Bureau, which administers the Title V Block Grant. Refer to
<http://www.mchb.hrsa.gov/about/default.htm> to view the Strategic Plan
for MCHB, FY 2003-2007. This relates directly to HRSA goals in the
agency's Strategic Plan at <http://www.hrsa.gov/about/strategicplan.htm>
For additional resources to share around cultural competence, see
<http://www.hrsa.gov/culturalcompetence/>[www.mchlibrary.info](http://www.mchlibrary.info/).
This timely, easy-to-use virtual library for the MCH community holds
resource guides, searchable databases of publications, programs and
organizations within the MCH Bureau, an A-Z search function and
frequently asked questions.

**DSCSHN National Center Websites:**

[www.championsforprogress.org]()

The Champions for Progress Center, housed at the Early Intervention
Research Institute (EIRI) at Utah State University, is a cooperative
agreement funded by the Maternal and Child Health Bureau to assist state
and territorial CSHCN programs in providing leadership to accelerate the
process of systems building at the state and community levels. Access
presentations and outcomes of multi-state meetings, summaries of states'
activities in the six core outcomes, including results or incentive
awards.

<http://www.championsinc.org/>

ChampionsInC supports states and communities implementing community-
based systems of services and supports for children and youth with
special health care needs (CYSHCN) and their families. Find out about
community services: [best
practices](http://www.championsinc.org/main/practices.cfm?CFID=508284&CFTOKEN=67054138),
[State
Snapshots](http://www.championsinc.org/main/stateSnapshots.cfm?CFID=508284&CFTOKEN=67054138),
[measuring
outcomes](http://www.championsinc.org/main/measuringOutcomes.cfm?CFID=508284&CFTOKEN=67054138),
access a [Community Tool
Box](http://www.championsinc.org/main/ctb.cfm?CFID=508284&CFTOKEN=67054138),
[community
partnerships](http://www.championsinc.org/main/partnerships.cfm?CFID=508284&CFTOKEN=67054138),
[state & national
Resources](http://www.championsinc.org/index.cfm?CFID=508284&CFTOKEN=67054138),
[state
contacts](http://www.championsinc.org/main/stateContacts.cfm?CFID=508284&CFTOKEN=67054138),
other MCHB [National
Centers](http://www.championsinc.org/main/nationalCenters.cfm?CFID=508284&CFTOKEN=67054138)
and access a [Free
eNewsletter](http://www.championsinc.org/main/newsletter.cfm?CFID=508284&CFTOKEN=67054138).

[www.cshcndata.org](http://www.cshcndata.org/)

The Data Resource Center on CYSHCN, developed by the Child and
Adolescent Health Measurement Initiative (CAHMI), features easy to use,
hands-on access to each states' data from the National Survey of CSHCN.
Also available are resources, tools and templates to assist users in
communicating current data to stimulate improvements and create
Community-Based Systems of services for CYSHCN and the 2001 and soon the
2004 National Survey Chartbook. The broader website, Data Resource
Center for Child and Adolescent Health, where you can also access CSHCN
data, has family friendly information about the National Survey for
Children's Health. <http://www.childhealthdata.org/content/Default.aspx>

[http://www.familyvoices.org](http://www.familyvoices.org/)

Family Voices, provides a website for a national grassroots network of
families and friends, advocates for health care services that are
family-centered, community-based, comprehensive, coordinated and
culturally competent for all children and youth with special health care
needs; and provides information promoting the inclusion of all families
as decision makers at all levels of health care; how to support
essential partnerships between families and professionals and on
Family-To-Family Health Information Centers.  Access the national Center
for Family/Professional Partnerships through this site.

[www.georgetown.edu/research/gucdc/nccc](http://www.georgetown.edu/research/gucdc/nccc)

The National Center for Cultural Competence maintains a website on
information related to families, systems and program perspectives and
implementation of cultural and linguistic competence. Tools, resources,
consultants and materials can be accessed, and there is a Spanish Portal
to health information in Spanish and family stories. See: the conceptual
framework and definitions for cultural and linguistic competence,
checklists for "getting started", self assessment and cultural broker
tools and materials and archives from topical conference calls around
the six core outcomes.

[http://www.hdwg.org](http://www.hdwg.org/)

The Catalyst Center seeks to promote adequate financing for
comprehensive, family-centered care of children and youth with special
health care needs. The Center works with a broad range of stakeholders
in financing and coverage issues including government agencies, parent
groups, health and social service agencies, employers, payers and other
stakeholders to determine family and community needs, identify gaps in
current funding to meet those needs, and develop creative funding
strategies. Goals of the Center are: to promote health coverage of all
CYSHCN, to eliminate underinsurance among CYSHCN, to disseminate
innovative financing methods for services to CYSHCN, and to enhance
knowledge and collaboration among stakeholder groups around financing
issues. 

 [www.infanthearing.org](http://www.infanthearing.org/)

The goal of the National Center for Hearing Assessment and Management at
Utah State University is to ensure that all infants (newborns) and
toddlers with hearing loss are identified as early as possible and
provided with timely and appropriate audiological, educational, and
medical intervention.

[www.hrtw.org](http://www.hrtw.org/)

The mission of the Health and Ready to Work (HRTW) National Center is to
create changes in policy, programs and practices that will help youth
with special health care needs transition to adult health care. Its
website has resources for agencies, providers, families and youth
related to transition, including state-specific SSI Information. See "A
Consensus Statement on Health Care Transitions for Young Adults With
Special Health Care Needs", PEDIATRICS Vol. 110 No. 6 December 2002 on
this web site.

[http://www.medicalhomeinfo.org](http://www.medicalhomeinfo.org/)

The National Center of Medical Home Initiatives for Children with
Special Needs provides support to physicians, families, and other
medical and non-medical providers who care for children with special
needs so that they have access to a medical home

See the American Academy of Pediatrics' "Policy Statement on the Medical
Home - Organizational Principles to Guide and Define the Child Health
Care System and/or Improve the Health of All Children" on this web site.

**Other Helpful** **Websites:**

[www.ichp.edu](http://www.ichp.edu/)

The Institute for Child Health Policy, located in Gainesville, Florida,
maintains a comprehensive web site that is dedicated to "creative vision
in research and science." The goal of the Institute is to research,
evaluate, formulate and advance health policies, programs and systems
that promote the health and well being of children and youth.

[www.neserve.org](http://www.neserve.org/)

Established in 1983, New England SERVE is a health policy, research and
planning organization working to promote quality systems of care for
children with special health care needs and their families. Its "Shared
Responsibilities Toolkit" contains tools for health plans to use to
improve care for children with special health care needs. It elaborates
on who children with special health care needs are, why health plans
should identify this population, and where the opportunities for
improvement at health plans are.

[http://genes-r-us.uthscsa.edu](http://genes-r-us.uthscsa.edu/)

The National Newborn Screening and Genetics Resource Center serves as a
national resource center for information and education regarding newborn
screening and genetics programs and policies.

  

[www.geneticalliance.org](http://www.geneticalliance.org/)

Genetic Alliance i**s** an international coalition of families, health
professionals and genetic organizations, representing more than 300 lay
advocacy organizations. The Alliance works to foster the integration of
genetic advances into quality healthcare, public awareness and
consumer-informed public policy.

[www.mchoralhealth.org/Toolbox/families.html](http://www.mchoralhealth.org/Toolbox/families.html)

[National Maternal and Child Oral Health Resource Center, Georgetown
University.](http://rds.yahoo.com/_ylt=A0geu9drs2lGZb8Aht5XNyoA;_ylu=X3oDMTFhdWZodTJwBHNlYwNzcgRwb3MDMTAEY29sbwNlBHZ0aWQDTUFQMDAzXzExNQRsA1dTMQ--/SIG=126l4ktk9/EXP=1181418731/**http%3A/www.mchoralhealth.org/Toolbox/families.html)has
fact sheets for families that cover a wide range of health and safety
issues, like how to find a dentist and has materials in other languages.

[www.P2PUSA.org](http://www.p2pusa.org/)

Parent-to-Parent USA is a national non-profit organization committed to
assuring access and quality in Parent to Parent support programs in
organizations across the country. This site highlights statewide
programs committed to implementing evidence-based practices. Parent to
Parent programs provide emotional and informational support to families
of children who have special needs, most notably by matching parents
seeking support with an experienced, trained \'Support Parent\'.

[]{#__RefHeading___Toc178485833 .anchor}**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 in item 8c 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, service area,
> barriers to health care, or health care needs in your community. 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. Avoid the risk of
> having reviewers hunt through your application for information.
>
> **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. Your budget
> should reflect back to the proposed activities, and all forms should
> be filled in accurately and completely.
>
> **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 attachments.** Do not use the attachments
> for information that is required in the body of the application. Be
> sure to cross-reference all tables and attachments to the appropriate
> text in the application. Be sure to upload the attachments in the
> order indicated in the forms.
>
> **Carefully proofread the application.** Misspellings and grammatical
> errors will impede reviewers in understanding the application. Be sure
> that page limits are followed. Limit the use of abbreviations and
> acronyms, and define each one at its first use and periodically
> throughout application. Make sure you submit your application in final
> form, without markups.
>
> **Print out and carefully review an electronic application to ensure
> accuracy and completion.** When submitting electronically, print out
> the application before submitting it to ensure appropriate formatting
> and adherence to page limit requirements. **Check to ensure that all
> attachments are included before sending the application forward.**
>
> **Ensure that all information is submitted at the same time. We will
> not consider additional information and/or materials submitted after
> your initial submission, nor will we accept e-mailed applications or
> supplemental materials once your application has been received.**

[]{#__RefHeading___Toc178485834 .anchor}APPENDIX A: HRSA's Electronic
Submission User Guide

# 1. Introduction

## 1.1 Document Purpose and Scope {#document-purpose-and-scope .unnumbered}

Major changes are coming to HRSA's Grant Application Process. For
guidances released/posted on or after January 1, 2006, HRSA will no
longer accept applications for grant opportunities on paper. Applicants
submitting new and competing continuations and a selected number of
noncompeting continuation applications will be required to submit
electronically through Grants.gov. 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.

The purpose of this document is to provide detailed instructions to help
applicants and grantees submit applications electronically to HRSA
through Grants.gov. The document is intended to be the comprehensive
source of all information related to the new processes that HRSA and its
customers have to adopt and will be updated periodically. This document
is not meant to replace program guidance documents for funding
announcements.

## 1.2 Document Organization and Version Control {#document-organization-and-version-control .unnumbered}

This document contains 5 sections apart from the Introduction. Following
is the summary:

  ------------------------------ ----------------------------------------
  **Section**                    **Description**

  Noncompeting Continuation      Provides detailed instructions to
  Application                    existing HRSA grantees for applying
                                 electronically using Grants.gov for all
                                 noncompeting announcements

  Competing Application          Provides detailed instructions to
                                 applicant organizations for applying
                                 electronically using Grants.gov for all
                                 competing announcements

  General Instructions for       Provides instructions and important
  Application Submission         policy guidance on application format
                                 requirements

  Customer Support Information   Provides contact information to address
                                 technical and programmatic questions

  Frequently Asked Questions     Provides answers to frequently asked
  (FAQs)                         questions by various categories
  ------------------------------ ----------------------------------------

This document is under version control. Please visit
<http://www.hrsa.gov/grants> to retrieve the latest published version.

# 2. Noncompeting Continuation Application

## 2.1 Process Overview {#process-overview .unnumbered}

Following is the process for submitting a noncompeting continuation
application through Grants.gov:

1.  HRSA will communicate noncompeting announcement number to the
    project director (PD) and authorizing official (AO) via email. The
    announcement number will be required to search for the announcement
    in Grants.gov.

2.  Search for the announcement in Grants.gov Apply
    (<http://www.grants.gov/Apply>).

3.  Download the application package and instructions from Grants.gov.
    The program guidance is also part of the instructions that must be
    downloaded.

4.  Save a local copy of the application package on your computer and
    complete all the forms based on the instructions provided in the
    program guidance.

5.  Submit the application package through Grants.gov. (Requires
    registration)

6.  Track the status of your submitted application at Grants.gov until
    you receive a notification from Grants.gov that your application has
    been received by HRSA.

7.  HRSA Electronic Handbooks (EHBs) software pulls the application
    information into EHBs and validates the data against HRSA's business
    rules.

8.  HRSA notifies the project director, authorizing official, business
    official (BO) and application point of contact (POC) by email to
    check HRSA EHBs for results of HRSA validations and enter additional
    information, including in some cases performance measures, necessary
    to process the noncompeting continuation.

9.  AO verifies the application in HRSA EHBs, fixes any validation
    errors, makes necessary corrections and submits the application to
    HRSA. (Requires registration)

## 2.2 Grantee Organization Needs to Register With Grants.gov (if not already registered) -- See Appendix B {#grantee-organization-needs-to-register-with-grants.gov-if-not-already-registered-see-appendix-b .unnumbered}

Grants.gov requires a **one-time** registration by the applicant
organization. This is a three step process and should be completed by
any organization wishing to apply for grant. If you do not complete this
registration process you will not be able to submit an application. The
registration process will require some time (anywhere from 5 business
days to a month). Therefore, applicants or those considering applying at
some point in the future should register immediately. Registration with
Grants.gov provides the individuals from the organization the required
credentials in order to apply.

If an applicant organization has already completed Grants.gov
registration for another Federal agency, this section can be skipped.

For those applicant organizations still needing to register with
Grants.gov, registration information can be found on the Grants.gov Get
Started website (<http://www.grants.gov/GetStarted>). 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)

```{=html}
<!-- -->
```
-   Obtain a username and password from the Grants.gov Credential
    Provider

-   Register the username and password with Grants.gov

-   Get authorized as an AOR by your organization

In addition, if an applicant does not have a Taxpayer Identification
Number (TIN) or Employer Identification Number (EIN), allow for extra
time. Beginning Oct. 30, 2005, the CCR also validates the EIN against
Internal Revenue Service records, a step that will take one to two
business days.

Please direct questions regarding Grants.gov registration to the
Grants.gov Contact Center at Tel.: 1-800-518-4726. Contact Center hours
of operation are Monday-Friday from 7:00 a.m. to 9:00 p.m. Eastern Time,
excluding Federal holidays.

-   It is recommended that this registration process be completed at
    least two weeks prior to the submittal date of your organization's
    first Grants.gov submission.

## 2.3 Project Director and Authorizing Official Need to Register with HRSA EHBs (if not already registered) {#project-director-and-authorizing-official-need-to-register-with-hrsa-ehbs-if-not-already-registered .unnumbered}

In order to access your noncompeting continuation application in HRSA
EHBs, existing grantee organizations must register within the EHBs. The
purpose of the registration process is to collect consistent information
from all users, avoid collection of redundant information and allow for
the unique identification of each system user. Note that registration
within HRSA EHBs is required only **once for each user for each
organization they represent.**

Registration within HRSA EHBs is a two-step process. In the first step,
individual users from an organization who participate in the grants
process such as applying for noncompeting continuations must create
**individual** system accounts. In the second step, the users must
associate themselves with the appropriate grantee organization. **To
find your organization record use the 10-digit grant number from the
Notice of Grant Award (NGA) belonging to your grant.** Note that since
all existing grantee organization records already exist within EHBs,
there is no need to create a new one.

To complete the registration quickly and efficiently we recommend that
you have the following information handy:

1.  Identify your role in the grants management process. HRSA EHBs offer
    the following three functional roles for individuals from
    applicant/grantee organizations:

• Authorizing Official (AO),

• Business Official (BO), and

• Other Employee (for project directors, assistant staff, AO designees
and others).

For more information on functional responsibilities refer to the HRSA
EHBs online help.

2.  10-digit grant number from the latest NGA belonging to your grant
    (Box 4b on NGA). You must use the grant number to find your
    organization during registration. All individuals from the
    organization working on the grant must use the same grant number to
    ensure correct registration.

In order to access the noncompeting application, the project director
and other participants have to register the specific grant and add it to
their respective portfolios. This step is required to ensure that only
the authorized individuals from the organization have access to grant
data. **Project directors will need the last released NGA in order to
complete this additional step**. Again, note that this is a one time
requirement.

The project director must give the necessary privileges to the
authorizing official and other individuals who will assist in the
noncompeting continuation application submission using the administer
feature in the grant handbook. The project director should also delegate
the "Administer Grant Users" privilege to the authorizing official.

Once you have access to your grant handbook, use the "Noncompeting
Continuations" link under the deliverables section to access your
noncompeting application.

Note that registration with HRSA EHBs is independent of Grants.gov
registration.

For assistance in registering with HRSA EHBs, call 877-GO4-HRSA
(877-464-4772) between 9:00 am to 5:30 pm ET or email
<callcenter@hrsa.gov>.

-   You must use your 10-digit grant number (box 4b from NGA) to
    identify your organization.

## 2.4 Apply through Grants.gov {#apply-through-grants.gov .unnumbered}

### 2.4.1 Find Funding Opportunity {#find-funding-opportunity .unnumbered}

Search for the announcement in Grants.gov **Apply**
(<http://www.grants.gov/Apply>).

Enter the announcement number communicated to you in the field *Funding
Opportunity Number*. (Example announcement number: 5-S45-06-001)

-   Noncompeting announcements are not available in Grants.gov FIND!

### 2.4.2 Download Application Package {#download-application-package .unnumbered}

Download the application package and instructions. In order to view
application package and instructions, you will also need to download and
install the PureEdge Viewer (<http://www.grants.gov/DownloadViewer>).
This small, free program will allow you to access, complete, and submit
applications electronically and securely.

-   Please review the system requirements for PureEdge Viewer on the
    Grants.gov website.

### 2.4.3 Complete Application {#complete-application .unnumbered}

Complete the application using both the built-in instructions and the
instructions provided in the program guidance. Ensure that you save a
copy of the application on your local computer.

-   Ensure that you provide your 10-digit grant number (box 4b from NGA)
    in the Federal Award Identifier field (box 5b in SF424 or box 4 in
    SF424 R&R)

Please direct questions regarding PureEdge to Grants.gov. Contact the
Grants.gov Contact Center at Tel.: 1-800-518-4726. Contact Center hours
of operation are Monday-Friday from 7:00 a.m. to 9:00 p.m. Eastern Time,
excluding Federal holidays.

For assistance with program guidance related questions, please contact
the program contact listed on the program guidance.

-   You can complete the application offline -- you do not have to be
    connected to the Internet.

### 2.4.4 Submit Application {#submit-application .unnumbered}

The \"Submit\" button on the application package cover page will become
active after you have downloaded the application package, completed all
required forms, attached all required documents, and saved your
application package. Click on the \"Submit\" button once you have done
all these things and you are ready to send your completed application to
Grants.gov.

Review the provided application summary to confirm that the application
will be submitted to the program you wish to apply for. To submit, you
will be asked to Log into Grants.gov. Once you have logged in, your
application package will automatically be uploaded to Grants.gov. A
confirmation screen will appear once the upload is complete. Note that a
Grants.gov Tracking number will be provided on this screen. Please
record this number so that you may refer to it for all subsequent help.

Please direct questions regarding application submission to the
Grants.gov Contact Center at Tel.: 1-800-518-4726. Contact Center hours
of operation are Monday-Friday from 7:00 a.m. to 9:00 p.m. Eastern Time,
excluding Federal holidays.

-   You must be connected to the Internet and must have a Grants.gov
    username and password to submit the application package.

### 2.4.5 Verify Status of Application {#verify-status-of-application .unnumbered}

Once Grants.gov has received your submission, Grants.gov will send email
messages to advise you of the progress of your application through the
system. Over the next 24 to 48 hours, you should receive two emails. The
first will confirm receipt of your application by the Grants.gov system
("Received"), and the second will indicate that the application has
either been successfully validated ("Validated") by the system prior to
transmission to the grantor agency or has been rejected due to errors
("Rejected with Errors").

In case of any errors, you must correct the application and resubmit it
to Grants.gov. If you are unable to resubmit because the opportunity has
since closed, **contact the HRSA Call Center** at 877-GO4-HRSA
(877-464-4772) between 9:00 am to 5:30 pm ET or email
<callcenter@hrsa.gov>. You may be asked to provide a copy of the
"Rejected with Errors" notification you received from Grants.gov.

You can check the status of your application(s) anytime after
submission, by logging into Grants.gov using the black \'Applicants\'
link at the top of any page, and clicking on the \'Check Application
Status\' link.

If there are no errors, the application will be downloaded by HRSA. On
successful download at HRSA, the status of the application will change
to "Received by Agency" and you will receive an additional email from
Grants.gov. Subsequently within two to three business days the status
will change to "Agency Tracking Number Assigned."

-   It is recommended that you check the status of your application in
    Grants.gov until the status is changed to "Agency Tracking Number
    Assigned".

## 2.5 Verify in HRSA Electronic Handbooks {#verify-in-hrsa-electronic-handbooks .unnumbered}

For assistance in registering with or using HRSA EHBs, call 877-GO4-HRSA
(877-464-4772) between 9:00 am to 5:30 pm ET or email
<callcenter@hrsa.gov>.

-   Grant Project Director must be registered in HRSA EHBs and have
    access to the specific grant for which the noncompeting application
    is being submitted for further actions.

### 2.5.1 Verify Status of Application {#verify-status-of-application-1 .unnumbered}

Once your application is received by HRSA, it will be processed to
ensure that the application is submitted for the correct funding
announcement, with the correct grant number and grantee organization.
Upon this processing, which is expected to take up to two to three
business days, HRSA will assign a unique tracking number to your
application. This tracking number will be posted to Grants.gov and the
status of your application will be changed to "Agency Tracking Number
Assigned". Note the HRSA tracking number and use it for all
correspondence with HRSA. At this point, your application is ready for
review and submission in HRSA EHBs.

You should also receive an email from HRSA EHBs confirming the
successful receipt of your application at HRSA. The email is sent to the
project director, authorizing official, point of contact for the
application and the business official -- all from the submitted
application. The email is also sent to the current project director
listed on the NGA. Because email is not always reliable, please check
the HRSA EHBs or Grants.gov to see if the application is available for
review in HRSA EHBs.

-   Because email is not reliable, check HRSA EHBs within two to three
    business days from submission within Grants.gov for availability of
    your application.

### 2.5.2 Manage Access to Your Application {#manage-access-to-your-application .unnumbered}

You must be registered in HRSA EHBs to get access to your application.
To ensure that only the right individuals from the organization get
access to the application, you must follow the process described
earlier.

The project director, using the Administer feature in the grant
handbook, must give the necessary privileges to the authorizing official
and other individuals who will assist in the submission of the
noncompeting continuation application. Project directors must also
delegate the "Administer Grant Users" privilege to the authorizing
official so that future administration can be managed by the authorizing
official.

Once you have access to your grant handbook, use the "Noncompeting
Continuations" link under the deliverables section to access your
noncompeting application.

### 2.5.3 Check Validation Errors {#check-validation-errors .unnumbered}

HRSA EHBs will apply HRSA's business rules to the application received
through Grants.gov. All validation errors are recorded and displayed to
the applicant. To view the validation errors use the 'Grants.gov Data
Validation Comments' link on the application status page in HRSA EHBs.

### 2.5.4 Fix Errors and Complete Application {#fix-errors-and-complete-application .unnumbered}

Applicants must review the errors in HRSA EHBs and make necessary
changes. Applicants must also complete the detailed budget and other
required forms in HRSA EHBs and assign an AO registered in HRSA EHBs to
the application. HRSA EHBs will show the status of each form in the
application package and all forms must be complete before submission.

### 2.5.5 Submit Application {#submit-application-1 .unnumbered}

To submit an application, you must have the 'Submit Noncompeting
Continuation' privilege. This privilege must be given by the project
director to the authorizing official or a designee. Once all forms are
complete, the application can be submitted to HRSA.

-   You will have two weeks from the date the application was due in
    Grants.gov for submission of the remaining information in HRSA EHBs.
    The new due date will be listed in HRSA EHBs.

-   Face page must be printed from HRSA EHBs and not from Grants.gov
    application.

# 3. Competing Application

## 3.1 Process Overview {#process-overview-1 .unnumbered}

Following is the process for submitting a competing application through
Grants.gov:

1\. HRSA will post all competing announcements on Grants.gov FIND
(<http://grants.gov/search/>). Announcements are typically posted at the
beginning of the fiscal year when HRSA releases its annual Preview,
although program guidances are generally not available until later. For
more information visit <http://www.hrsa.gov/grants>.

2\. When program guidance is available, search for the announcement in
Grants.gov Apply (<http://www.grants.gov/Apply>).

3\. Download the application package and instructions from Grants.gov.
The program guidance is also part of the instructions that must be
downloaded.

4\. Save a local copy of the application package on your computer and
complete all the forms based on the instructions provided in the program
guidance.

5\. Submit the application package through Grants.gov. (Requires
registration)

6\. Track the status of your submitted application at Grants.gov until
you receive a notification from Grants.gov that your application has
been received by HRSA.

## 3.2 Grantee Organization Needs to Register With Grants.gov (if not already registered) -- See Appendix B {#grantee-organization-needs-to-register-with-grants.gov-if-not-already-registered-see-appendix-b-1 .unnumbered}

Grants.gov requires a **one-time** registration by the applicant
organization. This is a three step process and should be completed by
any organization wishing to apply for grant. If you do not complete this
registration process you will not be able to submit an application. The
registration process will require some time (anywhere from 5 business
days to a month). Therefore, applicants or those considering applying at
some point in the future should register immediately. Registration with
Grants.gov provides the individuals from the organization the required
credentials in order to apply.

If an applicant organization has already completed Grants.gov
registration for another Federal agency, this section can be skipped.

For those applicant organizations still needing to register with
Grants.gov, registration information can be found on the Grants.gov Get
Started website (<http://www.grants.gov/GetStarted>). 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)

```{=html}
<!-- -->
```
-   Obtain a username and password from the Grants.gov Credential
    Provider

-   Register the username and password with Grants.gov

-   Get authorized as an AOR by your organization

In addition, if an applicant does not have a Taxpayer Identification
Number (TIN) or Employer Identification Number (EIN), allow for extra
time. Beginning Oct. 30, 2005, the CCR also validates the EIN against
Internal Revenue Service records, a step that will take one to two
business days.

Please direct questions regarding Grants.gov registration to the
Grants.gov Contact Center at Tel.: 1-800-518-4726. Contact Center hours
of operation are Monday-Friday from 7:00 a.m. to 9:00 p.m. Eastern Time,
excluding Federal holidays.

-   It is recommended that this registration process be completed at
    least two weeks prior to the submittal date of your organization's
    first Grants.gov submission.

## 3.3 Apply through Grants.gov {#apply-through-grants.gov-1 .unnumbered}

### 3.3.1 Find Funding Opportunity {#find-funding-opportunity-1 .unnumbered}

Search for announcements in Grants.gov **FIND**
(<http://grants.gov/search/>) and select the announcement that you wish
to apply for. Refer to the program guidance for eligibility criteria.

Please visit <http://www.hrsa.gov/grants> to read annual HRSA Preview.

-   All competing announcements should be available in Grants.gov FIND!
    When program guidance is release, announcements are made available
    in Grants.gov APPLY.

### 3.3.2 Download Application Package {#download-application-package-1 .unnumbered}

Download the application package and instructions. In order to view
application package and instructions, you will also need to download and
install the PureEdge Viewer (<http://www.grants.gov/DownloadViewer>).
This small, free program will allow you to access, complete, and submit
applications electronically and securely.

-   Please review the system requirements for PureEdge Viewer on the
    Grants.gov website.

### 3.3.3 Complete Application {#complete-application-1 .unnumbered}

Complete the application using both the built-in instructions and the
instructions provided in the program guidance. Ensure that you save a
copy of the application on your local computer.

-   If you are applying for a competing continuation or a supplemental
    grant, ensure that you provide your 10-digit grant number (box 4b
    from NGA) in the Federal Award Identifier field (box 5b in SF424 or
    box 4 in SF424 R&R)

Please direct questions regarding PureEdge to Grants.gov. Contact the
Grants.gov Contact Center at Tel.: 1-800-518-4726. Contact Center hours
of operation are Monday-Friday from 7:00 a.m. to 9:00 p.m. Eastern Time,
excluding Federal holidays.

For assistance with program guidance related questions, please contact
the program contact listed on the program guidance.

-   You can complete the application offline -- you do not have to be
    connected to the Internet.

### 3.3.4 Submit Application {#submit-application-2 .unnumbered}

The \"Submit\" button on the application package cover page will become
active after you have downloaded the application package, completed all
required forms, attached all required documents, and saved your
application package. Click on the \"Submit\" button once you have done
all these things and you are ready to send your completed application to
Grants.gov.

Review the provided application summary to confirm that the application
will be submitted to the program you wish to apply for. To submit, you
will be asked to Log into Grants.gov. Once you have logged in, your
application package will automatically be uploaded to Grants.gov. A
confirmation screen will appear once the upload is complete. Note that a
Grants.gov Tracking number will be provided on this screen. Please
record this number so that you may refer to it for all subsequent help.

Please direct questions regarding application submission to the
Grants.gov Contact Center at Tel.: 1-800-518-4726. Contact Center hours
of operation are Monday-Friday from 7:00 a.m. to 9:00 p.m. Eastern Time,
excluding Federal holidays.

-   You must be connected to the Internet and must have a Grants.gov
    username and password to submit the application package.

### 3.3.5 Verify Status of Application {#verify-status-of-application-2 .unnumbered}

Once Grants.gov has received your submission, Grants.gov will send email
messages to advise you of the progress of your application through the
system. Over the next 24 to 48 hours, you should receive two emails. The
first will confirm receipt of your application by the Grants.gov system
("Received"), and the second will indicate that the application has
either been successfully validated ("Validated") by the system prior to
transmission to the grantor agency or has been rejected due to errors
("Rejected with Errors").

In case of any errors, you must correct the application and resubmit it
to Grants.gov. If you are unable to resubmit because the opportunity has
since closed, **contact the Director of the Division of Grants Policy**
via email at <DGPWaivers@hrsa.gov> and thoroughly explain the situation;
include a copy of the "Rejected with Errors" notification.

You can check the status of your application(s) anytime after
submission, by logging into Grants.gov using the black \'Applicants\'
link at the top of any page, and clicking on the \'Check Application
Status\' link.

If there are no errors, the application will be downloaded by HRSA. On
successful download at HRSA, the status of the application will change
to "Received by Agency" and you will receive an additional email from
Grants.gov.

Once your application is received by HRSA, it will be processed to
ensure that the application is submitted for the correct funding
announcement, with the correct grant number (if applicable), and
applicant/grantee organization. Upon this processing, which is expected
to take up to two to three business days, HRSA will assign a unique
tracking number to your application. This tracking number will be posted
to the Grants.gov and the status of your application will be changed to
"Agency Tracking Number Assigned". Note the HRSA tracking number and use
it for all correspondence with HRSA.

-   It is recommended that you check the status of your application in
    Grants.gov until the status is changed to "Agency Tracking Number
    Assigned".

# 4. General Instructions for Application Submission

-   It is mandatory to follow the instructions provided in this section
    to ensure that your application can be printed efficiently and
    consistently for review.

-   

-   Failure to follow the instructions may make your application
    non-compliant. Non-compliant applications will not be given any
    consideration and the particular applicants will be notified.

## 4.1 Narrative Attachment Guidelines {#narrative-attachment-guidelines .unnumbered}

-   The following guidelines are applicable to both electronic and paper
    submissions (when allowed) unless otherwise noted.

### 4.1.1 Font  {#font .unnumbered}

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. 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.

Please do not include organizational brochures or other promotional
materials, slides, films, clips, etc. 

### 4.1.2 Paper Size and Margins {#paper-size-and-margins .unnumbered}

For duplication 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.

### 4.1.3 Names {#names .unnumbered}

Please include the name of the applicant and 10-digit grant number (if
competing continuation, supplemental or noncompeting continuation) on
each page.

### 4.1.4 Section Headings {#section-headings .unnumbered}

Please put all section headings flush left in bold type.

### 4.1.5 Page Numbering {#page-numbering .unnumbered}

**Electronic Submissions**

For electronic submissions, applicants only have to number the
electronic attachment pages sequentially, resetting the numbering for
each attachment, i.e., start at page 1 for each attachment.

Do not number the standard OMB approved form pages.

**Paper Submissions (When allowed)**

Do not number the standard OMB approved forms. Please number each
attachment page sequentially. Reset the numbering for each attachment.
(Treat each attachment/document as a separate section.)

### 4.1.6 Allowable Attachment or Document Types {#allowable-attachment-or-document-types .unnumbered}

**Electronic Submissions**

The following attachment types are supported in HRSA EHBs. Even though
grants.gov may allow you to upload any type of attachment, it is
important to note that HRSA only accepts the following types of
attachments:

.DOC - Microsoft Word

.RTF - Rich Text Format

.TXT - Text

.WPD - Word Perfect Document

.PDF - Adobe Portable Document Format

.XLS - Microsoft Excel

## 4.2 Application Content Order (Table of Contents) {#application-content-order-table-of-contents .unnumbered}

When applications were submitted in paper, it was easy to direct the
applicants to prepare a table of contents and make it as a part of the
application. Applicants did not have any problem in preparing the
package that included standard forms as well as attachments. All the
pages were numbered sequentially. Preparation instructions were given in
the program guidance. With the transition to electronic application
receipt, this process has changed significantly. HRSA is using an
approach that will ensure that regardless of the mode of submission
(electronic or paper when exemptions are granted), all applications will
look the same when printed for objective review.

HRSA uses two standard packages from Grants.gov.

SF 424 (otherwise known as 5161) -- For service delivery programs

SF 424 R&R -- For research and training programs (programs previously
using the 398 or the 6025 and 2590 application packages)

For each package HRSA has defined a standard order of forms and that
order is available within the program guidance. The program guidance may
also provide applicants with explicit instructions on where to upload
specific documents.

If you are applying on paper (when allowed), you must use the program
guidance for the order of the forms and all other applicable guidelines.

## 4.3 Page Limit {#page-limit .unnumbered}

HRSA prints your application for review regardless of whether it is
submitted electronically or by paper (when allowed).

When your application is printed, the narrative documents may not exceed
80 pages in length unless otherwise stated in the program guidance.
These narrative documents include the abstract, project and budget
narratives, and any other attachments such as appendices, letters of
support required as a part of the guidance. This 80 page limit does not
include the OMB approved forms. Note that some program guidances may
require submission of OMB approved program specific forms as
attachments. These attachments will not be included in the 80 page
limit.

Applicants must follow the instructions provided in this section and
ensure that they print out all attachments on paper and count the number
of pages before submission.

-   Applications, whether submitted electronically or on paper, that
    exceed the specified limits will be deemed non-compliant.
    Non-compliant competing applications will not be given any
    consideration and the particular applicants will be notified.
    Non-compliant noncompeting applications will have to be resubmitted
    to comply with the page limits.

# 5. Customer Support Information

### 5.1.1 Grants.gov Customer Support {#grants.gov-customer-support .unnumbered}

Please direct ALL questions regarding Grants.gov to Grants.gov Contact
Center at Tel.: 1-800-518-4726. Contact Center hours of operation are
Monday-Friday from 7:00 a.m. to 9:00 p.m. Eastern Time, excluding
Federal holidays.

Please visit the following support URL for additional material on
Grants.gov website.

<http://www.grants.gov/CustomerSupport>

### 5.1.2 HRSA Call Center {#hrsa-call-center .unnumbered}

For assistance with or using HRSA EHBs, call 877-GO4-HRSA (877-464-4772)
between 9:00 am to 5:30 pm ET or email <callcenter@hrsa.gov>.

Please visit HRSA EHBs for online help. Go to:

<https://grants.hrsa.gov/webexternal/home.asp> and click on 'Help'

### 5.1.3 HRSA Program Support {#hrsa-program-support .unnumbered}

For assistance with program guidance related questions, please contact
the program contact listed on the program guidance. Do not call the
program contact for technical questions related to either Grants.gov or
HRSA EHBs.

# 6. FAQs

## 6.1 Software {#software .unnumbered}

### 6.1.1 What are the software requirements for using Grants.gov? {#what-are-the-software-requirements-for-using-grants.gov .unnumbered}

Applicants will need to download the PureEdge viewer. Grants.gov website
provides the following information:

**System Requirements:**

For PureEdge Viewer to function properly, your computer must meet the
following system requirements:

Windows 98, ME, NT 4.0, 2000, XP\
500 Mhz processor\
128 MB of RAM\
40 MB disk space\
Web browser: Internet Explorer 5.01 or higher, Netscape Communicator
4.5 - 4.8, Netscape 6.1, 6.2, or 7

If you do not have a Windows operating system, you will need to use a
Windows Emulation program.

Please visit <http://www.grants.gov/DownloadViewer> for all details and
any updates.

### 6.1.2 Why can't I download PureEdge Viewer onto my machine? {#why-cant-i-download-pureedge-viewer-onto-my-machine .unnumbered}

Depending on your organization's computer network and security protocols
you may not have the necessary permissions to download software onto
your workstation. Contact your IT department or system administrator to
download the software for you or give you access to this function.

### 6.1.3 I have heard that Grants.gov is not Macintosh compatible. What do I do if I use only a Macintosh? {#i-have-heard-that-grants.gov-is-not-macintosh-compatible.-what-do-i-do-if-i-use-only-a-macintosh .unnumbered}

Grants.gov is aware of the issues facing Macintosh users who apply for
Federal grants electronically. Grants.gov has provided the following
response regarding this issue on its website at
<http://www.grants.gov/MacSupport>:

> *Grants.gov recognizes that support to users of Non-Windows operating
> systems and the PureEdge Viewer is often required across a distinct
> segment of the grant applicant community. Although at this time, the
> PureEdge Viewer is only available for Windows based installs,
> Grants.gov offers support for Non-Windows platforms.*
>
> *Grants.gov is working with PureEdge in the development of a
> Non-Windows compatible viewer. PureEdge has committed to providing a
> platform independent viewer by November 2006. Information related to
> the Non-Windows compatible viewer will be posted to this webpage
> (http://www.grants.gov/MacSupport). Please bookmark this page and
> return at your convenience for more details.*

Grants.gov and NIH have partnered to provide free access to Citrix
servers for Macintosh Users who are looking for an alternative to using
PC emulation software with the PureEdge forms. A Citrix server
connection allows Macintosh users to remotely launch a Windows session
on their own machines by using the free Citrix client application.
Applicants will need to download and install the free Citrix client
application in order to work. This service is now available for use.

Grants.gov website states:

> *Beginning December 20, 2005, non-Windows users will be able to
> download and complete the PureEdge forms by taking advantage of the
> free Citrix server. Non-Windows users are also able to submit
> completed grant applications via the Citrix environment.*

For details, please visit <http://www.grants.gov/MacSupport>

### 6.1.4 What are the software requirements for HRSA EHBs? {#what-are-the-software-requirements-for-hrsa-ehbs .unnumbered}

HRSA EHBs can be accessed over the Internet using Internet Explorer (IE)
v5.0 and above and Netscape 4.72 and above. HRSA EHBs are 508 compliant.

IE 6.0 and above is the recommended browser.

HRSA EHBs use pop-up screens to allow users to view or work on multiple
screens. Ensure that your browser settings allow for pop-ups.

In addition, to view attachments such as Word and PDF, you will need
appropriate viewers.

### 6.1.5 What are the system requirements for using HRSA EHBs on a Macintosh computer?  {#what-are-the-system-requirements-for-using-hrsa-ehbs-on-a-macintosh-computer .unnumbered}

Mac users are requested to download the latest version of Netscape for
their OS version. It is recommended that Safari v1.2.4 and above or
Netscape v7.2 and above be used.

Note that Internet Explorer (IE) for Mac has known issues with SSL and
Microsoft is no longer supporting IE for Mac. HRSA EHBs do not work on
IE for Mac.

In addition, to view attachments such as Word and PDF, you will need
appropriate viewers.

## 6.2 Application Receipt {#application-receipt .unnumbered}

### 6.2.1 What will be the receipt date\--the date the application is stamped as received by Grants.gov or the date the data is received by HRSA? {#what-will-be-the-receipt-date--the-date-the-application-is-stamped-as-received-by-grants.gov-or-the-date-the-data-is-received-by-hrsa .unnumbered}

**Competing Submissions:**

The submission/receipt date will be the date the application is received
by Grants.gov.

**Noncompeting Submissions:**

The submission/receipt date will be the date the application is
submitted in HRSA EHBs.

### 6.2.2 When do I need to submit my application? {#when-do-i-need-to-submit-my-application .unnumbered}

**Competing Submissions:**

Applications must be submitted to Grants.gov by 8 PM ET on the due date.

**Noncompeting Submissions:**

Applications must be submitted to Grants.gov by 8 PM ET on the due date.

Applications must be verified and submitted in HRSA EHBs by 5:00 PM ET
on the due date. (2 weeks after the due date in Grants.gov) Refer to the
program guidance for specific dates.

### 6.2.3 What emails can I expect once I submit my application? Is email reliable? {#what-emails-can-i-expect-once-i-submit-my-application-is-email-reliable .unnumbered}

**Competing Submissions:**

When you submit your noncompeting application in Grants.gov, it is first
received and validated by Grants.gov. Typically, this takes a few hours
but it may take up to 48 hours during peak volumes. You should receive
two emails from Grants.gov.

The first will confirm receipt of your application by the Grants.gov
system ("Received"), and the second will indicate that the application
has either been successfully validated ("Validated") by the system prior
to transmission to the grantor agency or has been rejected due to errors
("Rejected with Errors").

Subsequently, the application will be downloaded by HRSA. This happens
within minutes of when your application is successfully validated by
Grants.gov and made available for HRSA to download. On successful
download at HRSA, the status of the application will change to "Received
by Agency" and you will receive another email from Grants.gov.

You will receive an additional email from HRSA once your signed face
page is received and processed. This email serves as the official
receipt for your application.

Because email is not reliable, you must check the respective systems if
you do not receive any emails within the specified timeframes.

**Noncompeting Submissions:**

When you submit your noncompeting application in Grants.gov, it is first
received and validated by Grants.gov. Typically, this takes a few hours
but it may take up to 48 hours during peak volumes. You should receive
two emails from Grants.gov.

Subsequently, the application will be downloaded by HRSA. This happens
within minutes of when your application is successfully validated by
Grants.gov and made available for HRSA to download. On successful
download at HRSA, the status of the application will change to "Received
by Agency" and you will receive another email from Grants.gov.

Subsequently, it is processed by HRSA to ensure that the application is
submitted for the correct funding announcement, with the correct grant
number and grantee organization. This may take up to 3 business days. At
this point you will receive an email from HRSA confirming the successful
receipt of your application and asking the PD and AO to review and
resubmit the application in HRSA EHBs.

You will receive an additional email from HRSA once your signed face
page is received and processed. This email serves as the official
receipt for your application.

Because email is not reliable, you must check the respective systems if
you do not receive any emails within the specified timeframes.

-   For more information refer to sections 2.4 and 2.5 in this guide

### 6.2.4 If a resubmission is required because of Grants.gov system problems, will these be considered \"late\"? {#if-a-resubmission-is-required-because-of-grants.gov-system-problems-will-these-be-considered-late .unnumbered}

**Competing Submissions:**

No. But you must **contact the Director of the Division of Grants
Policy** via email at <DGPWaivers@hrsa.gov> and thoroughly explain the
situation. Include a copy of the "Rejected with Errors" notification you
received from Grants.gov.

**Noncompeting Submissions:**

No. But you must **contact the HRSA Call Center** at 877-GO4-HRSA
(877-464-4772) between 9:00 am to 5:30 pm ET or email
<callcenter@hrsa.gov>. You may be asked to provide a copy of the
"Rejected with Errors" notification you received from Grants.gov.

## 6.3 Application Submission {#application-submission .unnumbered}

### 6.3.1 How can I make sure that my electronic application is presented in the right order for objective review? {#how-can-i-make-sure-that-my-electronic-application-is-presented-in-the-right-order-for-objective-review .unnumbered}

Follow the instructions provided in section 4.2 to ensure that your
application is presented in the right order and is compliant with all
the requirements.

## 6.4 Grants.gov {#grants.gov .unnumbered}

For a list of frequently asked questions and answers maintained by
Grants.gov please visit the following URL:

<http://www.grants.gov/GrantsGov_UST_Grantee/!SSL!/WebHelp/GrantsGov_UST_Grantee.htm#index.html>

[]{#__RefHeading___Toc178485894 .anchor}**Appendix B -- Registering and
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 [not]{.underline}
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 <DGPWaivers@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.

**[REGISTRATION:]{.underline}**

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](../www.grants.gov). Individual assistance is available
at [http://www.grants.gov/Support](http://www.grants.gov/Support  ) or
1-800-518-4726. 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. 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.
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 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
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. See Appendix A for specific
information.

b\. [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. All applications must be received by
www.grants.gov/Apply by 8:00 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. 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.

**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. You must, however, ensure that a copy of the
SF-424/5161 Face Sheet is printed, signed, scanned, and included you're
your application as Attachment 1. For competitive applications, the
SF-424/5161 must be printed from Grants.gov.

Competitive 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 included in the electronic application submission.

**Performance Measures for Competitive Applications**

Many HRSA guidances include specific data forms and require performance
measure reporting. If the completion of performance measure information
is indicated in this guidance, successful applicants receiving grant
funds will be required, within 30 days of the Notice of Grant Award
(NGA), to register in HRSA's Electronic Handbooks (EHBs) and
electronically complete the program specific data forms that appear in
this guidance. This requires the provision of budget breakdowns in the
financial forms based on the grant award amount, the project abstract
and other grant summary data, and objectives for the performance
measures.

**Performance Measures for Non-Competing Continuation Applications**

For applications which require submittal of performance measures
electronically through the completion of program specific data forms,
instructions will be provided both in the program guidance and through
an e-mail, notifying grantees of their responsibility to provide this
information, and providing instructions on how to do so.

> OMB #0915-0298
>
> EXPIRATION DATE: March 31, 2009

[]{#__RefHeading___Toc178485895 .anchor}**APPENDIX C: MCHB Discretionary
Grant Performance Measures**

> Performance Measures 3, 7, 10, 19, 23, and 31

+-----------------------------------+-----------------+-----------------+
| **03 PERFORMANCE MEASURE**        | OMB #0915-0298  |                 |
|                                   |                 |                 |
| **Goal 1: Provide National        | EXPIRATION      |                 |
| Leadership for MCHB**             | DATE: March 31, |                 |
|                                   | 2009            |                 |
| **(Strengthen the MCH knowledge   |                 |                 |
| base and support scholarship      | The percent of  |                 |
| within the MCH community)**       | completed MCHB  |                 |
|                                   | supported       |                 |
| **Level: Grantee**                | projects        |                 |
|                                   | publishing      |                 |
| **Category: Information           | findings in     |                 |
| Dissemination**                   | peer-reviewed   |                 |
|                                   | journals.       |                 |
+-----------------------------------+-----------------+-----------------+
| **GOAL**                          | To increase the |                 |
|                                   | number of study |                 |
|                                   | findings from   |                 |
|                                   | research        |                 |
|                                   | projects that   |                 |
|                                   | are published   |                 |
|                                   | in              |                 |
|                                   | peer-reviewed   |                 |
|                                   | journals.       |                 |
+-----------------------------------+-----------------+-----------------+
|                                   |                 |                 |
+-----------------------------------+-----------------+-----------------+
| **MEASURE**                       | The percent of  |                 |
|                                   | completed MCHB  |                 |
|                                   | supported       |                 |
|                                   | projects        |                 |
|                                   | publishing      |                 |
|                                   | findings in     |                 |
|                                   | peer-reviewed   |                 |
|                                   | journals.       |                 |
+-----------------------------------+-----------------+-----------------+
|                                   |                 |                 |
+-----------------------------------+-----------------+-----------------+
| **DEFINITION**                    | **Numerator:**  |                 |
+-----------------------------------+-----------------+-----------------+
|                                   | Number of       |                 |
|                                   | completed       |                 |
|                                   | projects        |                 |
|                                   | publishing main |                 |
|                                   | study findings  |                 |
|                                   | in              |                 |
|                                   | peer-reviewed   |                 |
|                                   | journals no     |                 |
|                                   | later than 3    |                 |
|                                   | years following |                 |
|                                   | completion in a |                 |
|                                   | cohort year.    |                 |
+-----------------------------------+-----------------+-----------------+
|                                   | *               |                 |
|                                   | *Denominator:** |                 |
+-----------------------------------+-----------------+-----------------+
|                                   | Total number of |                 |
|                                   | completed       |                 |
|                                   | projects in a   |                 |
|                                   | cohort year.    |                 |
+-----------------------------------+-----------------+-----------------+
|                                   | **Units:** 100  | **Text:**       |
|                                   |                 | Percent         |
+-----------------------------------+-----------------+-----------------+
|                                   | A completed     |                 |
|                                   | project means   |                 |
|                                   | that the        |                 |
|                                   | funding period  |                 |
|                                   | has ended and   |                 |
|                                   | the final       |                 |
|                                   | report has been |                 |
|                                   | submitted by    |                 |
|                                   | the grantee.    |                 |
|                                   |                 |                 |
|                                   | Cohort year is  |                 |
|                                   | defined as      |                 |
|                                   | projects        |                 |
|                                   | completed in a  |                 |
|                                   | given fiscal    |                 |
|                                   | year. Each      |                 |
|                                   | cohort year     |                 |
|                                   | will be         |                 |
|                                   | collected for   |                 |
|                                   | three years.    |                 |
+-----------------------------------+-----------------+-----------------+
|                                   |                 |                 |
+-----------------------------------+-----------------+-----------------+
| **HEALTHY PEOPLE 2010 OBJECTIVE** | Related to Goal |                 |
|                                   | 1: Improve      |                 |
|                                   | access to       |                 |
|                                   | comprehensive,  |                 |
|                                   | high-quality    |                 |
|                                   | health care     |                 |
|                                   | services        |                 |
|                                   | (Objectives     |                 |
|                                   | 1.1- 1.16).     |                 |
+-----------------------------------+-----------------+-----------------+
|                                   |                 |                 |
+-----------------------------------+-----------------+-----------------+
| **DATA SOURCE(S) AND ISSUES**     | -   Attached    |                 |
|                                   |     data        |                 |
|                                   |     collection  |                 |
|                                   |     form will   |                 |
|                                   |     be sent     |                 |
|                                   |     annually to |                 |
|                                   |     grantees    |                 |
|                                   |     after the   |                 |
|                                   |     funding     |                 |
|                                   |     period for  |                 |
|                                   |     3 years.    |                 |
|                                   |                 |                 |
|                                   | -   Some        |                 |
|                                   |     preliminary |                 |
|                                   |     information |                 |
|                                   |     may be      |                 |
|                                   |     gathered    |                 |
|                                   |     from        |                 |
|                                   |     mandated    |                 |
|                                   |     project     |                 |
|                                   |     final       |                 |
|                                   |     reports.    |                 |
+-----------------------------------+-----------------+-----------------+
|                                   |                 |                 |
+-----------------------------------+-----------------+-----------------+
| **SIGNIFICANCE**                  | To be           |                 |
|                                   | successful, MCH |                 |
|                                   | information     |                 |
|                                   | must reach      |                 |
|                                   | professionals   |                 |
|                                   | who are         |                 |
|                                   | delivering      |                 |
|                                   | services,       |                 |
|                                   | developing      |                 |
|                                   | programs and    |                 |
|                                   | making policy   |                 |
|                                   | in order to     |                 |
|                                   | ensure that the |                 |
|                                   | latest          |                 |
|                                   | evidence-based, |                 |
|                                   | scientific      |                 |
|                                   | knowledge is    |                 |
|                                   | applied in      |                 |
|                                   | practice and    |                 |
|                                   | policy          |                 |
|                                   | development.    |                 |
|                                   | Peer reviewed   |                 |
|                                   | journals are    |                 |
|                                   | considered one  |                 |
|                                   | of the best     |                 |
|                                   | methods for     |                 |
|                                   | distributing    |                 |
|                                   | new knowledge   |                 |
|                                   | because of      |                 |
|                                   | their wide      |                 |
|                                   | circulation and |                 |
|                                   | rigorous        |                 |
|                                   | standard of     |                 |
|                                   | review.         |                 |
+-----------------------------------+-----------------+-----------------+

> OMB #0915-0298
>
> EXPIRATION DATE: March 31, 2009

**DATA COLLECTION FORM FOR DETAIL SHEET #03**

**LIST OF PUBLICATIONS RELATED TO THE RESEARCH PROJECT FUNDED OR**

**CO-FUNDED BY MCHB**

FUNDED PROJECT
#:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

PROJECT TITLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

PRINCIPAL INVESTIGATOR:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

GRANTEE/INSTITUTION:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(At the time the research was conducted)

######## 

TYPE OF PROJECT: Research \_\_\_\_ Training \_\_\_\_\_\_ Programmatic
\_\_\_\_\_\_\_

**LIST OF PUBLICATIONS**

**Produced by or for the Funded Project**

Please attach a reprint of listed article(s) to this form

TITLE OF THE ARTICLE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

JOURNAL:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

VOLUME:\_\_\_\_\_\_ NUMBER:\_\_\_\_\_\_\_\_
SUPPLEMENT:\_\_\_\_\_\_\_YEAR:\_\_\_\_\_\_PAGE:\_\_\_\_\_\_

+----------------------------------+-----------------------------------+
| **07 PERFORMANCE MEASURE**       | OMB #0915-0298                    |
|                                  |                                   |
| **Goal 1: Provide National       | EXPIRATION DATE: March 31, 2009   |
| Leadership for MCHB**            |                                   |
|                                  | The degree to which MCHB          |
| **(Promote family participation  | supported programs ensure family  |
| in care)**                       | participation in program and      |
|                                  | policy activities.                |
| **Level: Grantee**               |                                   |
|                                  |                                   |
| **Category: Family               |                                   |
| Participation**                  |                                   |
+----------------------------------+-----------------------------------+
| **GOAL**                         | To increase family participation  |
|                                  | in MCHB programs.                 |
+----------------------------------+-----------------------------------+
|                                  |                                   |
+----------------------------------+-----------------------------------+
| **MEASURE**                      | The degree to which MCHB          |
|                                  | supported programs ensure family  |
|                                  | participation in program and      |
|                                  | policy activities.                |
+----------------------------------+-----------------------------------+
|                                  |                                   |
+----------------------------------+-----------------------------------+
| **DEFINITION**                   | Attached is a checklist of 6      |
|                                  | elements that demonstrate family  |
|                                  | participation. Please check the   |
|                                  | degree to which the elements have |
|                                  | been implemented.                 |
+----------------------------------+-----------------------------------+
|                                  |                                   |
+----------------------------------+-----------------------------------+
| **HEALTHY PEOPLE 2010            | Related to Objective 16.23.       |
| OBJECTIVE**                      | Increase the proportion of        |
|                                  | Territories and States that have  |
|                                  | service systems for Children with |
|                                  | Special Health Care Needs to 100  |
|                                  | percent.                          |
+----------------------------------+-----------------------------------+
|                                  |                                   |
+----------------------------------+-----------------------------------+
| **DATA SOURCE(S) AND ISSUES**    | Attached data collection form to  |
|                                  | be completed by grantees.         |
+----------------------------------+-----------------------------------+
|                                  |                                   |
+----------------------------------+-----------------------------------+
| **SIGNIFICANCE**                 | Over the last decade, policy      |
|                                  | makers and program administrators |
|                                  | have emphasized the central role  |
|                                  | of families as advisors and       |
|                                  | participants in policy-making     |
|                                  | activities. In accordance with    |
|                                  | this philosophy, MCHB is          |
|                                  | facilitating such partnerships at |
|                                  | the local, state and national     |
|                                  | levels. Family/professional       |
|                                  | partnerships have been:           |
|                                  | incorporated into the MCHB Block  |
|                                  | Grant Application, the MCHB       |
|                                  | strategic plan and is a           |
|                                  | requirement in the Omnibus Budget |
|                                  | Reconciliation Act of 1989 (OBRA  |
|                                  | '89), the legislative mandate     |
|                                  | that health programs supported by |
|                                  | Maternal and Child Health Bureau  |
|                                  | (MCHB) Children with Special      |
|                                  | Health Care Needs (CSHCN) provide |
|                                  | and promote family centered,      |
|                                  | community‑based, coordinated      |
|                                  | care.                             |
+----------------------------------+-----------------------------------+

> OMB #0915-0298
>
> EXPIRATION DATE: March 31, 2009

**DATA COLLECTION FORM FOR DETAIL SHEET #07**

Using a scale of 0-3, please rate the degree to which our grant program
has included families into their program and planning activities.

  ------- ------- ------- ------- -------------------------------------------
  **0**   **1**   **2**   **3**   **Element**

                                  Family members participate on advisory
                                  committees or task forces and are offered
                                  training, mentoring and reimbursement.

                                  Financial support (financial grants,
                                  technical assistance, travel, and child
                                  care) is offered for parent activities or
                                  parent groups.

                                  Family members participate in the planning,
                                  implementation and evaluation of the
                                  program's activities.

                                  Families members work with their
                                  professional partners to provide training (
                                  pre‑service, in-service and professional
                                  development) to MCH/CSHCN staff and
                                  providers.

                                  Family members are hired as paid staff or
                                  consultants to the program (a family member
                                  is hired for his or her expertise as a
                                  family member).

                                  Family members of diverse cultures are
                                  involved in all of the above activities.
  ------- ------- ------- ------- -------------------------------------------

0=Not Met

1=Partially Met

2=Mostly Met

3=Completely Met

Total the numbers in the boxes (possible 0‑18 score) \_\_\_\_\_\_\_\_\_

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+-----------------------------------+-----------------------------------+
| **10 PERFORMANCE MEASURE**        | OMB #0915-0298                    |
|                                   |                                   |
| **Goal 2: Eliminate Health        | EXPIRATION DATE: March 31, 2009   |
| Barriers & Disparities**          |                                   |
|                                   | The degree to which MCHB          |
| **(Develop and promote health     | supported programs have           |
| services and systems of care      | incorporated cultural competence  |
| designed to eliminate disparities | elements into their policies,     |
| and barriers across MCH           | guidelines, contracts and         |
| populations)**                    | training.                         |
|                                   |                                   |
| **Level: Grantee**                |                                   |
|                                   |                                   |
| **Category: Cultural Competence** |                                   |
+-----------------------------------+-----------------------------------+
| **GOAL**                          | To increase the number of MCHB    |
|                                   | supported programs that have      |
|                                   | integrated cultural competence    |
|                                   | into their policies, guidelines,  |
|                                   | contracts and training.           |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **MEASURE**                       | The degree to which MCHB          |
|                                   | supported programs have           |
|                                   | incorporated cultural competence  |
|                                   | elements into their policies,     |
|                                   | guidelines, contracts and         |
|                                   | training.                         |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **DEFINITION**                    | Attached is a checklist of 23     |
|                                   | elements that demonstrate         |
|                                   | cultural competency. Please check |
|                                   | the degree to which the elements  |
|                                   | have been implemented. The answer |
|                                   | scale is 0-69. Please keep the    |
|                                   | completed checklist attached.     |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **HEALTHY PEOPLE 2010 OBJECTIVE** | Related to Objective 16.23:       |
|                                   | Increase the proportion of States |
|                                   | and jurisdictions that have       |
|                                   | service systems for children with |
|                                   | or at risk for chronic and        |
|                                   | disabling conditions as required  |
|                                   | by Public Law 101-239.            |
|                                   |                                   |
|                                   | Related to Objective 23.11        |
|                                   | (Developmental) Increase the      |
|                                   | proportion of State and local     |
|                                   | public health agencies that meet  |
|                                   | national performance standards    |
|                                   | for essential public health       |
|                                   | services.                         |
|                                   |                                   |
|                                   | Related to Objective 23.15        |
|                                   | (Developmental) Increase the      |
|                                   | proportion of Federal, Tribal,    |
|                                   | State, and local jurisdictions    |
|                                   | that review and evaluate the      |
|                                   | extent to which their statutes,   |
|                                   | ordinances, and bylaws assure the |
|                                   | delivery of essential public      |
|                                   | health services.                  |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **DATA SOURCE(S) AND ISSUES**     | -   Attached data collection form |
|                                   |     to be completed by grantees.  |
|                                   |                                   |
|                                   | -   There is no existing national |
|                                   |     data source to measure the    |
|                                   |     extent to which MCHB          |
|                                   |     supported programs have       |
|                                   |     incorporated cultural         |
|                                   |     competence elements into      |
|                                   |     their policies, guidelines,   |
|                                   |     contracts and training.       |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **SIGNIFICANCE**                  | Over the last decade, researchers |
|                                   | and policymakers have emphasized  |
|                                   | the central influence of cultural |
|                                   | values and cultural/linguistic    |
|                                   | barriers: health seeking          |
|                                   | behavior, access to care, and     |
|                                   | racial and ethnic disparities. In |
|                                   | accordance with these concerns,   |
|                                   | cultural competence objectives    |
|                                   | have been: (1) incorporated into  |
|                                   | the MCHB strategic plan; and (2)  |
|                                   | in guidance materials related to  |
|                                   | the Omnibus Budget Reconciliation |
|                                   | Act of 1989 (OBRA '89), which is  |
|                                   | the legislative mandate that      |
|                                   | health programs supported by MCHB |
|                                   | Children with Special Health Care |
|                                   | Needs (CSHCN) provide and promote |
|                                   | family centered, community‑based, |
|                                   | coordinated care.                 |
+-----------------------------------+-----------------------------------+

> OMB #0915-0298
>
> EXPIRATION DATE: March 31, 2009

**DATA COLLECTION FORM FOR DETAIL SHEET #10**

Using a scale of 0-3, please rate the degree to which your grant program
has incorporated the following cultural competence elements into your
policies, guidelines, contracts and training.

+------+------+------+------+------------------------------------------+
| *    | *    | *    | *    | **Element**                              |
| *0** | *1** | *2** | *3** |                                          |
+------+------+------+------+------------------------------------------+
|      |      |      |      | **CORE FUNCTIONS:** Our organization     |
|      |      |      |      | incorporates the following culturally    |
|      |      |      |      | competent core function elements:        |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  Performs needs/assets assessments    |
|      |      |      |      |     with the culturally diverse groups   |
|      |      |      |      |     we serve.                            |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  Collects and analyzes data according |
|      |      |      |      |     to different cultural groups (e.g.   |
|      |      |      |      |     race, ethnicity, language).          |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 3.  Designs services to meet the needs   |
|      |      |      |      |     of culturally diverse groups (e.g.   |
|      |      |      |      |     use of traditional healers, flexible |
|      |      |      |      |     times of services, language          |
|      |      |      |      |     services).                           |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 4.  Uses data on different groups for    |
|      |      |      |      |     program development.                 |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 5.  Considers barriers and the provision |
|      |      |      |      |     of appropriate strategies to address |
|      |      |      |      |     them.                                |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 6.  Evaluates and monitors quality       |
|      |      |      |      |     services (via customer satisfaction  |
|      |      |      |      |     surveys, focus groups, chart         |
|      |      |      |      |     reviews).                            |
+------+------+------+------+------------------------------------------+
|      |      |      |      | Is there a policy to incorporate         |
|      |      |      |      | cultural competence in the core          |
|      |      |      |      | functions? *None\_\_\_ Informal\_\_\_    |
|      |      |      |      | Formal\_\_\_ In process\_\_\_*           |
+------+------+------+------+------------------------------------------+
|      |      |      |      | **TRAINING/HUMAN RESOURCES**: Our        |
|      |      |      |      | organization incorporates the following  |
|      |      |      |      | culturally competent training/human      |
|      |      |      |      | resource elements:                       |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  Employs a culturally diverse and     |
|      |      |      |      |     linguistically and culturally        |
|      |      |      |      |     competent staff.                     |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  Ensures the provision of training,   |
|      |      |      |      |     both in orientation and ongoing      |
|      |      |      |      |     professional development, for staff, |
|      |      |      |      |     volunteers, contractors and          |
|      |      |      |      |     subcontractors in the area of        |
|      |      |      |      |     cultural and linguistic competence.  |
+------+------+------+------+------------------------------------------+
|      |      |      |      | Is there a policy to incorporate         |
|      |      |      |      | cultural competence in training and      |
|      |      |      |      | human resources?                         |
|      |      |      |      |                                          |
|      |      |      |      | *None\_\_\_ Informal\_\_\_ Formal\_\_\_  |
|      |      |      |      | In process\_\_\_*                        |
+------+------+------+------+------------------------------------------+
|      |      |      |      | **COLLABORATION:** Our organization      |
|      |      |      |      | collaborates with informal community     |
|      |      |      |      | leaders/groups (e.g. natural networks,   |
|      |      |      |      | informal leaders, spiritual leaders,     |
|      |      |      |      | ethnic media, family advocacy groups) in |
|      |      |      |      | various aspects of the following         |
|      |      |      |      | categories::                             |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  Program planning                     |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  Service delivery                     |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 3.  Evaluation/monitoring of services    |
+------+------+------+------+------------------------------------------+
|      |      |      |      | **COLLABORATION:** Our organization      |
|      |      |      |      | collaborates with families of culturally |
|      |      |      |      | diverse groups in various aspects of the |
|      |      |      |      | following categories:                    |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  Program planning                     |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  Service delivery                     |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 3.  Evaluation/monitoring of services    |
+------+------+------+------+------------------------------------------+
|      |      |      |      | Is there a policy to support the above   |
|      |      |      |      | mentioned collaborative activities?      |
|      |      |      |      | *None\_\_\_ Informal\_\_\_ Formal\_\_\_  |
|      |      |      |      | In process\_\_\_*                        |
+------+------+------+------+------------------------------------------+

+------+------+------+------+------------------------------------------+
|      |      |      |      | **RESOURCE ALLOCATION:** Our             |
|      |      |      |      | organization's allocation of resources   |
|      |      |      |      | adequately meets the unique access,      |
|      |      |      |      | information and service needs of         |
|      |      |      |      | culturally diverse groups in the         |
|      |      |      |      | following program areas:                 |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  Planning                             |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  Implementation                       |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 3.  Evaluation/Monitoring (e.g. customer |
|      |      |      |      |     satisfaction surveys, focus groups)  |
+------+------+------+------+------------------------------------------+
|      |      |      |      | Is there a policy to support the         |
|      |      |      |      | allocation of fiscal resources for the   |
|      |      |      |      | needs and services for culturally        |
|      |      |      |      | diverse groups?                          |
|      |      |      |      |                                          |
|      |      |      |      | *None\_\_\_ Informal\_\_\_ Formal\_\_\_  |
|      |      |      |      | In process\_\_\_*                        |
+------+------+------+------+------------------------------------------+
|      |      |      |      | **CONTRACTS:** Our agency puts language  |
|      |      |      |      | in contracts that addresses our goals to |
|      |      |      |      | incorporate cultural competence for      |
|      |      |      |      | culturally and linguistically diverse    |
|      |      |      |      | groups in the following areas**:**       |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  Needs/assets assessments             |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  Outreach                             |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 3.  Specialized services                 |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 4.  Training for                         |
|      |      |      |      |     contractors/subcontractors           |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 5.  Sufficient funds to support 1-e      |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 6.  Reporting requirements for a-e       |
+------+------+------+------+------------------------------------------+
|      |      |      |      | Is there a policy to support monitoring  |
|      |      |      |      | of contractors/ subcontractors?          |
|      |      |      |      |                                          |
|      |      |      |      | *None\_\_\_ Informal\_\_\_ Formal\_\_\_  |
|      |      |      |      | In process\_\_\_*                        |
+------+------+------+------+------------------------------------------+

0=Not Met

1=Partially Met

2=Mostly Met

3=Completely Met

Total the numbers in the boxes (possible 0‑69 score)
\_\_\_\_\_\_\_\_\_\_

> []{.mark}

+-----------------------------------+-----------------------------------+
| **19 PERFORMANCE MEASURE**        | OMB #0915-0298                    |
|                                   |                                   |
| **Goal 3: Assure Quality of       | EXPIRATION DATE: March 31, 2009   |
| Care**                            |                                   |
|                                   | The degree to which grantees have |
| **(Develop and promote health     | assisted States in increasing the |
| services and systems designed to  | percent of children with special  |
| improve quality of care)**        | health care needs age 0 to 18 who |
|                                   | receive coordinated, ongoing,     |
| **Level: Grantee**                | comprehensive care within a       |
|                                   | medical home.                     |
| **Category: CSHN/Medical Home**   |                                   |
+-----------------------------------+-----------------------------------+
| **GOAL**                          | To increase the number of         |
|                                   | children with special health care |
|                                   | needs in the State and nationally |
|                                   | who have a medical home.          |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **MEASURE**                       | The degree to which grantees have |
|                                   | assisted States in achieving      |
|                                   | access to a medical home for all  |
|                                   | children with special health care |
|                                   | needs in the State and            |
|                                   | nationally.                       |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **DEFINITION**                    | Attached is a checklist of 5      |
|                                   | elements that demonstrate how a   |
|                                   | grantee has assisted their State  |
|                                   | in achieving access to a medical  |
|                                   | home for children with special    |
|                                   | health care needs. Please check   |
|                                   | the degree to which the elements  |
|                                   | have been implemented.            |
|                                   |                                   |
|                                   | The MCHB uses the AAP definition  |
|                                   | of "medical home." The definition |
|                                   | establishes that the medical care |
|                                   | of infants, children and          |
|                                   | adolescents should be accessible, |
|                                   | continuous, comprehensive, family |
|                                   | centered, coordinated and         |
|                                   | compassionate. It should be       |
|                                   | delivered or directed by          |
|                                   | well‑trained physicians who are   |
|                                   | able to manage or facilitate      |
|                                   | essentially all aspects of        |
|                                   | pediatric care. The physician     |
|                                   | should be known to the child and  |
|                                   | family and should be able to      |
|                                   | develop a relationship of mutual  |
|                                   | responsibility and trust with     |
|                                   | them. (AAP, Volume 90, No. 5,     |
|                                   | 11/92).                           |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **HEALTHY PEOPLE 2010 OBJECTIVE** | Related to Objective 16.22:       |
|                                   | (Developmental): Increase the     |
|                                   | proportion of children with       |
|                                   | special health care needs who     |
|                                   | have access to a medical home.    |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **DATA SOURCE(S) AND ISSUES**     | -   Attached data collection form |
|                                   |     to be completed by grantees.  |
|                                   |                                   |
|                                   | The data collection form          |
|                                   | represents a menu of strategies   |
|                                   | by which grantees may assist      |
|                                   | States in achieving access to a   |
|                                   | medical home for children with    |
|                                   | special health care needs.        |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **SIGNIFICANCE**                  | Providing primary care to         |
|                                   | children in a "medical home" is   |
|                                   | the standard of practice.         |
|                                   | Research indicates that children  |
|                                   | with a stable and continuous      |
|                                   | source of health care are more    |
|                                   | likely to receive appropriate     |
|                                   | preventive care and               |
|                                   | immunizations, are less likely to |
|                                   | be hospitalized for preventable   |
|                                   | conditions, and are more likely   |
|                                   | to be diagnosed early for chronic |
|                                   | or disabling conditions.          |
+-----------------------------------+-----------------------------------+

> OMB #0915-0298
>
> EXPIRATION DATE: March 31, 2009

**DATA COLLECTION FORM FOR DETAIL SHEET #19**

Using the scale below, indicate the degree to which your grant has
assisted the State to develop and implement medical home provision.

  --------- -------- -------- -------- ------------------------------------
  **N/A**   **1**    **2**    **3**    **Element**

                                       **1. Establishment of Medical Home
                                       Practice Sites** -- Through
                                       implementation of grantee
                                       activities, the number of medical
                                       home practice sites in the State has
                                       been increased.

                                       **2. Primary Care Providers Receive
                                       Training in the Medical Home
                                       Concept** -- The grantee has
                                       assisted the State to provide
                                       training in the medical home concept
                                       to primary care providers throughout
                                       the State.

                                       **3. Development of Medical Home
                                       Information Tools** -- The grantee
                                       has assisted the State to develop
                                       communications tools, including
                                       kits, brochures and internet
                                       websites accessible to other states
                                       and promoted the medical home
                                       concept.

                                       **4. Mentoring of Other States** --
                                       The grantee has assisted the State
                                       to provide mentorship activities to
                                       other States in support of fostering
                                       the medical home concept nationally.

                                       **5. Development of Medical Home CQI
                                       Tools --** The grantee has assisted
                                       the State to develop evaluation
                                       tools to continuously monitor the
                                       progress of care coordination in
                                       medical homes in the State, which
                                       may be used on a national basis.
  --------- -------- -------- -------- ------------------------------------

N/A=This item is not a planned component of the grant

1=This item is a planned component of the grant: Scheduled activities
have not begun

2=This item is a planned component of the grant: Scheduled activities
have just begun

3=This item is a planned component of the grant: Scheduled activities
are underway and timely

Total the numbers in the boxes (possible 0-15 score)\_\_\_\_\_\_\_\_\_\_

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+-----------------------------------+-----------------------------------+
| **23 PERFORMANCE MEASURE**        | OMB #0915-0298                    |
|                                   |                                   |
| **Goal 3: Assure Quality of       | EXPIRATION DATE: March 31, 2009   |
| Care**                            |                                   |
|                                   | The degree to which grantees have |
| **(Develop and promote health     | assisted States in increasing the |
| services and systems that assure  | percentage of children who are    |
| appropriate follow-up services)** | screened early and continuously   |
|                                   | for special health care needs and |
| **Level: Grantee**                | linked to medical homes,          |
|                                   | appropriate follow-up, and early  |
| **Category: CSHN/Screening**      | intervention.                     |
+-----------------------------------+-----------------------------------+
| **GOAL**                          | To assure early and continuous    |
|                                   | screening and early intervention  |
|                                   | for all children for special      |
|                                   | health care needs.                |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **MEASURE**                       | The degree to which grantees have |
|                                   | assisted States in enhancing the  |
|                                   | early and continuous screening,   |
|                                   | followed by early intervention    |
|                                   | for all children with special     |
|                                   | health care needs.                |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **DEFINITION**                    | Attached is a checklist of 8      |
|                                   | elements that demonstrate         |
|                                   | progress toward implementing a    |
|                                   | coordinated and comprehensive     |
|                                   | State system to assure early and  |
|                                   | continuous screening and early    |
|                                   | intervention for all children for |
|                                   | special health care needs. Please |
|                                   | respond 'Yes' or "No' when        |
|                                   | completing the checklist. Take    |
|                                   | into account the element          |
|                                   | descriptions and questions posed  |
|                                   | when formulating your response.   |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+

+-----------------------------------+-----------------------------------+
| **HEALTHY PEOPLE 2010 OBJECTIVE** | Related to Objectives 16.20:      |
|                                   | (Developmental) Ensure            |
|                                   | appropriate newborn bloodspot     |
|                                   | screening, follow-up testing, and |
|                                   | referral to services.             |
|                                   |                                   |
|                                   | Related to Objectives 16.21:      |
|                                   | (Developmental) Reduce            |
|                                   | hospitalization for               |
|                                   | life-threatening sepsis among     |
|                                   | children aged 4 years and under   |
|                                   | with sickling hemoglobinopathies. |
|                                   |                                   |
|                                   | Related to Objectives 28.1-4 :    |
|                                   | (Developmental) Increase the      |
|                                   | proportion of persons who have a  |
|                                   | dilated eye examination at        |
|                                   | appropriate intervals;            |
|                                   | (Developmental) Increase the      |
|                                   | proportion of preschool children  |
|                                   | aged 5 years and under who        |
|                                   | receive vision screening;         |
|                                   | (Developmental) Reduce            |
|                                   | uncorrected visual impairment due |
|                                   | to refractive errors; Reduce      |
|                                   | blindness and visual impairment   |
|                                   | in children and adolescents aged  |
|                                   | 17 years and under.               |
|                                   |                                   |
|                                   | Related to Objectives 28.11-14:   |
|                                   | (Developmental) Increase the      |
|                                   | proportion of newborns who are    |
|                                   | screened for hearing loss by age  |
|                                   | 1 month, have audiologic          |
|                                   | evaluation by age 3 months, and   |
|                                   | are enrolled in appropriate       |
|                                   | intervention services by age      |
|                                   |                                   |
|                                   | 6 months; Reduce otitis media in  |
|                                   | children and adolescents;         |
|                                   | (Developmental) Increase access   |
|                                   | by persons who have hearing       |
|                                   | impairments to hearing            |
|                                   | rehabilitation services and       |
|                                   | adaptive devices, including       |
|                                   | hearing aids, cochlear implants,  |
|                                   | or tactile or other assistive or  |
|                                   | augmentative devices;             |
|                                   | (Developmental) Increase the      |
|                                   | proportion of persons who have    |
|                                   | had a hearing examination on      |
|                                   | schedule.                         |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **DATA SOURCE(S) AND ISSUES**     | -   Attached data collection form |
|                                   |     to be completed by grantees.  |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **SIGNIFICANCE**                  | Screening programs for newborns   |
|                                   | and children have been shown to   |
|                                   | be cost-effective and successful  |
|                                   | and have been shown to prevent    |
|                                   | mortality and morbidity. Their    |
|                                   | success reflects the systems      |
|                                   | approach from early screening to  |
|                                   | appropriate early intervention    |
|                                   | and treatment.                    |
+-----------------------------------+-----------------------------------+

> OMB #0915-0298
>
> EXPIRATION DATE: March 31, 2009

**DATA COLLECTION FORM FOR DETAIL SHEET #23**

Using a scale of Yes or No, indicate the whether or not your grant
program has assisted States in enhancing early and continuous screening,
followed by early intervention for all children with special health care
needs.

+---+---+---------------------------------------------------------------+
| * | * | **Element**                                                   |
| * | * |                                                               |
| Y | N |                                                               |
| * | * |                                                               |
| * | * |                                                               |
+---+---+---------------------------------------------------------------+
|   |   | 1\) The grantee has assisted the State to expand or enhance   |
|   |   | its programs for early and continuous screening and           |
|   |   | intervention and treatment to identify and treat all children |
|   |   | with SHCN.                                                    |
|   |   |                                                               |
|   |   | a.  All live born infants screened for inherited or other     |
|   |   |     congenital disorders                                      |
|   |   |                                                               |
|   |   | b.  Conditions screened                                       |
|   |   |                                                               |
|   |   |     i.  Hearing loss                                          |
|   |   |                                                               |
|   |   |     ii. PKU                                                   |
|   |   |                                                               |
|   |   |     iii. Hemoglobinopathies                                   |
|   |   |                                                               |
|   |   |     iv. Hypothyroidism                                        |
|   |   |                                                               |
|   |   |     v.  Congenital Adrenal Hyperplasia                        |
|   |   |                                                               |
|   |   |     vi. MSUD                                                  |
|   |   |                                                               |
|   |   |     vii. MCAD                                                 |
|   |   |                                                               |
|   |   |     viii. Biotinidase                                         |
|   |   |                                                               |
|   |   |     ix. Cystic Fibrosis                                       |
|   |   |                                                               |
|   |   |     x.  Galactosemia                                          |
+---+---+---------------------------------------------------------------+
|   |   | 1)  The grantee has assisted the State to establish, maintain |
|   |   |     and coordinate state based surveillance systems to        |
|   |   |     identify infants and children with SHCN (e.g., birth      |
|   |   |     defects, newborn screening, EPSDT, hearing screening,     |
|   |   |     vision screening).                                        |
|   |   |                                                               |
|   |   |     a.  Establishment of tracking systems for the following   |
|   |   |         programs:                                             |
|   |   |                                                               |
|   |   |         i.  Newborn Genetic/Metabolic Screening               |
|   |   |                                                               |
|   |   |         ii. Hearing Screening                                 |
|   |   |                                                               |
|   |   |         iii. Birth Defects                                    |
|   |   |                                                               |
|   |   |         iv. EPSDT                                             |
|   |   |                                                               |
|   |   |         v.  Vision screening                                  |
|   |   |                                                               |
|   |   |     b.  Integration and Coordination between the previous     |
|   |   |         programs and their support systems                    |
+---+---+---------------------------------------------------------------+
|   |   | 2)  The grantee has assisted the State to develop and promote |
|   |   |     policies for early and continuous screening and           |
|   |   |     intervention and treatment for children identified with   |
|   |   |     SHCN.                                                     |
|   |   |                                                               |
|   |   |     a.  Does the State have a Newborn Screening Advisory      |
|   |   |         Committee                                             |
|   |   |                                                               |
|   |   |     b.  Does the State have procedures for informed consent   |
|   |   |                                                               |
|   |   |     c.  Does the state have procedures for genetic counseling |
|   |   |         for families with a infant screened positive in a     |
|   |   |         newborn screening program                             |
+---+---+---------------------------------------------------------------+
|   |   | 3)  The grantee has assisted the State to ensure that all     |
|   |   |     infants with test results that screen positive will have  |
|   |   |     confirmatory diagnosis as early as possible.              |
+---+---+---------------------------------------------------------------+
|   |   | 4)  The grantee has assisted the State to ensure that all     |
|   |   |     infants who screen positive are linked to a medical home. |
+---+---+---------------------------------------------------------------+
|   |   | 5)  The grantee has assisted the State to ensure that all     |
|   |   |     infants who are identified to be at risk for              |
|   |   |     developmental disability will be enrolled in a program of |
|   |   |     early intervention by 6 months of age                     |
+---+---+---------------------------------------------------------------+
|   |   | 6)  The grantee has assisted the State to leverage resources  |
|   |   |     to adequately fund public health approaches to early and  |
|   |   |     continuous screening and intervention and treatment for   |
|   |   |     children identified with SHCN.                            |
|   |   |                                                               |
|   |   |     a.  Does the state fund medical foods for infants         |
|   |   |         identified with a metabolic disorder such as PKU      |
|   |   |                                                               |
|   |   |     b.  Does the State law/regulation governing hearing       |
|   |   |         screening and follow-up services include              |
|   |   |         reimbursement                                         |
+---+---+---------------------------------------------------------------+
|   |   | 7)  The grantee has assisted the State to ensure that all     |
|   |   |     infants to be at risk for a special health care need will |
|   |   |     be linked to a family to family support network.          |
+---+---+---------------------------------------------------------------+

Total Score (Number of Yes responses 0 - 8) \_\_\_\_\_\_\_\_

> []{.mark}

+-----------------------------------+-----------------------------------+
| **31 PERFORMANCE MEASURE**        | OMB #0915-0298                    |
|                                   |                                   |
| **Goal 4: Improve the Health      | EXPIRATION DATE: March 31, 2009   |
| Infrastructure and Systems of     |                                   |
| Care**                            | The degree to which grantees have |
|                                   | assisted States in organizing     |
| **(Assist states and communities  | community-based service systems   |
| to plan and develop               | so that families of children with |
| comprehensive, integrated health  | special health care needs can use |
| services systems)**               | them easily.                      |
|                                   |                                   |
| **Level: Grantee**                |                                   |
|                                   |                                   |
| **Category: CSHN/Infrastructure** |                                   |
+-----------------------------------+-----------------------------------+
| **GOAL**                          | To assure access to integrated    |
|                                   | community systems of care for     |
|                                   | children with special health care |
|                                   | needs.                            |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **MEASURE**                       | The degree to which grantees have |
|                                   | assisted states in developing     |
|                                   | integrated systems of care for    |
|                                   | children with special health care |
|                                   | needs.                            |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **DEFINITION**                    | Attached is a checklist of 4      |
|                                   | elements that demonstrate the     |
|                                   | degree to which grantees have     |
|                                   | assisted States to develop        |
|                                   | integrated systems of care for    |
|                                   | children with special health care |
|                                   | needs. Please check the degree to |
|                                   | which the elements have been      |
|                                   | implemented.                      |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **HEALTHY PEOPLE 2010 OBJECTIVE** | Related to Objective 16.23:       |
|                                   | Increase the proportion of States |
|                                   | and jurisdictions that have       |
|                                   | service systems for children with |
|                                   | or at risk for chronic and        |
|                                   | disabling conditions as required  |
|                                   | by Public Law 101-239.            |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **DATA SOURCE(S) AND ISSUES**     | -   Attached data collection form |
|                                   |     to be completed by grantees.  |
|                                   |                                   |
|                                   | -   The National CSHCN Survey     |
|                                   |     will provide national and     |
|                                   |     state estimates on the extent |
|                                   |     to which families perceive    |
|                                   |     that integrated community     |
|                                   |     systems of care are available |
|                                   |     to their child with a special |
|                                   |     health care need.             |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **SIGNIFICANCE**                  | Families, service agencies and    |
|                                   | the Federal Interagency           |
|                                   | Coordinating Council (FICC) have  |
|                                   | identified major challenges       |
|                                   | confronting families in accessing |
|                                   | coordinated health and related    |
|                                   | services that families need for   |
|                                   | their children with special       |
|                                   | health care needs. Differing      |
|                                   | eligibility criteria, duplication |
|                                   | and gaps in services, inflexible  |
|                                   | funding streams and poor          |
|                                   | coordination among service        |
|                                   | agencies are concerns across most |
|                                   | States. This effort should        |
|                                   | provide model strategies for      |
|                                   | addressing these issues.          |
+-----------------------------------+-----------------------------------+

> OMB #0915-0298
>
> EXPIRATION DATE: March 31, 2009

**DATA COLLECTION FOR FORM FOR DETAIL SHEET #31**

Using the scale below, indicate the degree to which your grant has
assisted States to develop and implement an integrated system of care
for children with special health needs.

+------+------+------+------+------------------------------------------+
| **N  | *    | *    | *    | **Element**                              |
| /A** | *1** | *2** | *3** |                                          |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  **State Collaboration with Other     |
|      |      |      |      |     State Agencies and Private           |
|      |      |      |      |     Organizations:** The grantee has     |
|      |      |      |      |     assisted the State to establish and  |
|      |      |      |      |     maintain an ongoing interagency      |
|      |      |      |      |     collaborative process for the        |
|      |      |      |      |     assessment of needs with respect to  |
|      |      |      |      |     the development of community-based   |
|      |      |      |      |     systems of care for CSHCN. State     |
|      |      |      |      |     programs collaborate with other      |
|      |      |      |      |     agencies and organizations in the    |
|      |      |      |      |     formulation of coordinated policies, |
|      |      |      |      |     standards, data collection and       |
|      |      |      |      |     analysis, financing of services, and |
|      |      |      |      |     program monitoring to assure         |
|      |      |      |      |     comprehensive, coordinated services  |
|      |      |      |      |     for CSHCN.                           |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  **State Support for Communities:**   |
|      |      |      |      |     The grantee has assisted the State   |
|      |      |      |      |     to emphasize the development of      |
|      |      |      |      |     community-based programs by          |
|      |      |      |      |     establishing and maintaining a       |
|      |      |      |      |     process for facilitating community   |
|      |      |      |      |     systems building through mechanisms  |
|      |      |      |      |     such as technical assistance and     |
|      |      |      |      |     consultation, education and          |
|      |      |      |      |     training, common data protocols, and |
|      |      |      |      |     financial resources for communities  |
|      |      |      |      |     engaged in systems development to    |
|      |      |      |      |     assure that the unique needs of      |
|      |      |      |      |     CSHCN are met.                       |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 3.  **Coordination of Health Components  |
|      |      |      |      |     of Community-Based Systems:** The    |
|      |      |      |      |     grantee has assisted the State to    |
|      |      |      |      |     develop a mechanism in communities   |
|      |      |      |      |     across the State for coordination of |
|      |      |      |      |     health services with one another.    |
|      |      |      |      |     This includes coordination among     |
|      |      |      |      |     providers of primary care,           |
|      |      |      |      |     habilitative services, other         |
|      |      |      |      |     specialty medical treatment          |
|      |      |      |      |     services, mental health services and |
|      |      |      |      |     home health care.                    |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 4.  **Coordination of Health Services    |
|      |      |      |      |     with Other Services a the Community  |
|      |      |      |      |     Level:** The grantee has assisted    |
|      |      |      |      |     the State to develop a mechanism in  |
|      |      |      |      |     communities across the State for     |
|      |      |      |      |     coordination and services            |
|      |      |      |      |     integration among program serving    |
|      |      |      |      |     CSHCN, including early intervention  |
|      |      |      |      |     and special education, social        |
|      |      |      |      |     services, and family support         |
|      |      |      |      |     services.                            |
+------+------+------+------+------------------------------------------+

N/A=This item is not a planned component of the grant

1=This item is a planned component of the grant: Scheduled activities
have not begun

2=This item is a planned component of the grant: Scheduled activities
have just begun

3=This item is a planned component of the grant: Scheduled activities
are underway and timely

Total the numbers in the boxes (possible 0-12 score)\_\_\_\_\_\_\_\_\_\_

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[]{#__RefHeading___Toc178485896 .anchor}**APPENDIX D: Financial and
Demographic Forms**

> FORM 1: MCHB Project Budget Details
>
> FORM 2: Project Funding Profile
>
> FORM 4: Project Budget and Expenditures by Types of Services
>
> FORM 6: Maternal & Child Health Discretionary Grant Project Abstract
>
> FORM 7: Discretionary Grant Project Summary Data

**FORM 1**

**MCHB PROJECT BUDGET DETAILS FOR FY \_\_\_\_\_\_\_**

+---+---+-------+--------------------+---------------------+-----+----+
| * | * |       |                    |                     |     | \$ |
| * | * |       |                    |                     |     |    |
| 1 | M |       |                    |                     |     |    |
| . | C |       |                    |                     |     |    |
| * | H |       |                    |                     |     |    |
| * | B |       |                    |                     |     |    |
|   | G |       |                    |                     |     |    |
|   | R |       |                    |                     |     |    |
|   | A |       |                    |                     |     |    |
|   | N |       |                    |                     |     |    |
|   | T |       |                    |                     |     |    |
|   | A |       |                    |                     |     |    |
|   | W |       |                    |                     |     |    |
|   | A |       |                    |                     |     |    |
|   | R |       |                    |                     |     |    |
|   | D |       |                    |                     |     |    |
|   | A |       |                    |                     |     |    |
|   | M |       |                    |                     |     |    |
|   | O |       |                    |                     |     |    |
|   | U |       |                    |                     |     |    |
|   | N |       |                    |                     |     |    |
|   | T |       |                    |                     |     |    |
|   | * |       |                    |                     |     |    |
|   | * |       |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
| * | * |       |                    |                     |     | \$ |
| * | * |       |                    |                     |     |    |
| 2 | U |       |                    |                     |     |    |
| . | N |       |                    |                     |     |    |
| * | O |       |                    |                     |     |    |
| * | B |       |                    |                     |     |    |
|   | L |       |                    |                     |     |    |
|   | I |       |                    |                     |     |    |
|   | G |       |                    |                     |     |    |
|   | A |       |                    |                     |     |    |
|   | T |       |                    |                     |     |    |
|   | E |       |                    |                     |     |    |
|   | D |       |                    |                     |     |    |
|   | B |       |                    |                     |     |    |
|   | A |       |                    |                     |     |    |
|   | L |       |                    |                     |     |    |
|   | A |       |                    |                     |     |    |
|   | N |       |                    |                     |     |    |
|   | C |       |                    |                     |     |    |
|   | E |       |                    |                     |     |    |
|   | * |       |                    |                     |     |    |
|   | * |       |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
| * | * |       |                    |                     |     | \$ |
| * | * |       |                    |                     |     |    |
| 3 | M |       |                    |                     |     |    |
| . | A |       |                    |                     |     |    |
| * | T |       |                    |                     |     |    |
| * | C |       |                    |                     |     |    |
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|   | I |       |                    |                     |     |    |
|   | N |       |                    |                     |     |    |
|   | G |       |                    |                     |     |    |
|   | F |       |                    |                     |     |    |
|   | U |       |                    |                     |     |    |
|   | N |       |                    |                     |     |    |
|   | D |       |                    |                     |     |    |
|   | S |       |                    |                     |     |    |
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|   | R |       |                    |                     |     |    |
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|   | e |       |                    |                     |     |    |
|   | s |       |                    |                     |     |    |
|   | \ |       |                    |                     |     |    |
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|   | ] |       |                    |                     |     |    |
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|   | y |       |                    |                     |     |    |
|   | e |       |                    |                     |     |    |
|   | s |       |                    |                     |     |    |
|   | , |       |                    |                     |     |    |
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|   |   |       |                    |                     |     |    |
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|   | o |       |                    |                     |     |    |
|   | c |       |                    |                     |     |    |
|   | a |       |                    |                     |     |    |
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|   | u |       |                    |                     |     |    |
|   | n |       |                    |                     |     |    |
|   | d |       |                    |                     |     |    |
|   | s |       |                    |                     |     |    |
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|   | B |       |                    |                     | \$  |    |
|   | . |       |                    |                     |     |    |
|   | S |       |                    |                     |     |    |
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|   | a |       |                    |                     |     |    |
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|   | n |       |                    |                     |     |    |
|   | d |       |                    |                     |     |    |
|   | s |       |                    |                     |     |    |
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|   | C |       |                    |                     | \$  |    |
|   | . |       |                    |                     |     |    |
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|   | m |       |                    |                     |     |    |
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|   | D |       |                    |                     | \$  |    |
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|   | n |       |                    |                     |     |    |
|   | d |       |                    |                     |     |    |
|   | s |       |                    |                     |     |    |
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|   | E |       |                    |                     | \$  |    |
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|   | d |       |                    |                     |     |    |
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|   | : |       |                    |                     |     |    |
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| * | * |       |                    |                     |     | \$ |
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|   | A |       |                    |                     | \$  |    |
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|   | s |       |                    |                     |     |    |
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|   | B |       |                    |                     | \$  |    |
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+---+---+-------+--------------------+---------------------+-----+----+
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|   | d |       |                    |                     |     |    |
|   | s |       |                    |                     |     |    |
|   | ( |       |                    |                     |     |    |
|   | D |       |                    |                     |     |    |
|   | o |       |                    |                     |     |    |
|   | n |       |                    |                     |     |    |
|   | o |       |                    |                     |     |    |
|   | t |       |                    |                     |     |    |
|   | r |       |                    |                     |     |    |
|   | e |       |                    |                     |     |    |
|   | p |       |                    |                     |     |    |
|   | e |       |                    |                     |     |    |
|   | a |       |                    |                     |     |    |
|   | t |       |                    |                     |     |    |
|   | g |       |                    |                     |     |    |
|   | r |       |                    |                     |     |    |
|   | a |       |                    |                     |     |    |
|   | n |       |                    |                     |     |    |
|   | t |       |                    |                     |     |    |
|   | f |       |                    |                     |     |    |
|   | u |       |                    |                     |     |    |
|   | n |       |                    |                     |     |    |
|   | d |       |                    |                     |     |    |
|   | s |       |                    |                     |     |    |
|   | f |       |                    |                     |     |    |
|   | r |       |                    |                     |     |    |
|   | o |       |                    |                     |     |    |
|   | m |       |                    |                     |     |    |
|   | L |       |                    |                     |     |    |
|   | i |       |                    |                     |     |    |
|   | n |       |                    |                     |     |    |
|   | e |       |                    |                     |     |    |
|   | 1 |       |                    |                     |     |    |
|   | ) |       |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 1\)   |                    |                     | \$  |    |
|   |   | S     |                    |                     |     |    |
|   |   | PRANS |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 2\)   |                    |                     | \$  |    |
|   |   | CISS  |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 3\)   |                    |                     | \$  |    |
|   |   | SSDI  |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 4\)   |                    |                     | \$  |    |
|   |   | Absti |                    |                     |     |    |
|   |   | nence |                    |                     |     |    |
|   |   | Educ  |                    |                     |     |    |
|   |   | ation |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 5\)   |                    |                     | \$  |    |
|   |   | He    |                    |                     |     |    |
|   |   | althy |                    |                     |     |    |
|   |   | Start |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 6\)   |                    |                     | \$  |    |
|   |   | EMSC  |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 7\)   |                    |                     | \$  |    |
|   |   | Bi    |                    |                     |     |    |
|   |   | oterr |                    |                     |     |    |
|   |   | orism |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 8\)   |                    |                     | \$  |    |
|   |   | Trau  |                    |                     |     |    |
|   |   | matic |                    |                     |     |    |
|   |   | Brain |                    |                     |     |    |
|   |   | I     |                    |                     |     |    |
|   |   | njury |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 9\)   |                    |                     | \$  |    |
|   |   | State |                    |                     |     |    |
|   |   | Title |                    |                     |     |    |
|   |   | V     |                    |                     |     |    |
|   |   | Block |                    |                     |     |    |
|   |   | Grant |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 10\)  |                    |                     | \$  |    |
|   |   | O     |                    |                     |     |    |
|   |   | ther: |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   | O |       |                    |                     |     |    |
|   | t |       |                    |                     |     |    |
|   | h |       |                    |                     |     |    |
|   | e |       |                    |                     |     |    |
|   | r |       |                    |                     |     |    |
|   | H |       |                    |                     |     |    |
|   | R |       |                    |                     |     |    |
|   | S |       |                    |                     |     |    |
|   | A |       |                    |                     |     |    |
|   | F |       |                    |                     |     |    |
|   | u |       |                    |                     |     |    |
|   | n |       |                    |                     |     |    |
|   | d |       |                    |                     |     |    |
|   | s |       |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 1\)   |                    |                     | \$  |    |
|   |   | HIV   |                    |                     |     |    |
|   |   | /AIDS |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 2\)   |                    |                     | \$  |    |
|   |   | Pr    |                    |                     |     |    |
|   |   | imary |                    |                     |     |    |
|   |   | Care  |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 3\)   |                    |                     | \$  |    |
|   |   | H     |                    |                     |     |    |
|   |   | ealth |                    |                     |     |    |
|   |   | P     |                    |                     |     |    |
|   |   | rofes |                    |                     |     |    |
|   |   | sions |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 4\)   |                    |                     | \$  |    |
|   |   | O     |                    |                     |     |    |
|   |   | ther: |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   | O |       |                    |                     |     |    |
|   | t |       |                    |                     |     |    |
|   | h |       |                    |                     |     |    |
|   | e |       |                    |                     |     |    |
|   | r |       |                    |                     |     |    |
|   | F |       |                    |                     |     |    |
|   | e |       |                    |                     |     |    |
|   | d |       |                    |                     |     |    |
|   | e |       |                    |                     |     |    |
|   | r |       |                    |                     |     |    |
|   | a |       |                    |                     |     |    |
|   | l |       |                    |                     |     |    |
|   | F |       |                    |                     |     |    |
|   | u |       |                    |                     |     |    |
|   | n |       |                    |                     |     |    |
|   | d |       |                    |                     |     |    |
|   | s |       |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 1\)   |                    |                     | \$  |    |
|   |   | CMS   |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 2\)   |                    |                     | \$  |    |
|   |   | SSI   |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 3\)   |                    |                     | \$  |    |
|   |   | A     |                    |                     |     |    |
|   |   | gricu |                    |                     |     |    |
|   |   | lture |                    |                     |     |    |
|   |   | (     |                    |                     |     |    |
|   |   | WIC/o |                    |                     |     |    |
|   |   | ther) |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 4\)   |                    |                     | \$  |    |
|   |   | ACF   |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 5\)   |                    |                     | \$  |    |
|   |   | CDC   |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 6\)   |                    |                     | \$  |    |
|   |   | S     |                    |                     |     |    |
|   |   | AMHSA |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 7\)   |                    |                     | \$  |    |
|   |   | NIH   |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 8\)   |                    |                     | \$  |    |
|   |   | Educ  |                    |                     |     |    |
|   |   | ation |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   | 9\)   |                    |                     | \$  |    |
|   |   | O     |                    |                     |     |    |
|   |   | ther: |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   |       |                    |                     | \$  |    |
+---+---+-------+--------------------+---------------------+-----+----+
|   |   |       |                    |                     | \$  |    |
+---+---+-------+--------------------+---------------------+-----+----+
| * | * |       |                    |                     | \$  |    |
| * | * |       |                    |                     |     |    |
| 7 | T |       |                    |                     |     |    |
| . | O |       |                    |                     |     |    |
| * | T |       |                    |                     |     |    |
| * | A |       |                    |                     |     |    |
|   | L |       |                    |                     |     |    |
|   | C |       |                    |                     |     |    |
|   | O |       |                    |                     |     |    |
|   | L |       |                    |                     |     |    |
|   | L |       |                    |                     |     |    |
|   | A |       |                    |                     |     |    |
|   | B |       |                    |                     |     |    |
|   | O |       |                    |                     |     |    |
|   | R |       |                    |                     |     |    |
|   | A |       |                    |                     |     |    |
|   | T |       |                    |                     |     |    |
|   | I |       |                    |                     |     |    |
|   | V |       |                    |                     |     |    |
|   | E |       |                    |                     |     |    |
|   | F |       |                    |                     |     |    |
|   | E |       |                    |                     |     |    |
|   | D |       |                    |                     |     |    |
|   | E |       |                    |                     |     |    |
|   | R |       |                    |                     |     |    |
|   | A |       |                    |                     |     |    |
|   | L |       |                    |                     |     |    |
|   | F |       |                    |                     |     |    |
|   | U |       |                    |                     |     |    |
|   | N |       |                    |                     |     |    |
|   | D |       |                    |                     |     |    |
|   | S |       |                    |                     |     |    |
|   | * |       |                    |                     |     |    |
|   | * |       |                    |                     |     |    |
+---+---+-------+--------------------+---------------------+-----+----+

**INSTRUCTIONS FOR COMPLETION OF FORM 1**

**MCH BUDGET DETAILS FOR FY \_\_\_\_**

Line 1. Enter the amount of the Federal MCHB grant award for this
project.

Line 2. Enter the amount of carryover from the previous year's award, if
any (the unobligated balance).

Line 3. Indicate if matching funds are required by checking the
appropriate choice. If matching funds are required, enter the total
amount of the matching funds received or committed to the project. List
the amounts by source on lines 3A through 3D as appropriate. Do not
include "overmatch" funds. Any additional funds over and above the
amount required for matching purposes should be reported in Line 4.
Where appropriate, include the dollar value of in-kind contributions.

Line 4. Enter the amount of other funds received for the project, by
source on Lines 4A through 4E, specifying amounts from each source. Do
not include those amounts included in Line 3 above. Also include the
dollar value of in-kind contributions.

Line 5. Enter the sum of lines 1 through 4

Line 6. Line 6. Enter the amount of other Federal funds received on the
appropriate lines (A.1 through C.9) **other** than the MCHB grant award
for the project. Such funds would include those from other Departments,
other components of the Department of Health and Human Services, or
other MCHB grants or contracts.

Line 6C.1. Enter only project funds from the Center for Medicare and
Medicaid Services. Exclude Medicaid reimbursement, which is considered
Program Income and should be included on Line 3C or 4C.

If lines 6A.10, 6B.4, or 6C.9 are utilized, specify the source(s) of the
funds in the order of the amount provided, starting with the source of
the most funds. If more space is required, add a footnote at the bottom
of the page showing additional sources and amounts.

Line 7. Enter the sum of Lines 6A.1 through 6C.9.

NOTE: MCHB Training Grants must fill out Section "V. Detailed Budget" of
the currently approved SF 424 R&R in addition to this form.

**FORM 2**

**PROJECT FUNDING PROFILE**

<table style="width:100%;">
<colgroup>
<col style="width: 1%" />
<col style="width: 11%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 6%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 6%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 1%" />
<col style="width: 7%" />
</colgroup>
<tbody>
<tr class="odd">
<td></td>
<td></td>
<td colspan="3"><u>FY_____</u></td>
<td></td>
<td colspan="3"><u>FY_____</u></td>
<td></td>
<td colspan="3"><u>FY_____</u></td>
<td></td>
<td colspan="3"><u>FY_____</u></td>
<td></td>
<td colspan="3"><u>FY_____</u></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td><u>Budgeted</u></td>
<td></td>
<td><u>Expended</u></td>
<td></td>
<td><u>Budgeted</u></td>
<td></td>
<td><u>Expended</u></td>
<td></td>
<td><u>Budgeted</u></td>
<td></td>
<td><u>Expended</u></td>
<td></td>
<td><u>Budgeted</u></td>
<td></td>
<td><u>Expended</u></td>
<td></td>
<td><u>Budgeted</u></td>
<td></td>
<td><u>Expended</u></td>
</tr>
<tr class="odd">
<td><strong>1</strong></td>
<td><p><u>MCHB Grant</u></p>
<p><u>Award</u> <u>Amount</u></p>
<p><em>Line 1, Form 2</em></p></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
</tr>
<tr class="even">
<td><strong>2</strong></td>
<td><p><u>Unobligated Balance</u></p>
<p><em>Line 2, Form 2</em></p></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
</tr>
<tr class="odd">
<td><strong>3</strong></td>
<td><p><u>Matching Funds</u></p>
<p><u>(If required)</u></p>
<p><em>Line 3, Form 2</em></p></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
</tr>
<tr class="even">
<td><strong>4</strong></td>
<td><p><u>Other Project Funds</u></p>
<p><em>Line 4, Form 2</em></p></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
</tr>
<tr class="odd">
<td><strong>5</strong></td>
<td><p><u>Total Project Funds</u></p>
<p><em>Line 5, Form 2</em></p></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
</tr>
<tr class="even">
<td><strong>6</strong></td>
<td><p><u>Total Federal Collaborative Funds</u></p>
<p><em>Line 7, Form 2</em></p></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
<td></td>
<td><strong>$</strong></td>
</tr>
</tbody>
</table>

**INSTRUCTIONS FOR THE COMPLETION OF FORM 2**

**PROJECT FUNDING PROFILE**

**Instructions:**

> Complete all required data cells. If an actual number is not
> available, use an estimate. Explain all estimates in a footnote.
>
> The form is intended to provide at a glance funding data on the
> estimated budgeted amounts and actual expended amounts of an MCH
> project.
>
> For each fiscal year, the data in the columns labeled Budgeted on this
> form are to contain the same figures that appear on the Application
> Face Sheet and Lines 1 through 7 of Form 1. The lines under the
> columns labeled Expended are to contain the actual amounts expended
> for each grant year that has been completed.

**FORM 4**

**PROJECT BUDGET AND EXPENDITURES**

**By Types of Services**

+---+------------------------+--------+---+--------+---+--------+---+--------+
|   |                        | **FY   |   |        |   | **FY   |   |        |
|   |                        | \_\_\_ |   |        |   | \_\_\_ |   |        |
|   |                        | \_\_** |   |        |   | \_\_** |   |        |
+---+------------------------+--------+---+--------+---+--------+---+--------+
|   | **[TYPES OF            | **     |   | **     |   | **     |   | **     |
|   | S                      | [Budge |   | [Expen |   | [Budge |   | [Expen |
|   | ERVICES]{.underline}** | ted]{. |   | ded]{. |   | ted]{. |   | ded]{. |
|   |                        | underl |   | underl |   | underl |   | underl |
|   |                        | ine}** |   | ine}** |   | ine}** |   | ine}** |
+---+------------------------+--------+---+--------+---+--------+---+--------+
| * | **[Direct Health Care  | \$     |   | \$     |   | \$     |   | \$     |
| * | S                      |        |   |        |   |        |   |        |
| I | ervices]{.underline}** |        |   |        |   |        |   |        |
| . |                        |        |   |        |   |        |   |        |
| * | (Basic Health Services |        |   |        |   |        |   |        |
| * | and                    |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Health Services for    |        |   |        |   |        |   |        |
|   | CSHCN.)                |        |   |        |   |        |   |        |
+---+------------------------+--------+---+--------+---+--------+---+--------+
| * | **[Enabling            | \$     |   | \$     |   | \$     |   | \$     |
| * | S                      |        |   |        |   |        |   |        |
| I | ervices]{.underline}** |        |   |        |   |        |   |        |
| I |                        |        |   |        |   |        |   |        |
| . | (Transportation,       |        |   |        |   |        |   |        |
| * | Translation,           |        |   |        |   |        |   |        |
| * |                        |        |   |        |   |        |   |        |
|   | Outreach, Respite      |        |   |        |   |        |   |        |
|   | Care, Health           |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Education, Family      |        |   |        |   |        |   |        |
|   | Support                |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Services, Purchase of  |        |   |        |   |        |   |        |
|   | Health                 |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Insurance, Case        |        |   |        |   |        |   |        |
|   | Management,            |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | and Coordination with  |        |   |        |   |        |   |        |
|   | Medicaid,              |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | WIC and Education.)    |        |   |        |   |        |   |        |
+---+------------------------+--------+---+--------+---+--------+---+--------+
| * | **[Population-Based    | \$     |   | \$     |   | \$     |   | \$     |
| * | S                      |        |   |        |   |        |   |        |
| I | ervices]{.underline}** |        |   |        |   |        |   |        |
| I |                        |        |   |        |   |        |   |        |
| I | (Newborn Screening,    |        |   |        |   |        |   |        |
| . | Lead                   |        |   |        |   |        |   |        |
| * |                        |        |   |        |   |        |   |        |
| * | Screening,             |        |   |        |   |        |   |        |
|   | Immunization, Sudden   |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Infant Death Syndrome  |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Counseling, Oral       |        |   |        |   |        |   |        |
|   | Health,                |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Injury Prevention,     |        |   |        |   |        |   |        |
|   | Nutrition, and         |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Outreach/Public        |        |   |        |   |        |   |        |
|   | Education.)            |        |   |        |   |        |   |        |
+---+------------------------+--------+---+--------+---+--------+---+--------+
| * | **[Infrastructure      | \$     |   | \$     |   | \$     |   | \$     |
| * | Building               |        |   |        |   |        |   |        |
| I | S                      |        |   |        |   |        |   |        |
| V | ervices]{.underline}** |        |   |        |   |        |   |        |
| . |                        |        |   |        |   |        |   |        |
| * | (Needs Assessment,     |        |   |        |   |        |   |        |
| * | Evaluation, Planning,  |        |   |        |   |        |   |        |
|   | Policy Development,    |        |   |        |   |        |   |        |
|   | Coordination, Quality  |        |   |        |   |        |   |        |
|   | Assurance, Standards   |        |   |        |   |        |   |        |
|   | Development,           |        |   |        |   |        |   |        |
|   |                        |        |   |        |   |        |   |        |
|   | Monitoring, Training,  |        |   |        |   |        |   |        |
|   | Applied Research,      |        |   |        |   |        |   |        |
|   | Systems of Care, and   |        |   |        |   |        |   |        |
|   | Information Systems.)  |        |   |        |   |        |   |        |
+---+------------------------+--------+---+--------+---+--------+---+--------+
| * | ######### **TOTAL**    | \$     |   | \$     |   | \$     |   | \$     |
| * |                        |        |   |        |   |        |   |        |
| V |                        |        |   |        |   |        |   |        |
| . |                        |        |   |        |   |        |   |        |
| * |                        |        |   |        |   |        |   |        |
| * |                        |        |   |        |   |        |   |        |
+---+------------------------+--------+---+--------+---+--------+---+--------+

**INSTRUCTIONS FOR THE COMPLETION OF FORM 4**

**PROJECT BUDGET AND EXPENDITURES BY TYPES OF SERVICE**S

Complete all required data cells for all years of the g rant. If an
actual number is not available, make an estimate. Please explain all
estimates in a footnote. Administrative dollars should be allocated to
the appropriate level(s) of the pyramid on lines I, II, II or IV. If an
estimate of administrative funds use is necessary, one method would be
to allocate those dollars to Lines I, II, III and IV at the same
percentage as program dollars are allocated to Lines I through IV.

Note: Lines I, II and II are for projects providing services. If grant
funds are used to build the infrastructure for direct care delivery,
enabling or population-based services, these amounts should be reported
in Line IV (i.e., building data collection capacity for newborn hearing
screening).

Line I [Direct Health Care Services]{.underline} - enter the budgeted
and expended amounts for the appropriate fiscal year completed and
budget estimates only for all other years.

> **Direct Health Care Services** are those services generally delivered
> one-on-one between a health professional and a patient in an office,
> clinic or emergency room which may include primary care physicians,
> registered dietitians, public health or visiting nurses, nurses
> certified for obstetric and pediatric primary care, medical social
> workers, nutritionists, dentists, sub-specialty physicians who serve
> children with special health care needs, audiologists, occupational
> therapists, physical therapists, speech and language therapists,
> specialty registered dietitians. Basic services include what most
> consider ordinary medical care, inpatient and outpatient medical
> services, allied health services, drugs, laboratory testing, x-ray
> services, dental care, and pharmaceutical products and services. State
> Title V programs support - by directly operating programs or by
> funding local providers - services such as prenatal care, child health
> including immunizations and treatment or referrals, school health and
> family planning. For CSHCN, these services include specialty and
> sub-specialty care for those with HIV/AIDS, hemophilia, birth defects,
> chronic illness, and other conditions requiring sophisticated
> technology, access to highly trained specialists, or an array of
> services not generally available in most communities.

Line II [Enabling Services]{.underline} - enter the budgeted and
expended amounts for the appropriate fiscal year completed and budget
estimates only for all other years.

> **Enabling Services** allow or provide for access to and the
> derivation of benefits from, the array of basic health care services
> and include such things as transportation, translation services,
> outreach, respite care, health education, family support services,
> purchase of health insurance, case management, coordination of with
> Medicaid, WIC and educations. These services are especially required
> for the low income, disadvantaged, geographically or culturally
> isolated, and those with special and complicated health needs. For
> many of these individuals, the enabling services are essential - for
> without them access is not possible. Enabling services most commonly
> provided by agencies for CSHCN include transportation, care
> coordination, translation services, home visiting, and family
> outreach. Family support activities include parent support groups,
> family training workshops, advocacy, nutrition and social work.

Line III [Population-Based Services]{.underline} - enter the budgeted
and expended amounts for the appropriate fiscal year completed and
budget estimates only for all other years.

> **Population Based Services** are preventive interventions and
> personal health services, developed and available for the entire MCH
> population of the State rather than for individuals in a one-on-one
> situation. Disease prevention, health promotion, and statewide
> outreach are major components. Common among these services are newborn
> screening, lead screening, immunization, Sudden Infant Death Syndrome
> counseling, oral health, injury prevention, nutrition and
> outreach/public education. These services are generally available
> whether the mother or child receives care in the private or public
> system, in a rural clinic or an HMO, and whether insured or not.

Line IV [Infrastructure Building Services]{.underline} - enter the
budgeted and expended amounts for the appropriate fiscal year completed
and budget estimates only for all other years.

> **Infrastructure Building Services** are the base of the MCH pyramid
> of health services and form its foundation. They are activities
> directed at improving and maintaining the health status of all women
> and children by providing support for development and maintenance of
> comprehensive health services systems and resources including
> development and maintenance of health services standards/guidelines,
> training, data and planning systems. Examples include needs
> assessment, evaluation, planning, policy development, coordination,
> quality assurance, standards development, monitoring, training,
> applied research, information systems and systems of care. In the
> development of systems of care it should be assured that the systems
> are family centered, community based and culturally competent.

Line V [Total]{.underline} -- enter the total amounts for each column,
budgeted for each year and expended for each year completed.

**FORM 6**

**MATERNAL & CHILD HEALTH DISCRETIONARY GRANT**

**PROJECT ABSTRACT**

**FOR FY\_\_\_\_**

**PROJECT:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**I. PROJECT IDENTIFIER INFORMATION**

1\. Project Title:

> 2\. Project Number:
>
> 3\. E-mail address:

**II. BUDGET**

1\. MCHB Grant Award \$\_\_\_\_\_\_\_\_\_\_\_\_\_

(Line 1, Form 2)

2\. Unobligated Balance \$\_\_\_\_\_\_\_\_\_\_\_\_\_

(Line 2, Form 2)

3\. Matching Funds (if applicable) \$\_\_\_\_\_\_\_\_\_\_\_\_\_

> (Line 3, Form 2)

4\. Other Project Funds \$\_\_\_\_\_\_\_\_\_\_\_\_\_

> (Line 4, Form 2)

5\. Total Project Funds \$\_\_\_\_\_\_\_\_\_\_\_\_\_

> (Line 5, Form 2)

**III. TYPE(S) OF SERVICE PROVIDED (Choose all that apply)**

\[ \] Direct Health Care Services

> \[ \] Enabling Services
>
> \[ \] Population-Based Services
>
> \[ \] Infrastructure Building Services

IV. **PROJECT DESCRIPTION OR EXPERIENCE TO DATE**

> A. Project Description

1.  Problem (in 50 words, maximum):

2.  Goals and Objectives: (List up to 5 major goals and time-framed
    objectives per goal for the project)

> Goal 1:

Objective 1:

Objective 2:

Goal 2:

Objective 1:

Objective 2:

Goal 3:

Objective 1:

Objective 2:

Goal 4:

Objective 1:

Objective 2:

Goal 5:

Objective 1:

Objective 2:

3.  Activities planned to meet project goals

4.  Specify the primary *Healthy People 2010* objectives(s) (up to
    three) which this project addresses:

> a\.
>
> b\.
>
> c\.

5\. Coordination (List the State, local health agencies or other
organizations involved in the project and their roles)

> 6\. Evaluation (briefly describe the methods which will be used to
> determine whether process and outcome objectives are met)

B.  Continuing Grants ONLY

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1.  Experience to Date (For continuing projects ONLY):

2.  Website URL and annual number of hits

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V.  **KEY WORDS**

**VI. ANNOTATION**

> **INSTRUCTIONS FOR THE COMPLETION OF FORM 6**

**PROJECT ABSTRACT**

**NOTE:** All information provided should fit into the space provided in
the form. The completed form should be no more than 3 pages in length.
Where information has previously been entered in forms 1 through 5, the
information will automatically be transferred electronically to the
appropriate place on this form.

**Section I -- Project Identifier Information**

Project Title: List the appropriate shortened title for the project.

Project Number: This is the number assigned to the project when funded,
and will, for new projects, be filled in later.

E-mail address: Include electronic mail addresses

**Section II -- Budget -** These figures will be transferred from Form
1, Lines 1 through 5.

**Section III - Types of Services**

Indicate which type(s) of services your project provides, checking all
that apply (consistent with Form 5)

**Section IV -- Program Description OR Current Status (DO NOT EXCEED THE
SPACE PROVIDED)**

A. New Projects only are to complete the following items:

1.  A brief description of the project and the problem it addresses such
    as preventive and primary care services for pregnant women, mothers,
    and infants; preventive and primary care services for children; and
    services for Children with Special Health Care Needs.

2.  Up to 5 goals of the project, in priority order. Examples are: To
    reduce the barriers to the delivery of care for pregnant women, to
    reduce the infant mortality rate for minorities and "services or
    system development for children with special healthcare needs." MCHB
    will capture annually every project's top goals in an information
    system for comparison, tracking, and reporting purposes; you must
    list at least 1 and no more than 5 goals. For each goal, list the
    two most important objectives. The objective must be specific (i.e.,
    decrease incidence by 10%) and time limited (by 2005).

3.  List the primary Healthy people 2010 goal(s) that the project
    addresses.

4.  Describe the programs and activities used to attain the goals and
    objectives, and comment on innovation, cost, and other
    characteristics of the methodology, proposed or are being
    implemented. Lists with numbered items can be used in this section.

5.  Describe the coordination planned and carried out, in the space
    provided, if applicable, with appropriate State and/or local health
    and other agencies in areas(s) served by the project.

6.  Briefly describe the evaluation methods that will be used to assess
    the success of the project in attaining its goals and objectives.

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B.  For continuing projects ONLY:

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1.  Provide a brief description of the major activities and
    accomplishments over the past year (not to exceed 200 words).

2.  Provide website and number of hits annually, if applicable.

**Section V -- Key Words**

> Key words describe the project, including populations served. Choose
> key words from the included list.

**Section VI -- Annotation**

> Provide a three- to five-sentence description of your project that
> identifies the project's purpose, the needs and problems, which are
> addressed, the goals and objectives of the project, the activities,
> which will be used to attain the goals, and the materials, which will
> be developed.

**FORM 7**

**DISCRETIONARY GRANT PROJECT**

**SUMMARY DATA**

1.  **Project Service Focus**

> \[ \] Urban/Central City \[ \] Suburban \[ \] Metropolitan Area (city
> & suburbs)
>
> \[ \] Rural \[ \] Frontier \[ \] Border (US-Mexico)

2.  **Project Scope**

> \[ \] Local \[ \] Multi-county \[ \] State-wide
>
> \[ \] Regional \[ \] National

3.  **Grantee Organization Type**

> \[ \] State Agency

\[ \] Community Government Agency

\[ \] School District

\[ \] University/Institution Of Higher Learning (Non-Hospital Based)

\[ \] Academic Medical Center

\[ \] Community-Based Non-Governmental Organization (Health Care)

\[ \] Community-Based Non-Governmental Organization (Non-Health Care)

\[ \] Professional Membership Organization (Individuals Constitute Its
Membership)

\[ \] National Organization (Other Organizations Constitute Its
Membership)

\[ \] National Organization (Non-Membership Based)

\[ \] Independent Research/Planning/Policy Organization

\[ \] Other
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

4.  **Project Infrastructure Focus** (from MCH Pyramid) if applicable

\[ \] Guidelines/Standards Development And Maintenance

\[ \] Policies And Programs Study And Analysis

\[ \] Synthesis Of Data And Information

\[ \] Translation Of Data And Information For Different Audiences

\[ \] Dissemination Of Information And Resources

\[ \] Quality Assurance

\[ \] Technical Assistance

\[ \] Training

\[ \] Systems Development

\[ \] Other

**5. Products and Dissemination**

  -------------------------------------------------------- --------------
  **PRODUCTS**                                             **NUMBER**

  Peer reviewed Journal Article                            

  Book/Chapter                                             

  Report/Monograph                                         

  Presentation                                             

  Doctoral Dissertation                                    

  Other:                                                   
  -------------------------------------------------------- --------------

**6. Demographic Characteristics of Project Participants for Clinical
Services Projects**

+-----------+--------+------+--------+--------+-------+-------+-----+---+
|           | **RACE |      |        |        |       | **E   |     |   |
|           | (In    |      |        |        |       | THNIC |     |   |
|           | dicate |      |        |        |       | ITY** |     |   |
|           | all    |      |        |        |       |       |     |   |
|           | that   |      |        |        |       |       |     |   |
|           | ap     |      |        |        |       |       |     |   |
|           | ply)** |      |        |        |       |       |     |   |
+===========+========+======+========+========+=======+=======+=====+===+
|           | Am     | A    | Black  | Native | White | His   | Not |   |
|           | erican | sian | or     | Ha     |       | panic | Hi  |   |
|           | Indian |      | A      | waiian |       | or    | spa |   |
|           | or     |      | frican | or     |       | L     | nic |   |
|           | Alaska |      | Am     | Other  |       | atino |     |   |
|           | Native |      | erican | P      |       |       | or  |   |
|           |        |      |        | acific |       |       | Lat |   |
|           |        |      |        | Is     |       |       | ino |   |
|           |        |      |        | lander |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| Pregnant  |        |      |        |        |       |       |     |   |
| Women     |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| Children  |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| Children  |        |      |        |        |       |       |     |   |
| with      |        |      |        |        |       |       |     |   |
| Special   |        |      |        |        |       |       |     |   |
| Health    |        |      |        |        |       |       |     |   |
| Care      |        |      |        |        |       |       |     |   |
| Needs     |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| Women     |        |      |        |        |       |       |     |   |
|           |        |      |        |        |       |       |     |   |
| (Not      |        |      |        |        |       |       |     |   |
| Pregnant) |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| Other     |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| TOTALS    |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+

7.  **Clients' Primary Language(s)**

> **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

8.  **Resource/TA and Training Centers ONLY**

> Answer all that apply.

a.  Characteristics of Primary Intended Audience(s)

> \[ \] Policy Makers/Public Servants
>
> \[ \] Consumers

\[ \] Providers/Professionals

b\. Number of Requests Received/Answered: \_\_\_/\_\_\_\_

c.  Number of Continuing Education credits provided: \_\_\_\_\_\_\_

d.  Number of Individuals/Participants Reached: \_\_\_\_\_\_\_

e.  Number of Organizations Assisted: \_\_\_\_\_\_\_

f.  Major Type of TA or Training Provided:

> \[ \] continuing education courses,

\[ \] workshops,

\[ \] on-site assistance,

\[ \] distance learning classes

\[ \] other

> **INSTRUCTIONS FOR THE COMPLETION OF FORM 7**

**PROJECT SUMMARY**

**NOTE:** All information provided should fit into the space provided in
the form. Where information has previously been entered in forms 2
through 9, the information will automatically be transferred
electronically to the appropriate place on this form.

**Section 1 -- Project Service Focus**

Select all that apply

**Section 2 -- Project Scope**

Choose the one that best applies to your project.

**Section 3 -- Grantee Organization Type**

Choose the one that best applies to your organization.

**Section 4 -- Project Infrastructure Focus**

If applicable, choose all that apply.

**Section 5 -- Products and Dissemination**

Indicate the number of each type of product resulting from the project.

**Section 6 -- Demographic Characteristics of Project Participants (for
Clinical Services Projects)**

Please fill in each of the cells as appropriate.

**Section 7 -- Clients Primary Language(s) (for Clinical Services
Projects)**

Indicate which languages your clients speak as their primary language,
other than English for the data provided in Section 6. List up to three.

**Section 8 -- Resource/TA and Training Centers (Only)**

Answer all that apply.

[]{#__RefHeading___Toc178485897 .anchor}**APPENDIX E: Additional Data
Elements**

**Children with Special Health Needs Data Elements**

1\. Are you involved in a broad statewide process for implementation of
the 10-Year Action Plan to Achieve Community-Based Service Systems for
Children and Youth with Special Health Care Needs and Their Families?

\[ \] Yes \[ \] No

If yes, how are you involved? (Check ALL that apply below)

\[ \] Participate in a state-level task force or work group on
implementation

\[ \] Work with other state agencies on implementation activities

\[ \] Work with other partners (e.g., American Academy of Pediatrics,
March of Dimes) on implementation activities

> \[ \] Provide technical assistance, consultation, education, and or
> training to communities engaged in system development
>
> \[ \] Provide financial resources to communities for systems
> development
>
> \[ \] Other
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2\. Are you working with other MCHB grants/grantees that are funded to
assist statewide implementation of the 10-Year Action Plan to Achieve
Community-Based Service Systems for Children and Youth with Special
Health Care Needs and Their Families either in your State or in other
States?

\[ \] Yes \[ \] No

If yes, which ones? (Check ALL that apply below)

\[ \] Family-to-family support

\[ \] Medical home

\[ \]Insurance/financing

\[ \] Newborn genetic screening

\[ \] Newborn hearing screening

\[ \] Integrated systems

\[ \] Healthy and Ready to Work

\[ \] Other
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3\. Is there a strategic planning process underway in your State?

\[ \] Yes \[ \] No

> If yes, is statewide implementation of the 10-Year Action Plan to
> Achieve Community-Based Service Systems for Children and Youth with
> Special Health Care Needs and Their Families part of the strategic
> planning process in your State?\
> \[ \] Yes \[ \] No

If yes, is your grant staff involved in that strategic planning process?

\[ \] Yes \[ \] No

4\. Is any mention of the 10-Year Action Plan to Achieve Community-Based
Service Systems for Children and Youth with Special Health Care Needs
and Their Families part of the budget planning process in your State?

\[ \] Yes \[ \] No

If yes, is your grant staff involved in that budget planning process?

\[ \] Yes \[ \] No

> **APPENDIX F**

**INTRODUCTION ON EVIDENCE BASED PRACTICE**

> The MCHB has developed key strategies that are the broad,
> cross-cutting approaches the Bureau uses in order to reach its
> five-year goals in the Bureau Strategic Plan (2003-2007). Goal 4 of
> the Strategic Plan is, **"Improve the Health Infrastructure and
> Systems of Care".** One key strategy used to support this goal is**,
> "Using the best available evidence, develop and promote guidelines and
> practices that improve services and systems of care**." In support of
> this strategy, the DSCSHN has developed specific review criteria
> requiring approaches/activities that are based on the current best
> evidence for making decisions on how to implement the six core
> outcomes for a system of services for CYSHCN.
>
> **DEFINITIONS**
>
> The definition for Evidence-Based Practice (EBP) for the purpose of
> this Integrated Services Branch/Maternal and Child Health Guidance is
> a combination of definitions used/recommended by the Association of
> Maternal and Child Health (AMCHP) Center for Best Practices and the
> Association of State and Territorial Dental Directors (ASTDD). *Please
> see the websites listed below for the separate definitions mentioned*.
> MCHB has combined the definitions to be more inclusive of the types of
> evidence the Bureau and our National Centers thought was reflective of
> evidence available for the six core outcomes, including "family
> wisdom". This combined definition includes four levels of evidence
> based practices which are:
>
> [Research]{.underline} - The use of scientifically validated
> assessment, interventions, and evaluation procedures, as well as the
> use of critical thinking when making practice decisions that matter to
> service recipients (Roberts & Yeager, 2004) with quantitative and
> qualitative data showing positive outcomes. These interventions have
> been subject to expert/peer review that has determined that a
> particular approach or strategy has a significant level of evidence of
> effectiveness.
>
> [Expert Opinion]{.underline} -- General professional or expert groups'
> opinions, an authoritative or multiple authoritative sources such as
> national family organizations/networks, professional organizations or
> agencies' opinions supporting a practice. Such groups
>
> should include meaningful input from members of the populations for
> which the practice/approach is intended.
>
> [Promising Practices/Field Lessons]{.underline} - Practices that are
> built upon strong philosophies, values, and characteristics of other
> effective public health interventions that appear to have been
> successful, yet do not have the needed evaluation data available to
> document positive outcomes.
>
> [Theoretical Rationale]{.underline} -- Practices may be linked by
> strong causal reasoning to the desired outcome of improving the system
> of services for CYSHCN and their families.
>
> When considering evidence practices one might also consider what has
> been the: (1) impact/effectiveness, (2) efficiency, (3) demonstrated
> sustainability, (4) degree of collaboration/integration, and (5)
> objectives/rationale behind it. ^1^
>
> **MCHB VALUES FOR USING EVIDENCE BASED PRACTICE**
>
> MCHB has established that family and community participation and
> engagement are key to the development of effective, quality health
> systems and services. For all levels of evidence, it is essential to
> delineate the populations for which the evidence has been generated.
> Evidence based practices that are validated for one population may or
> may not be appropriate for others with different cultural, racial,
> ethnic, gender, age or linguistic backgrounds without further
> validation. For example, in 2001, White Bison published a paper titled
> *Developing Culturally-Based Promising Practices for Native American
> Communities* and "points out the very significant difference between
> the framework of
>
> science, "what can be counted is what is observed", and the "Indian
> Way" of valuing the
>
> "unseen world" that can reflect disharmony in the seen world." ^2^
> Therefore, MCHB strongly supports when implementing any recommended
> evidence based practice, members of the populations for which the
> practice is intended, be included in the planning, implementation and
> evaluation of that practice. This approach would embrace families of
> children with special health care needs, youth with special health
> care needs and community representatives, including those of
> culturally and linguistically diverse backgrounds
>
> **SUMMARY OF EVIDENCE BASED PRACTICES FOR THIS GUIDANCE**
>
> Information in this section summarizes evidence based practices for
> cross-cutting strategies required by the Bureau. Specific review
> criteria, based upon these practices can be found in Section V1, page
> 25.
>
> Overall, the evidence base for **cultural and linguistic competence**
> in health care has demonstrated that cultural and linguistic
> competence policies and practices (1) increase access to, and the
> acceptability of, care; (2) improve quality and safety in the
> provision of care; and (3) reduce disparities in the delivery of
> health and mental health care services and outcomes for racially and
> ethnically diverse populations. The evidence also documents the
> consequences to patients and their families when these approaches to
> care are not provided. In summary:

-   Cultural competence policies in health care settings are associated
    with improved quality of care and parents' rating of care/services
    (Lieu, TA, Finkelstein, JA, Lozano, P, Capra, AM, Chi, FW, Jensvold,
    N, Quesenberry, CP & Farber, HJ. "Cultural competence policies and
    other predictors of asthma care quality for Medicaid-insured
    children". *Pediatrics**.*** 2004 Jul;114(1):e102-10.);

-   Culturally specific treatment approaches improve health outcomes and
    may lead to cost savings (La Roche, M. J., Koinis-Mitchell, D.,
    Gualdron, L. (2006, January). A culturally competent asthma
    management intervention: A randomized controlled pilot study. Annals
    of Allergy, Asthma & Immunology, 96(1), 80-85. )

-   Failure to provide appropriate language access is associated with
    significantly increased risk for serious medical events during
    pediatric hospitalization (Loeb, JM, Chang, A & Divi,C.
    *Understanding adverse events in patients with limited English
    proficiency*. Center for Patient Safety Research, Joint Commission
    on Accreditation of Healthcare Organizations. From the *2005
    presentation at AcademyHealth's Annual Research Meeting*, Boston,
    MA. Retrieved March 8, 2006 from
    [www.academyhealth.org/2005](http://www.academyhealth.org/2005/ppt/divi.ppt);
    Cohen, AL, Rivara, F, Marcuse, EK, McPhillips, H & Davis, R. "Are
    language barriers associated with serious medical events in
    hospitalized pediatric patients?" *Pediatrics* 2005 116(3) 575-9.);
    and cultural brokers can enhance care and health outcomes. ( *A
    Summary of the National Community Health Advisory Study: Weaving the
    Future,* 1998, reprinted 2000. Tucson, AZ: University of Arizona.)
    ^3^

> The following are reports citing evidence based practices that improve
> the effectiveness of **family-centered care in** programs. A
> multi-site evaluation of the efficacy of parent-to-parent support
> found that one-to-one support increased parents' confidence and
> problem-solving capacity. Interviewees noted that this type of support
> could not be supported through any other means. (Singer GHS, Marquis
> J, Powers LK, et al. A multi-site evaluation of parent to parent
> programs for parents of children with disabilities. *J Early
> Intervent.* 1999; 22:217-229\[ISI\]; Ainbinder JG, Blanchard LW,
> Singer GH, et al. A qualitative study of parent to parent support for
> parents of children with special needs. Consortium to evaluate Parent
> to Parent*. J Pediatr Psychol.* 1998; 23:99-109\[Abstract\].^4^ This
> family-to-family support can also have beneficial effects on the
> mental health status of mothers of children with chronic illness.
> (Ireys H, Chernoff R, DeVet KA, Kim Y. Maternal outcomes of a
> randomized controlled trial of a community-based support program for
> families of children with chronic illness. *Arch Pediatr Adolesc Med.*
> 2001; 155:771-777\[Abstract/Free Full Text\]^4^ Promising practices
> have indicated that families/children/youth need: 1) connections to
> other families/peers; 2) connections to sources of support and
> information from family/youth organizations, to help in navigating
> service systems; and 3) training to learn how to partner with
> professionals, advocate for their needs. In addition, families and
> youth with special health care needs have critical roles to play at
> the program and policy level: 1) in providing feedback on care; 2) in
> training/hiring/evaluating providers; 3) in designing facilities; 4)
> in ongoing advisory roles with providers such as Title V Programs,
> Medicaid and other public financing programs, private health plans,
> pediatric practices, hospitals, etc.; and 5) in measuring and assuring
> quality, in all aspects of research and documentation about care and
> systems. ^5^
>
> When working to effect **systems change** toward **integrated
> community based services,** two key constructs are prevalent in the
> evidence based literature. They are Participatory Action Research
> (PAR) and Continuous Quality Improvement (CQI). According to Reason
> and Bradbury (2001), PAR is a collective stakeholder effort that uses
> research methods in an ongoing process to affect systems change and/
> or acquire new knowledge in a manner that ensures that the process and
> the product represent the collective knowledge of the different
> stakeholders. In other words, PAR ensures that all key stakeholders
> are involved in the planning, implementation, and evaluation of all
> activities to ensure meaningful outcomes (Roberts & Magrab, 1999). CQI
> is one of several models of inquiry and systems change that allows a
> PAR process to move forward by collectively: 1) identifying the
> problem or issue to be addressed; 2) developing an evolving plan to
> gather information and apply that information to the questions or
> issues at hand; 3) implement the plan with the active participation of
> the collective team; and 4) examine the results in order to understand
> them and determine what needs to happen next. CQI is used extensively
> in the private sector to ensure high levels of customer satisfaction
> and system efficiency (Berry, 1999; Covey, 1990; Okes & Westcott,
> 2001), and it is now gaining recognition in the public sector through
> endeavors such as the Malcolm Baldrige National Quality Award and
> American Customer Satisfaction Index
> ([www.theacsi.org](http://www.theacsi.org/)). ^6^
>
> ^1^ AMCHP Center for Best Practices:
> [www.amchp.org/policy/bestpractice-definition.htm](http://www.amchp.org/policy/bestpractice-definition.htm),
>
> July 18, 2006.) and Association of State and Territorial Dental
> Directors Best Practices Committee:
> <http://www.astdd.org/docs/BPA2attachmentAevidence.pdf>
>
> ^2.^ Cruz, C. B.S., CPM, CPS , Spence J, Ph.D. and workgroup. Oregon
> Tribal Evidence- based and Cultural Practices, 2005.
> [www.oregon.gov/DHS/mentalhealth/tribal-ebp-report.pdf](http://www.oregon.gov/DHS/mentalhealth/tribal-ebp-report.pdf)
>
> ^3.^ Complied by Suzanne Bronhein, Ph.D., National Center for Cultural
> Competence, Georgetown University Center for Child and Human
> Development:
>
> [www.georgetown.edu/research/gucdc/nccc](http://www.georgetown.edu/research/gucdc/nccc)
>
> ^4.^ Policy Statement. Family-Centered Care and the Pediatrician's
> Role, Committee on Hospital Care, Pediatrics Vol. 112 No. 3 September
> 2003, pp. 691-696.
>
> ^5^ Wells N. *Learning to* *be a Parent Advocate for a Child with
> Special Needs***.** In [Optimizing Care for Children with Special
> Health Care Needs in their Early Years.]{.underline} Sobo E, Dennis K,
> Kurtin P, (eds.) Baltimore: Brookes Publishing Co, 2007.
>
> Families Partnering with Providers, Tips to Help Families Build
> Effective Partnerships with their Child's Health Care Providers,
> Family Voices, Albuquerque, New Mexico.
>
> Wells, N., Anderson, B. 2005. Families in Program and Policy FiPPs
> CSHCN Report, Interviews on Family Participation with State Title V
> Maternal and Child Health Programs, Family Voices, Albuquerque, New
> Mexico.
>
> Compiled by Nora Wells, National center for Family/Professional
> Partnerships, Family Voices, Inc.:
>
> [www.familyvoices.org](http://www.familyvoices.org/)
>
> ^6.^ Compiled by Diane Behl, Richard Roberts, Ph.D., Sydney Davis,
> National Center: Champions for Inclusive Communities, Utah State
> University:
>
> http://www.championsinc.org/