# OMB Approval No. 0985-0018

> Expiration 3/31/2007

######## 

######## Empowering Older People 

######## To Take More Control of their Health

######## Through Evidence-Based Prevention Programs 

######## A Public/Private Collaboration 

# Program Announcement and Grant Application Instructions

# 

# U.S. Administration on Aging

***FY 2006***

**Department of Health and Human Services (HHS)**

**Administration on Aging (AoA)**

**AoA Center for Planning and Policy Development**

######## Funding Opportunity Title: Empowering Older People to Take More Control of Their Health Through Evidence-Based Prevention Programs: A Public/Private Collaboration 

**Announcement Type:** Initial

**Funding Opportunity Number:** HHS-2006-AoA-BP-0611

**Catalog of Federal Domestic Assistance (CFDA) Number:** 93.048

**Key Dates:** The deadline date for submission of applications is
August 31, 2006.

The deadline date for submission of a letter of intent is July 15, 2006.

I.  **FUNDING OPPORTUNITY DESCRIPTION**

> **[Statutory Authority]{.underline}**
>
> The statutory authority for grants under this program announcement is
> contained in Title IV of the Older Americans Act (OAA) (42 U.S.C.
> 3032), as amended by the Older Americans Act Amendments of 2000, P.L.
> 106-501 (Catalog of Federal Domestic Assistance 93.048, Title IV
> Discretionary Projects).
>
> **Summary**
>
> The Administration on Aging (AoA) will award competitive grants in the
> form of cooperative agreements to states, as part of a public/private
> collaboration with the Atlantic Philanthropies, to empower older
> people to take more control over their own health through lifestyle
> changes that have proven effective in reducing the risk of disease and
> disability among the elderly. This collaboration advances President
> Bush's Healthier US Initiative and Department of Health and Human
> Service (HHS) Secretary Leavitt's Priority on Personalize Health Care.
> It also supports and complements the new emphasis on prevention and
> chronic disease management in Medicare. These grants are designed to
> mobilize the aging, public health and non-profit networks at the State
> and local level to accelerate the translation of HHS funded research
> into practice through the deployment of low-cost evidence-based
> disease and disability prevention programs at the community level.
> This initiative holds great potential for improving the quality of
> life of our seniors and reducing the cost of health care over the long
> run.
>
> **Background**

Older Americans are disproportionately affected by chronic diseases and
conditions, such as arthritis, diabetes and heart disease, as well as by
disabilities that result from injuries such as falls. These conditions
collectively account for seven out of every ten deaths, and more than
three-quarters of all health expenditures in the United States. Chronic
disease not only kills, but it also negatively affects quality of life,
and threatens the ability of older people to remain in their own homes
and communities. Chronic conditions currently limit activities for 12
million elderly individuals living in community settings; 25 percent of
these individuals are unable to perform basic activities of daily
living, such as bathing, shopping, dressing, or eating. The number of
older people living in our society with chronic conditions will increase
dramatically in the coming years with the aging of the baby boom
generation.

> HHS has made significant investments in research over the past decades
> to improve our understanding of chronic diseases and conditions, and
> to identify approaches to reducing the incidence and affects of such
> conditions. As a result of these investments, there is now a growing
> body of scientific evidence on the efficacy of low-cost programs that
> have proven effective in reducing older people's risk of disease,
> disability and injury. Many of these programs focus on helping older
> people to make life style and behavioral changes, and can be
> cost-effectively delivered at the local level through community-based
> service organizations, such as senior centers, adult day care
> programs, senior housing projects and faith-based organizations. One
> example is the Chronic Disease Self-Management Program developed at
> Stanford University with support from the Agency for Healthcare
> Research and Quality. This program is a six week workshop designed to
> empower people with various chronic diseases to take control of their
> health. The program has been shown to significantly improve
> participant health status while reducing the use of hospital care and
> physician services. A second example is the Matter of Balance Program,
> a fall prevention program, developed at Boston College with support
> from the National Institute on Aging. This program trains participants
> to improve their balance, gait and posture, to better manage their
> medication, and to remove home hazards. A RAND analysis of the
> evidence found that these types of programs, in combination with
> clinical assessments and appropriate medical intervention,
> significantly reduce the incidence of falls among participants and
> could in turn reduce emergency room use and hospitalizations related
> to falls. A final example is the Enhance Fitness Program developed
> with support from the Centers for Disease Control and Prevention. This
> program has been shown to help near-frail older adults to improve
> their health status and reduce their use of health care through
> structured group exercises that involve stretching, low impact
> aerobics, and strength training.
>
> In 2003, the Department of Health and Human Services, under the
> leadership of the Administration on Aging, launched a multi-year grant
> program involving the Centers for Disease Control and Prevention, the
> Agency for Healthcare Research and Quality, the National Institute on
> Aging, the Centers for Medicare and Medicaid Services, the Substance
> Abuse and Mental Health Services Administration, the John A. Hartford
> and Robert Wood Johnson Foundations, and a variety of other private
> foundations, to begin promoting the deployment of evidence-based
> disease and disability prevention programs through community-based
> aging services provider organizations.
>
> The goal of the 2003 initiative was to develop the knowledge,
> experience and national infrastructure necessary to support the
> nationwide implementation of such programs, and to effectuate AoA's
> role in working with the HHS science and health agencies to facilitate
> the rapid translation of research findings into practice at the
> community-level. Over \$6 million in grants were made to encourage
> partnerships at the State and community level between the aging and
> public health networks; implement 12 local evidence-based projects;
> establish a national technical assistance center; and conduct a
> special series of workshops targeted at State and community leaders
> from around the country. The goal of this initiative has largely been
> realized, and HHS now stands ready to take the initiative to a new
> level. More information on the projects funded in 2003 is available
> at: <http://www.aoa.gov/prof/evidence/evidence.asp>
>
> **Current Announcement**
>
> HHS, through AoA, will award competitive grants to States to gain
> experience in how States can play a leadership role in mobilizing
> public/private partnerships at the State and community level to
> implement and sustain the delivery of evidence-based prevention
> programs at the community level though non-profit aging services
> provider organizations. Participating States will be expected to begin
> implementing programs in at least 3 geographic areas of their States.
> Participating States will also be expected to begin developing the
> infrastructure and partnerships that will be necessary over the
> long-run to effectively embed evidence-based prevention programs for
> the elderly within their statewide systems of health and long-term
> care.
>
> A special feature of this current program initiative is that HHS is
> being joined by The Atlantic Philanthropies to greatly expand the
> scope and reach of the current grant opportunity, with particular
> emphasis on the deployment of the Stanford University Chronic Disease
> Self-Management Program (CDSMP). Through a grant to the Center for
> Healthy Aging at the National Council on the Aging, The Atlantic
> Philanthropies has generously agreed to provide funds and technical
> assistance to up to five grantees that show significant potential in
> developing State systems that will be able to reach large numbers of
> older adults with the CDSMP. The Center for Healthy Aging at NCOA,
> which is also serving as AoA's national resource center on
> evidence-based prevention, will select, on behalf of The Atlantic
> Philanthropies, the State programs to receive the awards during the
> latter half of the first year of the AoA grants. A separate
> application and selection process will be used for these awards. The
> total investment over the life of the project for this entire effort
> by HHS, the participating grantees, and The Atlantic Philanthropies
> will exceed twenty million dollars.
>
> **Overview**
>
> The current grant opportunity is designed to help States establish
> public/private partnerships as well as the statewide systems that will
> be necessary to support the on-going implementation of evidence-based
> programs that have proven effective at empowering older people to take
> more control of their health and reduce their risk of disease and
> disability. These partnerships will involve multiple agencies and
> organizations at both the State and community level. Specifically, AoA
> is looking to agencies on aging and State health departments to
> collaborate on the provision of policy leadership and on-going support
> for local partnerships involving non-profit aging services providers,
> area agencies on aging, health organizations, the business sector, and
> other potential partners from the private and public sectors. Within
> the first project year, States will implement community-level
> partnerships and programs in at least three geographic areas.
>
> A major expectation of this grant program is to deliver high quality
> evidence-based programs that maintain fidelity to both the original
> design and to the research outcomes associated with the evidence-based
> models that are being deployed [and]{.underline} to reach the maximum
> number of older adults that are at risk who can benefit from the
> programs. This expectation reflects both the design and implementation
> of efficient and well-managed programs, [and]{.underline} the need to
> find and commit funds from other public and private sources to these
> programs (as has occurred at the national level). Proposals that
> reflect success in locating and coordinating available public and
> private sector resources [above the match requirement]{.underline} to
> expand the reach and sustainability of this program will receive more
> favorable consideration.
>
> Based on AoA's experience with our current evidence-based programs,
> advice from our federal and national partners, and our estimates of
> the benefits for older adults, AoA will place an emphasis on improving
> the availability of the Stanford University Chronic Disease
> Self-Management Program. Therefore, applications under this
> announcement must propose to implement the CDSMP model in at least one
> geographic area. States may also implement the CDSMP in the other
> geographic areas it selects for its local projects, or it may
> implement one or more other evidence-based programs in the following
> subject areas:

-   Chronic Disease Self-Care

-   Physical Activity

-   Fall Prevention

-   Nutrition and Diet

```{=html}
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-   Depression and/or Substance Abuse

> More information on the specific types of programs that the State may
> opt to implement under this announcement is provided below.
>
> **Community-Based Aging Services Provider Organizations**
>
> Community-based aging services provider organizations, working with
> health organizations and other partners, are uniquely positioned to
> promote the availability and utilization of evidence-based disability
> and disease prevention programs for older people. These organizations
> are well respected, offer low-cost services, and already successfully
> serve large numbers of community-dwelling older adults. It is
> estimated that there are over 29,000 such organizations around the
> country serving over 8 million older adults each year.
>
> Aging services providers are particularly suited to reach the
> underserved elderly who often need such programs the most. Many of the
> older adults served by these organizations have limited incomes, live
> alone, belong to minority groups, have functional limitations, or are
> disadvantaged in other ways that put them at elevated risk of disease
> or disability that can be addressed through prevention programs.
>
> Aging services provider organizations that implement or oversee
> implementation of evidence-based programs through this grant must be
> non-profit community-based service provider organizations, including
> faith-based organizations and Tribal organizations, which primarily
> provide home and community-based social services to older persons and
> are funded, at least in part, through the Older Americans Act.
> However, aging services provider organizations that receive funds
> under this program are encouraged to use funds and staff resources
> (such as trainers, class instructors, and specialized staff) to
> provide services at sites that they do not directly operate or are
> outside of their usual service locations \-- such as HUD housing,
> churches, community centers, and community health centers.
>
> When community programs under this announcement are developed in an
> area served by an Aging and Disability Resource Center (ADRC), it is
> important that appropriate linkages be in place to optimize the
> service coordination, client referral, and support capacities of the
> ADRC. The reduction of risk factors for disease and disability in
> older adults is the core objective of the Evidence-Based Disease and
> Disability Prevention Program and that objective complements directly
> the work of the ADRC.

######## 

######## II. AWARD INFORMATION 

> [Size of Awards, Match and Allocation of Funds to Service
> Providers]{.underline}: AoA plans to fund up to12 cooperative
> agreements totaling up to \$300,000 per project for each year for a
> three year period, subject to the availability of funds. A 25% match
> will be required. Not less than 75% of the federal funds from this
> grant must be allocated to community-based aging services provider
> organizations to support the delivery of the evidence-based
> programming to older adults. States may allocate funds under this
> announcement either directly to participating aging services providers
> or indirectly through an area agency on aging. States are encouraged
> to expand the scope of the programs proposed under this grant
> announcement [beyond the required match]{.underline} with funds from
> various sources including (but not limited to) foundation grants,
> private corporations, or other federal funds such as the Centers for
> Disease Control and Prevention (CDC), the Substance Abuse and Mental
> Services Health Administration (SAMSHA) or Titles III-B, III-C, III-D,
> III-E of the Older Americans Act. However, States should
> **[not]{.underline}** propose to receive [federal funds that are
> available under this grant announcement (i.e. Title IV OAA
> funds)]{.underline} that exceed the \$300,000 limit per year indicated
> in this paragraph. Applicants that request more than \$300,000 in
> [federal funds that are available under this grant
> announcement]{.underline} per year will not be considered for funding.
>
> All funds under this grant announcement will be awarded by September
> 30, 2006.
>
> **[Subject Areas]{.underline}:** **Grant applications must propose to
> implement the Stanford University Chronic Disease Self-Management
> Program (CDSMP) self-care model in at least one geographic area**.
> States must propose [at least]{.underline} two more geographic areas
> for implementation of an evidence-based program. Those two other
> geographic areas may also implement the CDSMP or one or two other
> evidence-based programs. The programs selected by the State must fall
> into one or more of the following subject areas:

-   Chronic Disease Self-Care (i.e., chronic diseases generally or
    specific ones such as

> diabetes, hypertension, heart disease, arthritis, etc.)

-   Physical Activity (see [Cress ME et al. (2004).  \"Physical Activity
    Programs and
    Behavior](http://hmcrc.srph.tamhsc.edu/Literature/PhysicalActivity/PABehaviorCounseling.pdf)

> [Counseling in Older Adult Populations,\" Medicine & Science in Sports
> & Exercise, 36(11):
> 1997-2003.](http://hmcrc.srph.tamhsc.edu/Literature/PhysicalActivity/PABehaviorCounseling.pdf))

-   Fall Prevention (refer to Fall Interventions List)

-   Nutrition and Diet (including the role of nutrition in the
    maintenance of healthy and

> appropriate body weight and control of chronic diseases, etc.)

-   Mental Health and/or Substance Abuse Prevention (including early
    intervention for depression, anxiety, alcohol misuse or medication
    misuse

> While recognizing that some intervention programs may contain elements
> of more than one of the above subject areas, applicants must designate
> which of the subject areas is the **primary focus** for the
> demonstration program in each of the three geographic areas. The
> "subject area" relates both to the nature of the intervention and to
> the outcomes. For example, an exercise program may reduce depression
> but for this program announcement, an exercise program is in the
> "physical activity" subject area, not the "depression" subject area.
>
> These programs may build on existing health promotion or disease
> prevention programs designed for a general older adult population.
> However, the programs proposed for funding under this program
> announcement [must be selective preventive interventions]{.underline}
> targeted to individuals at risk. The interventions must go
> substantially beyond providing older adults with the results of a
> health risk assessment coupled with written advice, a referral and/or
> a single counseling session, and the risk factor must be more than
> just age. A program should not be proposed if it is basically an
> outreach or information campaign.
>
> For purposes of this grant program, the term "evidence-based disease
> prevention" program refers to a program that closely replicates a
> specific intervention that has been tested through randomly controlled
> experiments with results published in peer-reviewed journals. Sources
> of evidence include HHS sponsored research funded by the National
> Institutes of Health (including National Institute on Aging), the
> Centers for Disease Control and Prevention (CDC) (including work in
> the Prevention Research Centers' Healthy Aging Research Network),
> Agency for Health Care Research and Quality (AHRQ), the Centers for
> Medicaid and Medicare Services (CMS) and the Substance Abuse Mental
> Health Services Administration (SAMHSA). Studies performed by
> universities or other research organizations are also acceptable.
> Additional important criteria include the program's effectiveness with
> older adults and whether it can be adapted to various community
> settings. A summary review of the principles of evidence-based
> programs and the theoretical structure on which AoA and its partners
> are basing this grant opportunity can be found at: "Evidence-Based
> Issue Brief - No. 1, Revised Spring, 2006, Using the Evidence Base to
> Promote Healthy Aging" at
> [www.healthyagingprograms.org](../www.healthyagingprograms.org) .
>
> Based on the principles described in the above document, States should
> use the following criteria in selecting intervention programs:

-   The proposed intervention is based upon rigorously conducted
    research (a randomized controlled trial) with results published in a
    peer-reviewed journal.

-   The proposed intervention has been developed and tested on older
    adults or a rationale must be presented for why the intervention is
    likely to work with older adults.

-   The proposed intervention is replicable in a community-based setting
    (i.e. in a non-medical setting).

> In addition to selecting specific evidence-based programs, States must
> also ensure that the following steps/processes are addressed in the
> proposal:

-   Lead organizations at the community level have the organizational
    capacity and commitment necessary to mobilize public/private
    partnerships and implement an evidence-based prevention program.

-   Local programs will be able to reach and retain older adults who are
    at high risk of the specific diseases or disabilities that are the
    focus of the selected intervention.

-   Strong partnerships are formed with appropriate public and private
    organizations from aging, public health, health care and other
    sectors.

-   Programs are implemented with fidelity to both the original design
    and research outcomes associated with the selected evidence-based
    program with as few adaptations as necessary to address local
    conditions and the unique needs of the target population. Any
    adaptations that are made must not compromise the effectiveness of
    the original evidence-based program.

-   Information and monitoring systems are provided in order to monitor
    on-going fidelity to the original evidence-based design and research
    outcomes, and to conduct routine formative evaluations, including
    measuring participant/client satisfaction, to enable the program to
    be continually improved, and to provide accountability.

> States can learn more about these steps at
> [www.healthyagingprograms.org](http://www.healthyagingprograms.org/)
> and also at [www.re-aim.org](http://www.re-aim.org/).

[Specific Programs Suitable for Implementation Under This Grant
Announcement]{.underline}

> There are a number of specific programs that AoA and its partners have
> identified that meet our criteria of being evidence-based and are
> suitable for the specific populations addressed in this announcement.
> These programs can be directly implemented through community-based
> aging services provider organizations working in collaboration with
> health organizations and other potential partners. There may be other
> programs that are excellent that are not listed here.
>
> The following programs all have training materials, tool kits and/or
> manuals readily available and have been successfully replicated by the
> aging network.

-   Stanford University Chronic Disease Self-Management Program

> [www.]{.underline}[patienteducation.stanford.edu/programs/cdsmp.html](http://patienteducation.stanford.edu/programs/cdsmp.html)
>
> [www.healthyagingprograms.org/content.asp?sectionid=32&ElementID=38](http://www.healthyagingprograms.org/content.asp?sectionid=32&ElementID=38)
>
> [www.healthyagingprograms.org/content.asp?sectionid=32&ElementID=41](http://www.healthyagingprograms.org/content.asp?sectionid=32&ElementID=41)

-   Enhance Wellnes*s*

> [www.projectenhance.org/pro/wellness.html](http://www.projectenhance.org/pro/wellness.html)

-   Active Choices

> [hprc.stanford.edu/pages/store/itemDetail.asp?118](http://hprc.stanford.edu/pages/store/itemDetail.asp?118)
>
> [www.activeforlife.info](http://www.activeforlife.info/)

-   Enhance Fitness

> [www.projectenhance.org/pro/fitness.html](http://www.projectenhance.org/pro/fitness.html)
>
> [www.healthyagingprograms.org/content.asp?sectionid=32&ElementID=41](http://www.healthyagingprograms.org/content.asp?sectionid=32&ElementID=41)
>
> [www.healthyagingprograms.org/content.asp?sectionid=32&ElementID=127](http://www.healthyagingprograms.org/content.asp?sectionid=32&ElementID=127)

-   Matter of Balance

> [www.mainehealth.org/mh_body.cfm?id=432](http://www.mainehealth.org/mh_body.cfm?id=432)
>
> [www.bu.edu/hdr/products/balance/index.html](http://www.bu.edu/hdr/products/balance/index.html)
>
> [www.healthyagingprograms.org/content.asp?sectionid=32&ElementID=86](http://www.healthyagingprograms.org/content.asp?sectionid=32&ElementID=86)

-   Strong for Life

> [www.bu.edu/hdr/products/stronglife/index.html](http://www.bu.edu/hdr/products/stronglife/index.html)
>
> [www.bu.edu/sargent/about/inside_sargent/2002/roybal.html](http://www.bu.edu/sargent/about/inside_sargent/2002/roybal.html)

-   Healthy IDEAS or PEARLS

> Healthy IDEAS:
>
> [www.shelteringarms.org/index.cfm/CFID/28004092/CFTOKEN/96693372/MenuItemID/278.htm](http://www.shelteringarms.org/index.cfm/CFID/28004092/CFTOKEN/96693372/MenuItemID/278.htm)
>
> [www.healthyagingprograms.org/content.asp?sectionid=32&ElementID=40](http://www.healthyagingprograms.org/content.asp?sectionid=32&ElementID=40)

PEARLS

> [[www.cdc.gov/prc/interventions/effective/pearls.htm]{.underline}](http://www.cdc.gov/prc/interventions/effective/pearls.htm)
>
> [[www.ci.seattle.wa.us/humanservices/aging/Staff-Peers/Pearls.htm]{.underline}](http://www.ci.seattle.wa.us/humanservices/aging/Staff-Peers/Pearls.htm)

-   Prevention & Management of Alcohol Problems in Older Adults: A Brief
    Intervention

> [www.healthyagingprograms.org/content.asp?sectionid=71&ElementID=338](http://www.healthyagingprograms.org/content.asp?sectionid=71&ElementID=338)
>
> [preventionpathways.samhsa.gov//res_videos.htm](http://preventionpathways.samhsa.gov//res_videos.htm)
> (see third video on page)
>
> Additional programs that meet AoA's criteria for evidence-based
> prevention are described in Issue Brief 1 updated at
> [www.healthyagingprograms.org](http://www.healthyagingprograms.org/).
> These include evidence-based Nutrition programs, Self-Care, Medication
> Management, and additional Fall Prevention and Physical Activity
> Programs.
>
> Because AoA is very familiar with the programs referenced in this
> section, proposals to use these programs essentially unchanged do not
> need to describe the programs in depth. However, any planned or
> anticipated modifications to these programs should be described in
> detail in the proposal.
>
> **[Requirements for Proposed Intervention Programs Not Identified
> Above]{.underline}**
>
> States may propose to implement programs not referenced above,
> provided the proposed program meets the definition of an
> evidence-based disease and disability prevention program described in
> this announcement. For each such proposed program, applications must
> include the following details:

-   Describe the health issue you are targeting and provide data that
    support the importance of the issue.

-   Describe the intervention research that was used to develop this
    program. List a) articles in peer reviewed journals; b) other
    published materials; and c) unpublished results.

-   Describe materials and training manuals that are available to
    support program replication. Provide a Web site or contact
    information to obtain these materials and other assistance.

-   Describe the number and types of places that have replicated this
    program.

-   Describe the diversity of participants (age, gender, ethnicity,
    functional status) that have used this program.

-   Describe the resources required to replicate the program and the
    ongoing per participant costs of the program.

> In addition to the specific evidence-based prevention programs and
> resources that we have listed, there are many other valuable sources
> of information, such as scientific journals and Web sites that you may
> want to consider in designing your program and in preparing your
> application. Some descriptions of research and other helpful
> information, such as evaluation procedures and potential partners, can
> be obtained from the following agency Web sites:

-   **The National Institute on Aging (NIA)**

> <http://www.nia.nih.gov/>

-   **NIH Office of Behavioral and Social Science Research (OBSSR)**

> <http://www1.od.nih.gov/behaviorchange/index.htm>

-   **NIH CRISP Database**

> <http://crisp.cit.nih.gov/>

-   **The Centers for Disease Control and Prevention (CDC)**

<http://www.cdc.gov/aging>

http://www.cdc.gov/ncipc/factsheets/falls.htm

-   **The Agency for Health Research and Quality (AHRQ)**

<http://www.ahcpr.gov/clinic/epcquick.htm>

-   **The Centers for Medicare and Medicaid Services (CMS)**

> http://www.cms.hhs.gov/PrevntionGenInfo/01_overview.asp

-   **The Community Guide at CDC**

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

-   **U.S. Preventive Services Task Force**

> [www.preventiveservices.ahrq.gov](outbind://7-00000000F2ABB5B6D49DED4197722338DB8A223A0700B7C0A3811F83D3118AD000A0C9E47941000002D46BD70000B7C0A3811F83D3118AD000A0C9E47941000002D46C8B0000/www.preventiveservices.ahrq.gov)/
>
> Applicants should not limit themselves to these Web sites since there
> is a great deal of information published and available in other places
> that may be useful and appropriate.
>
> **[Clinical Preventive Services:]{.underline}** Clinical preventive
> services, such as flu shots and health screening programs, are a very
> important part of maintaining the health of older adults. However, the
> projects under this grant program are not intended to fund clinical
> preventive services; these services are paid for by Medicare,
> Medicaid, health plans, and in some cases privately. However, the
> projects funded under this grant program should identify opportunities
> to coordinate with health care systems, providers, and older adults,
> to encourage, coordinate, complement, and optimize the use of Clinical
> Preventive Services. AoA is actively partnering with CMS and working
> with the National Aging Services Network to ensure that Medicare
> Beneficiaries know about and receive the clinical preventive services
> that are now available under Medicare.
>
> **[Geographic Areas:]{.underline} As noted above, States will be
> required to implement projects in at least 3 geographic areas.** In
> general, a \"geographic area" or "site"\" will be a Planning and
> Services Area (PSA), as defined in the Older Americans Act. However,
> States may propose different types of boundaries and geographic
> configurations. For example:

-   States with a single PSA may select three or more counties to serve
    as their designated geographic areas.

-   States with many PSAs with small populations may combine several
    PSAs into \"one geographic area\" to be one of the three (or more)
    proposed areas.

-   Where a PSA is nested in a surrounding PSA (or set of suburban
    PSAs), the State may combine the PSAs as a single geographic area
    (implementation site).  All of the AAAs in a designated geographic
    area must be included in the partnership related to services in a
    geographic service area.

> **[Target Population:]{.underline}** The target population is
> community dwelling persons age 60 or older. However, other community
> dwelling persons with disabilities or chronic diseases may participate
> in these intervention programs. When possible, funds from other public
> or private sources should be applied to offset the cost of
> participants under age 60.
>
> Applicants must describe their target population(s) in terms of:

-   Socio-demographic characteristics, including racial/ethnic minority
    composition.

-   Population size and geographic distribution.

-   Number to be served by the program.

-   Estimated extent of unmet need.

-   Risk factors for this age group or the disease or disability that
    will be addressed by the program.

> **[Partnerships]{.underline}**: At the State level, AoA is requiring
> that there be a full partnership between the State Aging and the State
> Health Departments in the implementation of these projects. It is
> desirable (but optional) to include the State Medicaid Agency as a
> partner. States may identify and include other public or private State
> level organizations that can play a constructive role in building
> evidence-based prevention service systems that benefit older adults.
> The State partnership must explicitly include (designate) an internal
> agency or external partner (such as an academic organization) that
> will assist, monitor, assure, and report on the extent to which the
> evidence-based disease prevention models on which this program is
> based are implemented with [fidelity]{.underline} to the models
> selected for implementation. In addition, **a letter of support from
> the Governor's office** is required that indicates support of the
> project, names the lead agency, and indicates support for a strong
> partnership effort between the State Health Department and the State
> Agency on Aging.
>
> The partnerships required at the community level include certain key
> community organizations. They must be full partners in the design,
> implementation, and evaluation of the program. Community partners
> include at a minimum:

1.  A [community-based aging services provider organization]{.underline}
    to deliver the evidence-based program, to coordinate older adults'
    access to the program, and to coordinate services from other
    providers such as health care providers. For purposes of this grant
    program, an aging services provider organization must currently be
    operating a program that primarily serves older adults and is funded
    (at least in part) through the Older Americans Act. A Native
    American Tribal Organization funded under Title VI of the Older
    Americans Act can be included as an aging services provider under
    this grant announcement.

> 2\. An [AAA]{.underline} to help insure that the program is linked to
> appropriate organizations in the Aging Services Network including
> other public and private community partners, and to help promote the
> adoption, expansion, and sustainability of successful community
> programs.
>
> NOTE: A State grantee under this grants program may provide the funds
> to the aging services provider organizations through AAAs, or may
> provide the funds directly to the aging services provider
> organizations. However, not less than 75% of the [federal]{.underline}
> funds received under this grant must be allocated to the aging
> services provider organizations to support the delivery of the
> evidence-based programs to older adults.
>
> **EXCEPTIONS TO THE AAA PARTNER REQUIREMENT:** If the potential local
> partner is a Native American Tribal Organization, the organization
> may, but is not required to, coordinate with an Area Agency on Aging.
> However, if no AAA is included, the narrative must address how the
> activities described above for the AAA will otherwise be executed.
>
> If the applicant is a Single Planning and Service Area State, the
> narrative must also address how the role of the State Agency on Aging
> will include the AAA role.
>
> 3\. A [health care provider organization]{.underline}, such as a
> health plan or health department, to assure the quality and
> appropriateness of the program's health components and to enhance and
> promote coordination between the social service aging network and the
> health care service system in providing comprehensive service.

**No organization may fulfill more than one of the three required
partnership roles noted above.**

Additional State level or sub-State partners may include:

-   A [research organization]{.underline}, such as an institution of
    higher learning, to assist with translating the evidence-based model
    into a program, maintaining fidelity to the evidence-based
    intervention, and assisting in the training, evaluation, cost
    assessment, and other technical aspects of the program.

-   [A Local Health Department]{.underline} which, in addition to
    serving as the health partner, may have the capacity to perform the
    roles described for the "Research Organization," or assist in the
    implementation of services.

-   An [Aging and Disability Resource Center]{.underline} (ADRC) which
    can help clients access the disease and disability prevention
    programs and help clients address current or future long term care
    issues. ADRCs are not available in all places, but as they are
    established, they should become partners in evidence-based disease
    and disability prevention programs

-   Other community organizations that may assist in meeting program
    goals including, but not limited to: local foundations, charitable
    organizations, professional associations, USDA Extension Service
    programs, community organizations not currently receiving Older
    Americans Act funds, mental health agencies, and many others.

> [Technical Assistance for Grantees]{.underline}: AoA has funded a
> National Resource Center for Evidence-Based Prevention Programs to
> assist us, our partners, program organizers, and others in developing
> evidence-based prevention programs. In addition, AHRQ and other
> national partners are planning substantial training efforts to
> strengthen the capacity of both public and private sector
> organizations to accelerate the development and implementation of
> evidence-based prevention programs for older adults. The Aging
> Services Network and the health and public health networks will be the
> focus of these training and technical assistance efforts.
>
> **[Cooperative Agreements]{.underline}** These new grants will be
> issued as cooperative agreements because AoA anticipates having
> substantial involvement with the recipients during the performance of
> funded activities. This involvement may include collaboration,
> participation, or intervention in the funded activities. AoA will also
> be involved in developing and implementing the funded projects by
> conducting application reviews and providing technical assistance,
> training, guidance, and oversight throughout the three-year project
> period. This will include training and contact with the State agency,
> Area Agency on Aging, and the aging services provider organizations
> that receive and administer service funds through the grant, and other
> partners that are participating substantially in developing the
> Evidence-Based Disease Prevention (EBDP) program. Grantees will be
> expected to maintain regular contact with their Federal project
> officer and to cooperate with the AoA Resource Center that will be
> providing technical assistance. Grantees will also be expected to
> share with AoA all significant products from their projects.
>
> **[Award Size:]{.underline}** AoA plans to fund up to 12 grants
> totaling up to \$300,000 per project for each year for a three year
> period. Grantees are required to make a non-financial or cash
> recipient contribution (match) of at least twenty five percent (25%)
> of the total grant award.

A key consideration is that the size of the award correlates with the
significance of the proposed projects, rather than with the size of the
State. Significance will be measured in terms of the breadth of the
program (i.e., the potential number of people affected and the degree of
enduring change in the system).

AoA reserves the right to offer a funding level that differs from the
requested amount and to negotiate with the applicant regarding the scope
and intensity of effort that would be appropriate and commensurate with
the final funding level. AoA also reserves the right to select
alternates from the pool of applicants, and to defer funding of some
proposals to future fiscal years.

> **[Private Pay Clients]{.underline}** States may propose to serve
> private pay clients or use client cost sharing consistent with State
> policy under this initiative. The discretionary funds being used for
> this initiative are authorized under Title IV of the Older Americans
> Act, and are therefore, not subject to the restrictions on serving
> private pay clients or on cost sharing arrangements that apply to
> Title III of Act.
>
> **[Use of Funds]{.underline}:** These grant awards will provide funds
> to develop, implement, and sustain high quality evidence-based
> prevention programs and systems. Applicants must demonstrate that the
> grant: (a) establishes new capacity or significantly enhances existing
> capabilities; (b) does not duplicate existing work or supplant
> existing funding; and (c) devotes all funding under the new proposal
> to activities that advance the goal and vision of the program.

**III. ELIGIBILITY INFORMATION**

> **1. Eligible Applicants**
>
> State Aging Agencies and State Health Departments may apply for these
> grants. Only one application may be submitted by a State. Whichever
> State agency applies, the proposal must reflect the full commitment
> and cooperation of the other State agency. This should be reflected in
> a formal and detailed cooperative agreement or memorandum of
> understanding attached to the application. The whole proposal,
> including the work plan, should reflect substantial mutual effort,
> cooperation, and substantive contributions by each agency throughout
> the grant period. In addition, **a letter of support from the
> Governor's office** is required that indicates support of the project,
> names the lead agency, and indicates support for a strong partnership
> effort between the State Health Department and the State Agency on
> Aging
>
> **2. Cost Sharing or Matching**
>
> Under this grant program, AoA will fund no more than 75% of the
> project's total cost, meaning the applicant must cover at least 25% of
> the total cost with non-federal resources. In other words, for every
> three (3) dollars received in federal funding, the applicant must
> contribute at least one (1) dollar in non-federal resources toward the
> project's total cost (i.e., the amount on line 15g.). This
> "three-to-one" ratio is reflected in the formula included under Item
> 15 in Attachment B. You can use this formula to calculate your minimum
> required match. A common error applicants make is to match 25% of the
> federal share, rather than 25% of the project's total cost. Match is
> not one of the responsiveness criteria as noted in Section III 3.
> Application Screening Criteria.
>
> **3. Application Screening Criteria**
>
> All applications will be screened to assure a level playing field for
> all applications. Applications that fail to meet the four screening
> criteria described below will **[not]{.underline}** be reviewed and
> will receive **[no]{.underline}** further consideration.
>
> In order for an application to be reviewed, it must meet the following
> screening requirements:

1.  Applications must be submitted via
    [www.grants.gov](http://www.grants.gov/) by midnight (Eastern
    Daylight Savings Time) August 31, 2006.

2.  The project narrative section of the application must be
    double-spaced, on 8 ½" x 11" pages with 1" margins on both sides,
    and a Times Roman font size of not less than 12.

3.  The project narrative of each application submission must
    [not]{.underline} exceed 25 pages. NOTE: The project work plan,
    letters of commitment, and vitae of key project personnel **[are not
    counted]{.underline}** as part of the project narrative for purposes
    of the 25-page limit.

> 4\. The application must not request more than \$300,000 in federal
> funds per year [under this announcement]{.underline} for each of the
> three project years covered by this grant program

IV. **APPLICATION AND SUBMISSION INFORMATION**

## 

## 1. Address to Request Application Package 

> All applicants are required to submit electronically through
> [http://www.grants.gov](http://www.grants.gov/) by midnight August 31,
> 2006.
>
> Exceptions to this requirement may only by made by the AoA grants
> office: Stephen Daniels (202-357-3464). Exceptions may only be made to
> allow for catastrophic events such as tornadoes, floods, etc.
>
> Application materials can be obtained from
> [http://www.grants.gov](http://www.grants.gov/) or
> <http://www.aoa.gov/doingbus/fundopp/fundopp.asp>.
>
> Applicants with prior approval may write for materials to:
>
> U.S. Department of Health and Human Services
>
> Administration on Aging
>
> John Murphy
>
> Center for Planning and Policy Development
>
> Washington, D.C. 20201
>
> Or by calling: 202-357-0136
>
> Or e-mailing: john.murphy@aoa.hhs.gov
>
> Please note, AoA is requiring applications for this announcement to be
> submitted electronically through
> [www.grants.gov](http://www.grants.gov/). The Grants.gov registration
> process can take several days. If your organization is not currently
> registered with [www.grants.gov](http://www.grants.gov/), please begin
> this process immediately. **For assistance with
> [www.grants.gov](http://www.grants.gov/), please contact Arthur Miller
> at AoA's Grants.gov helpdesk at 202-357-3438.** At
> [www.grants.gov](http://www.grants.gov/), you will be able to download
> a copy of the application packet, complete it off-line, and then
> upload and submit the application via the Grants.gov website.
>
> Applications submitted via [www.grants.gov](http://www.grants.gov/):

-   You may access the electronic application for this program on
    [www.grants.gov](http://www.Grants.gov/). You must search the
    downloadable application page by the CFDA number (93.048).

-   You will find information at www.grants.gov about submitting an
    application electronically through the site, including the hours of
    operation. AoA strongly recommends that you do not wait until the
    application due date to begin the application process because of the
    time delay.

-   All applicants must have a Dun and Bradstreet (D&B) Data Universal
    Numbering System number and register in the Central Contractor
    Registry (CCR). You should allow a minimum of **five days** to
    complete the CCR registration.

-   You may submit all documents electronically, including all
    information 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 www.grants.gov that contains a
    Grants.gov tracking number. AoA will retrieve your application form
    from Grants.gov.

-   We may request that you provide original signatures on forms at a
    later date.

###### 2. Content and Form of Application Submission 

> **a. DUNS Number**
>
> The Office of Management and Budget requires applicants to provide a
> Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number
> when applying for federal grants or cooperative agreements on or after
> October 1, 2003. It is entered on the SF 424. It is a unique,
> **nine-digit identification number**, that provides unique identifiers
> of single business entities. The D-U-N-S number is *free and easy* to
> obtain.
>
> Organizations can receive a DUNS number at no cost by calling the
> dedicated toll-free DUNS Number request line at 1-866-705-5711 or by
> using this link:
> https://www.whitehouse.gov/omb/grants/duns_num_guide.pdf**.**
>
> **b. Project Narrative**

## The project narrative must be double-spaced, on 8 ½" x 11" paper with 1" margins on both sides, and a Times Roman font size of not less than 12. You can use smaller font sizes to fill in the Standard Forms and Sample Formats. The suggested length for the Project Narrative is 20-25 pages; 25 pages is the maximum length allowed. AoA will not accept applications with a project narrative that exceeds 25 pages. The project map, work plan, letters of cooperation, and vitae of key personnel are not counted as part of the project narrative for purposes of the 25-page limit, but all of the other sections noted below are included in the limit.

> The components counted as part of the 25-page limit include:

-   Summary/Abstract

-   Problem Statement

-   Proposed Intervention

-   Involvement of Key Partners

-   Performance Goals and Indicators

-   Project Management

-   Evaluation

-   Dissemination

-   Organizational Capability

> The project narrative is the most important part of the application,
> since it will be used as the primary basis to determine whether or not
> your project meets the minimum requirements for grants under Title IV
> of the Older Americans Act. The project narrative should provide a
> **clear and concise** description of your project. The project
> narrative should reflect the three-year timeframe of this grant
> announcement, particularly the sections on Performance Goals and
> Indicators, Evaluation, Dissemination, and Work Plan. However, more
> detail should be provided on the work to be accomplished in the first
> year of the grant. AoA recommends that your project narrative include
> the following components in the order listed below**. In writing your
> narrative, please supplement the instructions below with the
> information contained in Section V, Application Review Information**.
>
> **Summary/Abstract.** This section should include a brief - no more
> than 300 word - description of the proposed project including the
> goals and objectives, proposed activities, and anticipated outcomes.
> Detailed instructions for completing the summary/abstract are included
> in Attachment E of this document. (Length not to exceed one page.)
>
> **Problem Statement.** This section should be used to describe the
> need for developing EBDP programs in your State. This should include
> what EBDP programs are already in place and the accessibility of these
> programs to older adults to the extent that is known. Provide
> appropriate demographic and epidemiological information as it applies
> to the
>
> State and to specific sub-State geographic areas where the
> intervention(s) program will be implemented. This section should
> include a description of the problems this proposal is intended to
> address through the proposed intervention program.
>
> **Proposed Intervention Program.** This section should provide a clear
> and concise description of the intervention program you are proposing
> to use to address the problems described in the previous section. You
> should also describe your overall approach including any plans, in
> addition to those proposed for funding through this opportunity, to
> further advance the EBDP program in your State. Applicants should
> include the specific EBDP programs that they intend to implement
> (CDSMP and potentially others), the specific geographic areas
> targeted, and the partners that will implement at least three of the
> local projects required in this grant announcement. Your proposal will
> not be considered competitive if you submit a plan to select EBDP
> programs and designate local partnerships at a later point. At least
> three complete sub-State projects must be submitted in substantial
> detail in the application. Additional types of EBDP intervention
> programs in other communities also may be proposed. You should note
> any major barriers you anticipate and how your project will be able to
> overcome these barriers. This section should also describe how the
> project would improve collaboration in providing services among
> health, public health and Aging Services Network agencies at the State
> and local level.
>
> **Involvement of Key Partners.** Describe in detail the roles and
> makeup of the strategic State and local partnerships that will be
> involved in implementing the intervention program, including other
> agencies, organizations, funding entities, and/or citizen groups.
> (Attach key formal agreements to the proposal.) Describe how the EBDP
> program will coordinate with other programs and organizations to carry
> out the proposed activities. This section also should describe how the
> project will improve collaboration among health, public health and
> Aging Services Network agencies at the State and local level.
>
> **Performance Goals and Indicators.** Provide a description of
> measurable performance goals and indicators you will use to measure
> the success of your project. AoA and the Resource Center for EBDP
> programs will provide simple software to maintain and report
> participant/client (anonymous) activities. With respect to
> participants/clients served, we require at least:

-   The number of participants/clients that participate in each program

-   Their age, gender, and self-identified ethnicity

-   The number of sessions out of the total number for a complete course
    that is attended by each participant/client, or the number of
    contacts by a case manager (e.g., for CDSMP, Participant #62
    attended sessions 1, 2, 4, 5, 6.)

-   The evaluative feedback from the participant/client measured at the
    end of their participation in the program.

-   One or two indicators that the intervention program was implemented
    with fidelity to its core design features. The AoA Resource Center
    for EBDP programs will work with grantees and partners on outcome
    indicators and formative evaluation methods to facilitate attention
    to fidelity and continuous program improvement. Examples of ways to
    assist with and track fidelity for some programs are available on
    the CHA Web site at
    [www.healthyagingprograms.org](http://www.healthyagingprograms.org/).
    In related work, AoA will use a sample-based evaluation to assess
    the operations and effects of the program in more detail than the
    minimum core information provided above.

> Each applicant should describe their capacity, objectives, and
> proposed measures to track the progress of persons who participate in
> the EBDP program, how this tracking will be used, and plans for
> sustaining the program.
>
> **Project Management**. This section should include a clear
> delineation of the roles and responsibilities of project staff,
> consultants, and partner organizations, and how they will contribute
> to achieving the project's stated objectives and outcomes. It should
> specify who will have day-to-day responsibility for key tasks such as
> leadership of the project, monitoring the project's on-going progress
> (including training and monitoring fidelity of the program),
> preparation of reports, and communications with other partners and
> with AoA. It should also describe the approach that will be used to
> monitor and track progress of the project's tasks and in meeting the
> objectives.
>
> **Annual Training** State Agency partners and each of the 3 (or more)
> local intervention programs should budget to send one person (for a
> total of at least 5 people) to attend an annual training and
> information exchange program in the Washington D.C. area, each year of
> the 3-year grant period.
>
> **Evaluation**. The grantee and partners should describe in detail the
> formative evaluation and continuous improvement systems that they will
> use at both the State and local levels. These must address program
> development and coordination and describe how program quality will be
> monitored. States are encouraged to review existing materials about
> their selected programs, contact agencies that have already
> implemented the program, and work with their research partners to
> design useful and appropriate evaluation methods.
>
> **Dissemination.** This section should describe the method that will
> be used to disseminate the program results in a timely manner and in
> an easily understood format. Information and mentoring should be
> targeted and focused toward achieving a statewide system of disease
> and disability prevention programs and fostering such programs in
> other States and sub-State areas. The results should focus on the
> opportunities and barriers to statewide coverage of the program and
> the feasibility of implementing additional types of disease and
> disability prevention programs for seniors or people with disability,
> regardless of age. Proposals should budget for at least one person
> from each State agency to attend the annual ASA/NCOA National Aging
> Conference or a similar national conference to disseminate the
> program. The disease and disability prevention program sites may also
> budget moderate levels of conference travel to participate in
> dissemination activities that will be organized by AoA, the
> Evidence-Based Disease Prevention Program Resource Center, and our
> partners.
>
> **Organizational Capability.** Each application should include a
> description of their organizational capability and vitae for key
> project personnel. A capability description for both State partners
> should be included to demonstrate that the lead State agency and its
> partner have the capacity to implement the program. Similarly, the
> local entities that will be implementing the EBDP program at the
> community level should demonstrate that they have this capacity.
> Include a short vitae only for key project staff. Also include
> information about any contractual organization(s) that will have a
> significant role(s) in implementing the program and achieving project
> goals.
>
> **Project Map.** Include a project map of the State with county
> boundaries, major cities, and PSA boundaries and shade those PSAs
> selected for this project. Give the population 60+ for the State and
> for each of the selected PSAs.
>
> **Work Plan**. The work plan should reflect and be consistent with the
> project narrative and budget. It should include a statement of the
> project's overall goal, key objectives, anticipated outcome(s), and
> the major tasks/action steps that will be undertaken to achieve these.
> It is critical that the work plan reflect substantial active
> involvement of partners at both the State and local levels. There
> should be "sub-work plans" for each of the three (or more) sub-State
> geographic areas implementing an intervention program. For each major
> task/action step, the work plan should identify the timeframes
> involved (including start and end dates) and the lead person
> responsible for completing the task. Please use the work plan template
> included as Attachment D in this announcement.
>
> **Letters of Commitment from Key Participating Organizations and
> Agencies.** Include letters confirming the commitments to the project
> made by key collaborating organizations and agencies. Any organization
> that is specifically named as having a significant role in carrying
> out the project should be considered a key collaborator. In addition,
> **a letter of support from the Governor's office** is required that
> indicates support of the project, names the lead agency, and indicates
> support for a strong partnership effort between the State Health
> Department and the State Agency on Aging.
>
> **Vitae.** Include a short vitae only for key project staff.
>
> **3. Submission Dates and Times**
>
> The deadline for the submission of applications under this program
> announcement is August 31, 2006. Applications must be submitted
> electronically by midnight Eastern Time, August 31, 2006.
>
> Applications that fail to meet the application due date will
> **[not]{.underline}** be reviewed and will receive
> **[no]{.underline}** further consideration.
>
> Grants.gov will automatically send applicants a tracking number and
> date of receipt verification electronically once the application has
> been successfully received and validated in Grants.gov.
>
> **Potential applicants are encouraged to submit a letter of intent to
> apply for a grant no later than July 15, 2006. Letters of intent
> should tell us the subject areas that you propose to address in each
> of the three or more geographic areas of the State.** Letters of
> Intent should be submitted by facsimile or e-mail to the AoA Project
> Officer, Donald Grantt, (202) 357-3447, Fax (202) 357-3469, and
> <donald.grantt@aoa.hhs.gov>.
>
> **4. Intergovernmental Review**
>
> This funding opportunity announcement is not subject to the
> requirements of Executive Order 12372, "Intergovernmental Review of
> Federal Programs"
>
> **5. Funding Restrictions**
>
> The following activities are not fundable:

-   Construction and/or major rehabilitation of buildings

-   Basic research (e.g. scientific or medical experiments)

-   Continuation of existing projects without expansion or new and
    innovative approaches

> **6. Other Submission Requirements**
>
> Electronic submissions must be sent to:
> [http://www.grants.gov](http://www.grants.gov/).
>
> Applicants submitting their application through
> [www.grants.gov](http://www.grants.gov/) must register in the Central
> Contractor Registry (CCR) database in order to be able to submit the
> application. One element of the CCR is the DUNS number (see section
> IV.2), which must be obtained separately from CCR registration.
> Information about CCR is available at
> <http://www.grants.gov/CCRRegister>. You must also register with a
> Credential Provider to receive a username and password to securely
> submit your grant application. Information is available at
> <http://www.grants.gov/CredentialProvider>.
>
> Applicants unable to submit their application via
> [www.grants.gov](http://www.grants.gov/) may request permission to
> submit a hard copy from the AoA Project Officer, Donald Grantt, (202)
> 357-3447, Fax (202) 357-3469, and <donald.grantt@aoa.hhs.gov>.
>
> Applicants with prior approval may mail or hand deliver your
> application to AoA. You must submit **one original application and two
> copies**, plus a completed application checklist. The application
> deadline for applications sent by U.S. Postal Service must be
> post-marked by midnight August 31, 2006 or hand-delivered by 5:00 p.m.
> Eastern Time on August 31, 2006.
>
> Submissions using the regular, U.S. Postal Service must be addressed
> to:
>
> Department of Health and Human Services
>
> Administration on Aging
>
> Attention: Stephen Daniels
>
> Office of Grants Management
>
> Washington, DC 20201
>
> Attention: Stephen Daniels
>
> Submissions by courier, overnight delivery, delivered in person, etc.
> should be addressed to:
>
> Department of Health and Human Services
>
> Administration on Aging
>
> Office of Grants Management
>
> One Massachusetts Avenue, NW, Room 4604
>
> Washington, DC 20001

V.  **APPLICATION REVIEW INFORMATION**

**1. Review Criteria**

> a\. [Problem Statement]{.underline} [Weight: 15 points]{.underline}
>
> i\. Does this section clearly describe the need for developing EBDP
> programs in their state? Does the applicant describe EBDP programs
> that are already in place and the accessibility of these programs to
> older adults? Does the applicant provide appropriate demographic and
> epidemiological information as it applies to the State and to specific
> sub-State geographic areas where the intervention(s) program will be
> implemented? Does the applicant include a description of the problems
> this proposal is intended to address through the proposed intervention
> program?
>
> b\. [Approach, Work Plan and Activities]{.underline} [Weight: 40
> points]{.underline}
>
> i\. **Goals/Objectives:** Has the applicant stated clear and
> meaningful goals and objectives for the proposed program as well as
> problems that relate to the proposed intervention program? Are the
> goals and objectives reasonable and likely to be achieved? Have the
> EBDP intervention programs been identified and realistic
> implementation plans provided? Have the three required local
> geographic areas been selected? Are substantial partnerships and
> agreements described? Are clear and practical work plans included in
> the application?
>
> ii\. **Methods of Addressing the Problem**: Has the applicant clearly
> described a coherent approach to implementing the intervention program
> that would successfully address the problems described? Is it likely
> the approach will achieve the specified goals?
>
> iii\. **Coordination and Linkages**: Has the applicant demonstrated
> that the proposed activities (i) complement the activities of existing
> evidence-based disease prevention programs, where they exist; (ii)
> utilize existing programs and services in a coordinated way to expand
> or enhance the capacity of partners to make EBDP programs available to
> seniors; and (iii) reflect a commitment from partners and include
> descriptions of specific activities and areas of responsibility? Is
> both the State Agency on Aging and the State Health Department
> substantially involved in the program throughout the grant period?
> Does the applicant describe linkages with private and public groups?
> Does the application include a letter of support from the Governor's
> office?
>
> iv\. **Work Plan and Timeline**: Has the applicant included a work
> plan that documents reasonable benchmarks, measurable outcomes,
> milestones, timeframes, and identifies the parties responsible for
> accomplishing each specified objective? Are there comparable work
> plans for each of the three required geographic areas?
>
> 3\. [Project Outcomes and Evaluation]{.underline} [Weight: 25
> points]{.underline}
>
> i\. Are the anticipated outcomes of the proposed project likely to be
> achieved? Are the expected benefits/results of the proposed project
> clear and realistic? Will the evaluation properly reflect indicators
> for the systems changes and expanded reach in numbers of persons
> served that are expected from the grant? Does the applicant describe
> all the evaluation activities required by the program announcement?
> Will the evaluation system permit a continuous determination that
> fidelity to the selected evidence-based models is being maintained?
> Will the evaluation system permit a determination of whether
> sustainable State systems have been established to develop and
> maintain evidence-based disease and disability prevention programs?
>
> 4\. [Level of Effort]{.underline} [Weight: 20 points]{.underline}
>
> i\. **Organization and Management:** Do the proposed key
> staff/consultants have the background, experience and other
> qualifications required to carry out the proposed intervention
> programs? Are letters of support from participating organizations
> included and do they express the clear commitment and areas of
> responsibility?
>
> ii\. **Budget and Resources:** Has the applicant and its partners
> secured substantial resources (other than the required match) from
> other sources of funding that can be used to expand the numbers of
> people served by this project. Is the budget adequate and reasonable?
> Is the time commitment of the proposed director and other key project
> personnel sufficient to assure proper direction, management and timely
> completion of the project? Are budget line items clearly delineated
> and consistent with work plan objectives?

2.  **Review and Selection Process**

> An independent review panel of at least three individuals will
> evaluate applications that pass the initial screening. The reviewers
> will be experts in their field and may be drawn from academic
> institutions, research organizations, non-profit organizations, State
> and local government, federal government or other entities. Based on
> the specific programmatic considerations as outlined under section I,
> Funding Opportunity Description, the reviewers will comment on and
> score the applications, focusing their comments and scoring decisions
> on the criteria identified above for each funding opportunity.
>
> Final award decisions will be made by the Assistant Secretary for
> Aging (ASA). In making these decisions, the ASA will take into
> consideration the recommendations of the review panel, reviews for
> programmatic and grants management compliance, the reasonableness of
> the estimated cost to the government considering the available funding
> and anticipated results, geographic distribution, program diversity,
> and the likelihood that the proposed project will produce the benefits
> described.

## VI. AWARD ADMINISTRATION INFORMATION 

###### 1. *Award Notices* 

> Successful applicants will receive an Approval letter, and a Notice of
> Financial Assistance Award via U.S. mail. The Notice of Financial
> Assistance Award is the authorizing document, and will be signed by
> the AoA grants officer, the AoA authorizing official, and the AoA
> budget office. Unsuccessful applicants will be notified 30 days after
> successful applicants and will receive a disapproval letter via U.S.
> Mail.

###### 2. *Administrative and National Policy Requirements* 

The award is subject to DHHS Administrative Requirements which can be
found in 45CFR Part 74 and 92 and AoA Standard Terms and Conditions and
that are included with each grant Award Packet.

###### 3. *Reporting* 

> Instructions for annual financial and semi-annual program performance
> reports will be included with the Award Packets sent to successful
> applicants. An original and two copies of the SF-269 (Financial Status
> Report) and the AoA program progress report are requested. Awardees
> will receive instructions for program progress reports with their
> Notice of Financial Assistance Award. Final performance and SF-269
> reports are due 90 days after the end of the project period. For more
> information see DHHS / AoA Standard Terms and Conditions.

## VII. AGENCY CONTACTS 

[Project Officer:]{.underline}

> Donald Grantt

Center for Planning and Policy Development

> U.S. Administration on Aging
>
> Washington, DC 20201
>
> donald.grantt@aoa.hhs.gov

\(202\) 357-3447

Fax (202) 357-3469

[Grants Management Officer:]{.underline}

> Stephen Daniels
>
> Office of Grants Management
>
> U.S. Department of Health and Human Services
>
> Administration on Aging
>
> Washington, DC 20201
>
> stephen.daniels@aoa.hhs.gov

\(202\) 357-3464

Fax (202) 357-3466

## VIII. OTHER INFORMATION

###### A. Application Elements

> 1\. SF 424 -- Application for Federal Assistance.

2.  SF 424A -- Budget Information.

3.  Separate Budget Narrative/Justification (See Attachments for Sample
    Format).

4.  SF 424B -- Assurances. Note: Be sure to complete this form according
    to instructions and have it signed and dated by the authorized
    representative (see item 18d on the SF 424).

> 5\. Certification
>
> 6\. Copy of the applicant\'s most recent indirect cost agreement, as
> necessary.
>
> 7\. Project Narrative with Work Plan (See Attachment for Sample Work
> Plan Format).
>
> 8\. Organizational Capability Statement and Vitae for Key Project
> Personnel.
>
> 9\. Letters of Commitment from Key Partners.

**B. The Paperwork Reduction Act of 1995 (P.L. 104-13)**

An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently
valid OMB control number.

The project description and budget justification is approved under OMB
control number 0985-0018 which expires on 3/31/07.

Public reporting burden for this collection of information is estimated
to average 10 hours per response, including the time for reviewing
instructions, gathering and maintaining the data needed and reviewing
the collection information.

**ATTACHMENTS**

**Attachment A:**

**Instructions for completing the SF 424, Budget (SF 424A), Budget
Narrative and Other Required Forms**

**Attachment B:**

**Budget Justification Format -- Sample Format with Examples**

**Attachment C:**

**Budget Justification -- Sample Format**

**Attachment D:**

**Project Work Plan - Sample Format**

**Attachment E:**

**Instructions for Completing the Summary/Abstract**

#  Attachment A

# Instructions for completing the SF 424, Budget (SF 424A), Budget Narrative, and Other Required Forms

###### 

###### 

###### 

###### 

###### 

###### a. Standard Form 424

1\. **Type of Submission:** (Required): Select one type of submission in
accordance with agency instructions.

• Preapplication • Application • Changed/Corrected Application -- If AoA
requests, check if this submission is to change or correct a previously
submitted application.

2\. **Type of Application**: (Required) Select one type of application
in accordance with agency instructions.

• New . • Continuation • Revision

3\. **Date Received:** Leave this field blank.

4\. **Applicant Identifier**: Leave this field blank

5a. **Federal Entity Identifier**: Leave this field blank

5b. **Federal Award Identifier**: For new applications leave blank. For
a continuation or revision to an existing award, enter the previously
assigned Federal award (grant) number.

6\. **Date Received by State:** Leave this field blank.

7\. **State Application Identifier:** Leave this field blank.

8\. **Applicant Information**: Enter the following in accordance with
agency instructions:

**a. Legal Name**: (Required): Enter the name that the organization has
registered with the Central Contractor Registry. Information on
registering with CCR may be obtained by visiting the Grants.gov website.

**b. Employer/Taxpayer Number (EIN/TIN):** (Required): Enter the
Employer or Taxpayer Identification Number (EIN or TIN) as assigned by
the Internal Revenue Service.

**c. Organizational DUNS**: (Required) Enter the organization's DUNS or
DUNS+4 number received from Dun and Bradstreet. Information on obtaining
a DUNS number may be obtained by visiting the Grants.gov website.

**d. Address**: (Required) Enter the complete address including the
county.

**e. Organizational Unit:** Enter the name of the primary organizational
unit (and department or division, if applicable**)** that will undertake
the project.

**f. Name and contact information of person to be contacted on matters
involving this application**: Enter the name (First and last name
required), organizational affiliation (if affiliated with an
organization other than the applicant organization), telephone number
(Required), fax number, and email address (Required) of the person to
contact on

matters related to this application.

9\. **Type of Applicant:** (Required) Select the applicant organization
"type" from the following drop down list.

A. State Government B. County Government C. City or Township Government
D. Special District Government E. Regional Organization F. U.S.
Territory or Possession G. Independent School District H. Public/State
Controlled Institution of Higher Education I. Indian/Native American
Tribal Government (Federally Recognized) J. Indian/Native American
Tribal Government (Other than Federally Recognized) K. Indian/Native
American Tribally Designated Organization L. Public/Indian Housing
Authority M. Nonprofit with 501C3 IRS Status (Other than Institution of
Higher Education) N. Nonprofit without 501C3 IRS Status (Other than
Institution of Higher Education) O. Private Institution of Higher
Education P. Individual Q. For-Profit Organization (Other than Small
Business) R. Small Business S. Hispanic-serving Institution T.
Historically Black Colleges and Universities (HBCUs) U. Tribally
Controlled Colleges and Universities (TCCUs) V. Alaska Native and Native
Hawaiian Serving Institutions W. Non-domestic (non-US) Entity X. Other
(specify)

10\. **Name Of Federal Agency**: (Required) Enter U.S. Administration on
Aging

11\. **Catalog Of Federal Domestic Assistance Number/Title:** The CFDA
number can be found on page one of the Program Announcement.

12\. **Funding Opportunity Number/Title:** (Required) The Funding
Opportunity Number and title of the opportunity can be found on page one
of the program announcement.

13\. **Competition Identification Number/Title:** Leave this field
blank.

14\. **Areas Affected By Project:** List the largest political entity
affected (cities, counties, state etc).

15\. **Descriptive Title of Applicant's Project:** (Required) Enter a
brief descriptive title of the project.

16\. **Congressional Districts Of**: (Required) 16a. Enter the
applicant's Congressional District, and 16b. Enter all district(s)
affected by the program or project. Enter in the format: 2 characters
State Abbreviation -- 3 characters District Number, e.g., CA-005 for
California 5th district, CA-012 for California 12^th^ district, NC-103
for North Carolina's 103rd district. • If all congressional districts in
a state are affected, enter "all" for the district number, e.g., MD-all
for all congressional districts in Maryland. • If nationwide, i.e. all
districts within all states are affected, enter US-all.

17\. **Proposed Project Start and End Dates**: (Required) Enter the
proposed start date and end date of the project.

18\. **Estimated Funding:** (Required) Enter the amount requested or to
be contributed during the first funding/budget period by each
contributor. Value of in-kind contributions should be included on
appropriate lines, as applicable. If the action will result in a dollar
change to an existing award, indicate only the amount of the change. For
decreases, enclose the amounts in parentheses.

**NOTE:** Applicants should review cost sharing or matching principles
contained in Subpart C of 45 CFR Part 74 or 45 CFR Part 92 before
completing Item 18 and the Budget Information Sections A, B and C noted
below.

All budget information entered under item 18 should cover the upcoming
budget period. For sub-item 18a, enter the federal funds being
requested. Sub-items 18b-18e is considered matching funds. The dollar
amounts entered in sub-items 18b-18f must total at least 1/3^rd^ of the
amount of federal funds being requested (the amount in 18a). For a full
explanation of AoA's match requirements, see the information in the box
below. For sub-item 18f, enter only the amount, if any, that is going to
be used as part of the required match.

There are three types of match: 1.) non-federal cash; 2.) non-federal
non-cash (i.e., in-kind); and 3.) program income. In general, costs
borne by the applicant and cash contributions of any and all third
parties involved in the project, including sub-grantees, contractors and
consultants, are considered [cash matching funds]{.underline}.
Generally, most contributions from third parties will be non-cash (i.e.,
in-kind) matching funds. Examples of [non-cash (in-kind)
match]{.underline} include: volunteered time and use of facilities to
hold meetings or conduct project activities. A third form of non-federal
match is projected [program income]{.underline} derived from activities
of the project such as participant fees and sale of publications. [Only
program income that is to be used as part of the required match should
be shown on Line 18.]{.underline}

NOTE: **Indirect charges** may only be requested if: (1) the applicant
has a current indirect cost rate agreement approved by the Department of
Health and Human Services or another federal agency; or (2) the
applicant is a state or local government agency. State governments
should enter the amount of indirect costs determined in accordance with
DHHS requirements. **If indirect costs are to be included in the
application, a copy of the approved indirect cost agreement must be
included with the application.**

19\. **Is Application Subject to Review by State Under Executive Order
12372 Process?** Check c. Program is not covered by E.O. 12372

20\. **Is the Applicant Delinquent on any Federal Debt?** (Required)
This question applies to the applicant organization, not the person who
signs as the authorized representative. If yes, include an explanation
on the continuation sheet.

21\. **Authorized Representative**: (Required) To be signed and dated by
the authorized representative of the applicant organization. Enter the
name (First and last name required) title (Required), telephone number
(Required), fax number, and email address (Required) of the person
authorized to sign for the applicant. A copy of the governing body's
authorization for you to sign this application as the official
representative must be on file in the applicant's office. (Certain
Federal agencies may require that this authorization be submitted as
part of the application.)

**b. Standard Form 424A**

+-----------------------------------------------------------------------+
| > NOTE: Standard Form 424A is designed to accommodate applications    |
| > for multiple grant programs; thus, for purposes of this AoA         |
| > program, many of the budget item columns and rows are not           |
| > applicable. You should only consider and respond to the budget      |
| > items for which guidance is provided below. Unless otherwise        |
| > indicated, the SF 424A should reflect a one-year budget.            |
+-----------------------------------------------------------------------+

##### Section A ‑ Budget Summary

> [Line 5]{.underline}: Leave columns ( c) and (d) blank. Enter TOTAL
> federal costs in column (e) and total non‑federal costs (including
> third party in‑kind contributions and any program income to be used as
> part of the grantee match) in column (f). Enter the sum of columns (e)
> and (f) in column (g).

##### Section B ‑ Budget Categories

> Column 3: Enter the breakdown of how you plan to use the federal funds
> being
>
> requested by object class category (see instructions for each object
> class category below).
>
> Column 4: Enter the breakdown of how you plan to use the non-federal
> share by object class category.
>
> Column 5: Enter the total funds required for the project (the sum of
> Columns 3 and 4) by object class category.

+-----------------------------------------------------------------------+
| ###### Separate Budget Narrative/Justification Requirement            |
|                                                                       |
| > You must submit a separate budget narrative as part of your         |
| > application. **A blank sample format (and one with examples) has    |
| > been included in the attachments for your use in developing and     |
| > presenting your Budget Narrative.** In your budget justification,   |
| > you should include a breakdown of the budget which shows the costs  |
| > for all of the object class categories noted in Section B, across   |
| > three columns: federal; non-federal cash; and non-federal in-kind.  |
| > The justification should fully explain and justify the costs in     |
| > each of the major budget items for each of the object class         |
| > categories, as described below. Third party in-kind contributions   |
| > and program income designated as non-federal match contributions    |
| > should be clearly identified and justified separately from the      |
| > justification for the budget line items. The full budget            |
| > justification should be included in the application immediately     |
| > following the SF 424 forms. **The budget justification should       |
| > provide a detailed breakdown of large dollar values.**              |
+-----------------------------------------------------------------------+

> [Line 6a]{.underline}: [Personnel]{.underline}: Enter total costs of
> salaries and wages of applicant/grantee staff. Do not include the
> costs of consultants; consultant costs should be included under 6h ‑
> Other. [In the Justification]{.underline}: Identify the project
> director, if known. Specify the key staff, their titles, brief summary
> of project related duties, and the percent of their time commitments
> to the project in the budget justification.
>
> [Line 6b]{.underline}: [Fringe Benefits]{.underline}: Enter the total
> costs of fringe benefits unless treated as part of an approved
> indirect cost rate. [In the Justification]{.underline}: Provide a
> break‑down of amounts and percentages that comprise fringe benefit
> costs, such as health insurance, FICA, retirement insurance, etc.
>
> [Line 6c]{.underline}: [Travel]{.underline}: Enter total costs of
> [out‑of‑town travel]{.underline} (travel requiring per diem) for staff
> of the project. Do not enter costs for consultant\'s travel - this
> should be included in line 6h. [In the Justification]{.underline}:
> Include the total number of trips, destinations, purpose, length of
> stay, subsistence allowances and transportation costs (including
> mileage rates).
>
> [Line 6d]{.underline}: [Equipment]{.underline}: Enter the total costs
> of all equipment to be acquired by the project. For all grantees,
> \"equipment\" is non‑expendable tangible personal property having a
> useful life of more than one year and an acquisition cost of \$5,000
> or more per unit. If the item does not meet the \$5,000 threshold,
> include it in your budget under Supplies, line 6e. [In the
> Justification]{.underline}: Equipment to be purchased with federal
> funds must be justified as necessary for the conduct of the project.
> The equipment must be used for project-related functions; the
> equipment, or a reasonable facsimile, must not be otherwise available
> to the applicant or its sub‑grantees. The justification also must
> contain plans for the use or disposal of the equipment after the
> project ends.
>
> [Line 6e]{.underline}: [Supplies:]{.underline} Enter the total costs
> of all tangible expendable personal property
>
> (supplies) other than those included on line 6d. [In the
> Justification:]{.underline} Provide general description of types of
> items included.
>
> [Line 6f]{.underline}: [Contractual]{.underline}: Enter the total
> costs of all contracts, including (1) procurement
>
> contracts (except those, which belong on other lines such as
> equipment, supplies, etc.). Also include any contracts with
> organizations for the provision of technical assistance. Do not
> include payments to individuals on this line. [In the
> Justification]{.underline}: Attach a list of contractors indicating
> the name of the organization, the purpose of the contract, and the
> estimated dollar amount. If the name of the contractor, scope of work,
> and estimated costs are not available or have not been negotiated,
> indicate when this information will be available. Whenever the
> applicant/grantee intends to delegate a substantial part (one-third,
> or more) of the project work to another agency, the applicant/grantee
> must provide a completed copy of Section B, Budget Categories for each
> contractor, along with supporting information and justifications.
>
> [Line 6g]{.underline}: [Construction]{.underline}: Leave blank since
> construction is not an allowable cost under this AoA program.
>
> [Line 6h]{.underline}: [Other]{.underline}: Enter the total of all
> other costs. Such costs, where applicable, may
>
> include, but are not limited to: insurance, medical and dental costs
> (i.e. for project volunteers this is different from personnel fringe
> benefits); non-contractual fees and travel paid directly to
> *individual* consultants; [local]{.underline} transportation (all
> travel which does not require per diem is considered local travel);
> postage; space and equipment rentals/lease; printing and publication;
> computer use; training and staff development costs (i.e. registration
> fees). If a cost does not clearly fit under another category, and it
> qualifies as an allowable cost, then rest assured this is where it
> belongs. [In the Justification:]{.underline} Provide a reasonable
> explanation for items in this category. For individual consultants,
> explain the nature of services provided and the relation to activities
> in the work plan. Describe the types of activities for staff
> development costs.
>
> [Line 6i]{.underline}: [Total Direct Charges]{.underline}: Show the
> totals of Lines 6a through 6h.
>
> [Line 6j]{.underline}: [Indirect Charges]{.underline}: Enter the total
> amount of indirect charges (costs), if any. If
>
> no indirect costs are requested, enter \"none.\" Indirect charges may
> be requested if: (1) the applicant has a current indirect cost rate
> agreement approved by the Department of Health and Human Services or
> another federal agency; or (2) the applicant is a State or local
> government agency.
>
> Justification: [State governments should enter the amount of indirect
> costs determined in accordance with DHHS requirements]{.underline}. An
> applicant that will charge indirect costs to the grant must enclose a
> copy of the current rate agreement. If the applicant organization is
> in the process of initially developing or renegotiating a rate, it
> should immediately upon notification that an award will be made,
> develop a tentative indirect cost rate proposal based on its most
> recently completed fiscal year in accordance with the principles set
> forth in the cognizant agency\'s guidelines for establishing indirect
> cost rates, and submit it to the cognizant agency. Applicants awaiting
> approval of their indirect cost proposals may also request indirect
> costs. It should be noted that when an indirect cost rate is
> requested, those costs included in the indirect cost pool should not
> also be charged as direct costs to the grant. Also, if the applicant
> is requesting a rate which is less than what is allowed under the
> program, the authorized representative of the applicant organization
> must submit a signed acknowledgement that the applicant is accepting a
> lower rate than allowed.
>
> [Line 6k]{.underline}: [Total]{.underline}: Enter the total amounts of
> Lines 6i and 6j.
>
> [Line 7]{.underline}: [Program Income]{.underline}: As appropriate,
> include the estimated amount of income, if any, you expect to be
> generated from this project that you wish to designate as match (equal
> to the amount shown for Item 18(f) on Form 424). [Note]{.underline}:
> Any program income indicated at the bottom of Section B and for item
> 15(f) on the face sheet of Form 424 will be included as part of
> non-Federal match and will be subject to the rules for documenting
> completion of this pledge. If program income is expected, but is not
> needed to achieve matching funds, do not include that portion here or
> on Item 18(f) of the Form 424 face sheet. Any anticipated program
> income that will not be applied as grantee match should be described
> in the Level of Effort section of the Program Narrative.

##### 

##### Section C ‑ Non‑Federal Resources

> [Line 12]{.underline}: Enter the amounts of non‑Federal resources that
> will be used in carrying out the proposed project, by source
> (Applicant; State; Other) and enter the total amount in Column (e). Do
> not include program income unless it is used to meet the match
> requirement. Keep in mind that if program income used to meet the
> match requirement and the projected level of program income is not
> met, thereby decreasing the level of match, the amount of federal
> funds available to the grantee may be reduced if the match falls below
> required levels.
>
> [Section D ‑ Forecasted Cash Needs]{.underline} - Not applicable.
>
> [Section E ‑ Budget Estimate of Federal Funds Needed for Balance of
> the Project]{.underline}
>
> [Line 20]{.underline}: NOTE: Leave this line blank. Section E is
> relevant only for multi-year grant applications, where the project
> period is 24 months or longer. This section does not apply to grant
> awards where the project period is less than 17 months.

###### Section F ‑ Other Budget Information

> [Line 22]{.underline}: [Indirect Charges]{.underline}: Enter the type
> of indirect rate (provisional, predetermined,
>
> final or fixed) to be in effect during the funding period, the base to
> which the rate is applied, and the total indirect costs. Include a
> copy of your current Indirect Cost Rate Agreement.
>
> [Line 23]{.underline}: [Remarks]{.underline}: Provide any other
> comments deemed necessary.

###### c. Standard Form 424B - Assurances

> This form contains assurances required of applicants under the
> discretionary funds programs administered by the Administration on
> Aging. Please note that a duly authorized representative of the
> applicant organization must certify that the organization is in
> compliance with these assurances.

###### d. Certification Regarding Lobbying

> This form contains certifications that are required of the applicant
> organization regarding (a) lobbying; (b) debarment, suspension, and
> other responsibility matters; and (c) drug-free workplace
> requirements. Please note that a duly authorized representative of the
> applicant organization must attest to the applicant's compliance with
> these certifications.

###### e. Other Application Components

**Survey on Ensuring Equal Opportunity for Applicants**

> The Office of Management and Budget (OMB) has approved an HHS form to
> collect information on the number of faith-based groups applying for a
> HHS grant. Non-profit organizations, excluding private universities,
> are asked to include a completed survey with their grant application
> packet. Attached you will find the OMB approved HHS "Survey on
> Ensuring Equal Opportunity for Applicants" form (Attachment G). Your
> help in this data collection process is greatly appreciated.

**Proof of Non-Profit Status**

> Non-profit applicants must submit proof of non-profit status. Any of
> the following constitutes acceptable proof of such status:
>
> A copy of a currently valid IRS tax exemption certificate.
>
> A statement from a State taxing body, State Attorney General, or other
> appropriate State official certifying that the applicant organization
> has a non-profit status and that none of the net earnings accrue to
> any private shareholders or individuals.
>
> A certified copy of the organization's certificate of incorporation or
> similar document that clearly establishes non-profit status.

## Indirect Cost Agreement

> Applicants that have included indirect costs in their budgets must
> include a copy of the current indirect cost rate agreement approved by
> the Department of Health and Human Services or another federal agency.
> This is optional for applicants that have not included indirect costs
> in their budgets.

**Attachment B: Budget Narrative, Page 1 -- Sample Format with
EXAMPLES**

+---------+------+-----+------+--------+----------------------------+
| > *     | *    | **N | **N  | #      | ### Justification          |
| *Object | *Fed | on- | on-F |  TOTAL |                            |
| > Class | eral | Fed | eder |        |                            |
| > Cat   | Fun  | era | al** |        |                            |
| egory** | ds** | l** |      |        |                            |
|         |      |     | **I  |        |                            |
|         |      | **  | n-Ki |        |                            |
|         |      | Cas | nd** |        |                            |
|         |      | h** |      |        |                            |
+---------+------+-----+------+--------+----------------------------+
| **Pers  | \$40 |     | \$5  | \$     | Project Supervisor (name)  |
| onnel** | ,000 |     | ,000 | 45,000 | = .3FTE @ \$50,000/yr =    |
|         |      |     |      |        | \$15,000                   |
|         |      |     |      |        |                            |
|         |      |     |      |        | Project Director (name) =  |
|         |      |     |      |        | 1FTE @ \$30,000 = \$30,000 |
+---------+------+-----+------+--------+----------------------------+
| *       | \$12 | 0   | 0    | \$     | Fringes on Supervisor and  |
| *Fringe | ,600 |     |      | 12,600 | Director @ 28% of salary.  |
| Ben     |      |     |      |        |                            |
| efits** |      |     |      |        | FICA (7.65%) = \$3,442     |
|         |      |     |      |        |                            |
|         |      |     |      |        | Health (12%) = \$5,400     |
|         |      |     |      |        |                            |
|         |      |     |      |        | Dental (5%) = \$2,250      |
|         |      |     |      |        |                            |
|         |      |     |      |        | Life (2%) = \$ 900         |
|         |      |     |      |        |                            |
|         |      |     |      |        | Workers Comp Insurance     |
|         |      |     |      |        | (.75%) = \$ 338            |
|         |      |     |      |        |                            |
|         |      |     |      |        | Unemployment Insurance     |
|         |      |     |      |        | (.6%) = \$ 270             |
+---------+------+-----+------+--------+----------------------------+
| **T     | \$3  | 0   | \$   | \      | Travel to Annual Grantee   |
| ravel** | ,000 |     | 967  | $3,967 | Meeting:                   |
|         |      |     |      |        |                            |
|         |      |     |      |        | Airfare: 1 RT x 2 people x |
|         |      |     |      |        | \$750/RT = \$1,500         |
|         |      |     |      |        |                            |
|         |      |     |      |        | Lodging: 3 nights x 2      |
|         |      |     |      |        | people x \$100/night = \$  |
|         |      |     |      |        | 600                        |
|         |      |     |      |        |                            |
|         |      |     |      |        | Per Diem: 4 days x 2       |
|         |      |     |      |        | people x \$40/day = \$ 320 |
|         |      |     |      |        |                            |
|         |      |     |      |        | Out-of-Town Project Site   |
|         |      |     |      |        | Visits                     |
|         |      |     |      |        |                            |
|         |      |     |      |        | Car mileage: 3 trips x 2   |
|         |      |     |      |        | people x 350 miles/trip    |
|         |      |     |      |        |                            |
|         |      |     |      |        | x \$ .365/mile = \$ 767    |
|         |      |     |      |        |                            |
|         |      |     |      |        | Lodging: 3 trips x 2       |
|         |      |     |      |        | people x 1 night/ trip     |
|         |      |     |      |        |                            |
|         |      |     |      |        | x \$50/night = \$300       |
|         |      |     |      |        |                            |
|         |      |     |      |        | Per Diem: 3 trips x 2      |
|         |      |     |      |        | people x 2days/trip        |
|         |      |     |      |        |                            |
|         |      |     |      |        | x \$40/day = \$480         |
+---------+------+-----+------+--------+----------------------------+

Attachment B: Budget Narrative, Page 2 - Sample Format with EXAMPLES

+--------+-------+------+-----+-------+------------------------------+
| **     | *     | #    | *   | #     | ### Justification            |
| Object | *Fede | #### | *No | ### * |                              |
| C      | ral** |  Non | n-F | [TOTA |                              |
| lass** |       | -Fed | ede | L]{.u |                              |
|        | #     | eral | ral | nderl |                              |
| **Cate | Funds |      | In- | ine}* |                              |
| gory** |       | ##   | Kin |       |                              |
|        |       | ###  | d** |       |                              |
|        |       | Cash |     |       |                              |
+--------+-------+------+-----+-------+------------------------------+
| *      | 0     | 0    | 0   | 0     | No equipment requested       |
| *Equip |       |      |     |       |                              |
| ment** |       |      |     |       |                              |
+--------+-------+------+-----+-------+------------------------------+
| **Supp | \$    |      | \   | \$    | Laptop computer for use in   |
| lies** | 1,500 |      | $2, | 3,500 | client intakes = \$1,340     |
|        |       |      | 000 |       |                              |
|        |       |      |     |       | Consumable supplies (paper,  |
|        |       |      |     |       | pens, etc.)                  |
|        |       |      |     |       |                              |
|        |       |      |     |       | \$100/mo x 12 months =       |
|        |       |      |     |       | \$1,200                      |
|        |       |      |     |       |                              |
|        |       |      |     |       | Copying \$80/mo x 12 months  |
|        |       |      |     |       | = \$ 960                     |
+--------+-------+------+-----+-------+------------------------------+
| **C    | \$20  | \$50 | 0   | \$25  | Contracts to A,B,C direct    |
| ontrac | 0,000 | ,000 |     | 0,000 | service providers (name      |
| tual** |       |      |     |       | providers)                   |
|        |       |      |     |       |                              |
|        |       |      |     |       | adult day care contractor =  |
|        |       |      |     |       | \$75,000                     |
|        |       |      |     |       |                              |
|        |       |      |     |       | respite care contractor in   |
|        |       |      |     |       | home= \$75,000               |
|        |       |      |     |       |                              |
|        |       |      |     |       | respite care contractor-NF = |
|        |       |      |     |       | \$50,000                     |
|        |       |      |     |       |                              |
|        |       |      |     |       | personal care/companion      |
|        |       |      |     |       | provider = \$50,000          |
|        |       |      |     |       |                              |
|        |       |      |     |       | See detailed budget          |
|        |       |      |     |       | justification for each       |
|        |       |      |     |       | provider (and then provide   |
|        |       |      |     |       | it!)                         |
+--------+-------+------+-----+-------+------------------------------+

+------+-------+------+------+-------+-------------------------------+
| At   |       |      |      |       |                               |
| tach |       |      |      |       |                               |
| ment |       |      |      |       |                               |
| B:   |       |      |      |       |                               |
| Bu   |       |      |      |       |                               |
| dget |       |      |      |       |                               |
| Na   |       |      |      |       |                               |
| rrat |       |      |      |       |                               |
| ive, |       |      |      |       |                               |
| Page |       |      |      |       |                               |
| 3 -- |       |      |      |       |                               |
| Sa   |       |      |      |       |                               |
| mple |       |      |      |       |                               |
| Fo   |       |      |      |       |                               |
| rmat |       |      |      |       |                               |
| with |       |      |      |       |                               |
| EXAM |       |      |      |       |                               |
| PLES |       |      |      |       |                               |
+------+-------+------+------+-------+-------------------------------+
| *    | \$1   | \$8  | \$19 | \$3   | Local conference registration |
| *Oth | 0,000 | ,000 | ,800 | 7,800 | fee (name conference) = \$    |
| er** |       |      |      |       | 200                           |
|      |       |      |      |       |                               |
|      |       |      |      |       | Printing brochures (50,000 @  |
|      |       |      |      |       | \$ .05 ea) = \$ 2,500         |
|      |       |      |      |       |                               |
|      |       |      |      |       | Video production = \$19,800   |
|      |       |      |      |       |                               |
|      |       |      |      |       | Video Reproduction = \$ 3,500 |
|      |       |      |      |       |                               |
|      |       |      |      |       | NF Respite Training Manual    |
|      |       |      |      |       | reproduction                  |
|      |       |      |      |       |                               |
|      |       |      |      |       | \$3/manual x \$2000 manuals = |
|      |       |      |      |       | \$ 6,000                      |
|      |       |      |      |       |                               |
|      |       |      |      |       | Postage \$150/mo x 12 months  |
|      |       |      |      |       | = \$ 1,800                    |
|      |       |      |      |       |                               |
|      |       |      |      |       | Caregiver Forum meeting room  |
|      |       |      |      |       | rentals                       |
|      |       |      |      |       |                               |
|      |       |      |      |       | \$200/day x 12 forums = \$    |
|      |       |      |      |       | 2,400                         |
|      |       |      |      |       |                               |
|      |       |      |      |       | Respite Training Scholarships |
|      |       |      |      |       | = \$1,600                     |
+------+-------+------+------+-------+-------------------------------+
| **   | 0     | 0    | 0    | 0     | None                          |
| Indi |       |      |      |       |                               |
| rect |       |      |      |       |                               |
| C    |       |      |      |       |                               |
| harg |       |      |      |       |                               |
| es** |       |      |      |       |                               |
+------+-------+------+------+-------+-------------------------------+
| ###  | \$26  | \$60 | \$27 | \$35  |                               |
| ## T | 5,700 | ,800 | ,767 | 4,267 |                               |
| OTAL |       |      |      |       |                               |
+------+-------+------+------+-------+-------------------------------+

Attachment C: Budget Narrative -- Page 1 -- Sample Format

+-------+-----+-----+-----+--------+---------------------------------+
| > **O | **F | **N | **N | #      | ### Justification               |
| bject | ede | on- | on- |  TOTAL |                                 |
| >     | ral | Fed | Fed |        |                                 |
| Class | F   | era | era |        |                                 |
| >     | und | l** | l** |        |                                 |
| Categ | s** |     |     |        |                                 |
| ory** |     | **  | **  |        |                                 |
|       |     | Cas | In- |        |                                 |
|       |     | h** | Kin |        |                                 |
|       |     |     | d** |        |                                 |
+-------+-----+-----+-----+--------+---------------------------------+
| **P   |     |     |     |        |                                 |
| erson |     |     |     |        |                                 |
| nel** |     |     |     |        |                                 |
+-------+-----+-----+-----+--------+---------------------------------+
| **F   |     |     |     |        |                                 |
| ringe |     |     |     |        |                                 |
| Benef |     |     |     |        |                                 |
| its** |     |     |     |        |                                 |
+-------+-----+-----+-----+--------+---------------------------------+
| **Tra |     |     |     |        |                                 |
| vel** |     |     |     |        |                                 |
+-------+-----+-----+-----+--------+---------------------------------+
| **E   |     |     |     |        |                                 |
| quipm |     |     |     |        |                                 |
| ent** |     |     |     |        |                                 |
+-------+-----+-----+-----+--------+---------------------------------+

**Attachment C: Budget Narrative -- Page 2 -- Sample Format**

+--------+-----+-----+-----+--------+--------------------------------+
| > **   | **F | **N | **N | #      | ### Justification              |
| Object | ede | on- | on- |  TOTAL |                                |
| >      | ral | Fed | Fed |        |                                |
|  Class | F   | era | era |        |                                |
| > Cate | und | l** | l** |        |                                |
| gory** | s** |     |     |        |                                |
|        |     | **  | **  |        |                                |
|        |     | Cas | In- |        |                                |
|        |     | h** | Kin |        |                                |
|        |     |     | d** |        |                                |
+--------+-----+-----+-----+--------+--------------------------------+
| **Supp |     |     |     |        |                                |
| lies** |     |     |     |        |                                |
+--------+-----+-----+-----+--------+--------------------------------+
| **C    |     |     |     |        |                                |
| ontrac |     |     |     |        |                                |
| tual** |     |     |     |        |                                |
+--------+-----+-----+-----+--------+--------------------------------+
| **O    |     |     |     |        |                                |
| ther** |     |     |     |        |                                |
+--------+-----+-----+-----+--------+--------------------------------+
| **In   |     |     |     |        |                                |
| direct |     |     |     |        |                                |
| Cha    |     |     |     |        |                                |
| rges** |     |     |     |        |                                |
+--------+-----+-----+-----+--------+--------------------------------+
| #####  |     |     |     |        |                                |
|  TOTAL |     |     |     |        |                                |
+--------+-----+-----+-----+--------+--------------------------------+

Attachment D: Project Work Plan, Page 1 -- Sample Format

  --------------- ------------------------------- ---------- ------------- -- -- -- -- -- -- -- -- -- -- -- --
  **Goal:**                                                                                                 

  **Measurable                                                                                              
  Outcome(s):**                                                                                             

  **Major         **Key Tasks**                   **Lead     **Timeframe                                    
  Objectives**                                    Person**   (Start and                                     
                                                             End Date by                                    
                                                             Month)**                                       

  1\.                                                                                                       

                                                                                                            

                                                                                                            

                                                                                                            

  2\.                                                                                                       

                                                                                                            

                                                                                                            

                                                                                                            
  --------------- ------------------------------- ---------- ------------- -- -- -- -- -- -- -- -- -- -- -- --

Attachment D: Project Work Plan, Page 2 -- Sample Format

  -------------- -------------------------- ---------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- -------- -------- --------
  **Major        **Key Tasks**              **Lead     **Timeframe                                                                                     
  Objectives**                              Person**   (Start and                                                                                      
                                                       End Date by                                                                                     
                                                       Month)**                                                                                        

                                                       **1**         **2**   **3**   **4**   **5**   **6**   **7**   **8**   **9**   **10**   **11**   **12**

  3\.                                                                                                                                                  

                                                                                                                                                       

                                                                                                                                                       

                                                                                                                                                       

  4\.                                                                                                                                                  

                                                                                                                                                       

                                                                                                                                                       

                                                                                                                                                       
  -------------- -------------------------- ---------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- -------- -------- --------

Attachment D: Project Work Plan, Page 3 -- Sample Format

  -------------- -------------------------- ---------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- -------- -------- --------
  **Major        **Key Tasks**              **Lead     **Timeframe                                                                                     
  Objectives**                              Person**   (Start and                                                                                      
                                                       End Date by                                                                                     
                                                       Month)**                                                                                        

                                                       **1**         **2**   **3**   **4**   **5**   **6**   **7**   **8**   **9**   **10**   **11**   **12**

  5\.                                                                                                                                                  

                                                                                                                                                       

                                                                                                                                                       

                                                                                                                                                       

  6\.                                                                                                                                                  

                                                                                                                                                       

                                                                                                                                                       

                                                                                                                                                       
  -------------- -------------------------- ---------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- -------- -------- --------

NOTE: Please do note infer from this sample format that your work plan
must have 6 major objectives. If you need more pages, simply repeat this
format on additional pages.

**Attachment E**

Instructions for Completing the Project Summary/Abstract

-   All applications for grant funding must include a Summary/Abstract
    that concisely describes the proposed project. It should be written
    for the general public.

```{=html}
<!-- -->
```
-   To ensure uniformity, please limit the length to no more than 300
    words on a single page with a Times Roman font size of not less than
    12, doubled-spaced.

-   The abstract must include the project's goal(s), objectives, overall
    approach (including target population and significant partnerships),
    anticipated outcomes, products, and duration. The following are very
    simple descriptions of these terms, and a sample Compendium
    abstract.

> **Goal(s)** -- broad, overall purpose, usually in a mission statement,
> i.e. what you want to do, where you want to be
>
> **Objective(s)** -- narrow, more specific, identifiable or measurable
> steps toward a goal. Part of the planning process or sequence (the
> "how"). Specific performances which will result in the attainment of a
> goal.
>
> **Outcomes -** measurable results of a project. Positive benefits or
> negative changes, or measurable characteristics that occur as a result
> of an organization's or program's activities. (outcomes are the
> end-point)

**Products --** materials, deliverables.

-   A model abstract/summary is provided below:

The grantee, Okoboji University, supports this three year Dementia
Disease demonstration (DD) project in collaboration with the local
Alzheimer's Association

and related Dementias groups. The [goal]{.underline} of the project is
to provide comprehensive, coordinated care to individuals with memory
concerns and to their caregivers. The approach is to expand the services
and to integrate the bio-psycho-social aspects of care. The
[objectives]{.underline} are: 1) to provide dementia specific care,
i.e., care management fully integrated into the services provided; 2) to
train staff, students and volunteers; 3) to establish a system
infrastructure to support services to individuals with early stage
dementia and to their caregivers; 4) to develop linkages with community
agencies; 5) to expand the assessment and intervention services; 6) to
evaluate the impact of the added services; 7) to disseminate project
information. The expected [outcomes]{.underline} of this DD project are:
patients will maintain as high a level of mental function and physical
functions (thru Yoga) as possible; caregivers will increase ability to
cope with changes; and pre and post -- project patient evaluation will
reflect positive results from expanded and integrated services. The
[products]{.underline} from this project are: a final report, including
evaluation results; a website; articles for publication; data on driver
assessment and in-home cognitive retraining; abstracts for national
conferences.

**Applicant's (Organization) Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Applicant's DUNS Number:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Grant Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_CFDA
Number: \_\_\_\_\_\_\_\_\_\_\_\_\_**

1\. Does the applicant have 501(c)(3) status?

Yes No

2\. How many full-time equivalent employees does the applicant have?
*(Check only one box).*

> 3 or Fewer 15-50
>
> 4-5 51-100
>
> 6-14 over 100

3\. What is the size of the applicant's annual budget? *(Check only one
box.)*

Less Than \$150,000

\$150,000 - \$299,999

\$300,000 - \$499,999

\$500,000 - \$999,999

\$1,000,000 - \$4,999,999

\$5,000,000 or more

4\. Is the applicant a faith-based/religious\
organization?

Yes No

5\. Is the applicant a non-religious community-based organization?

Yes No

6\. Is the applicant an intermediary that will manage the grant on
behalf of other organizations?

> Yes No

7\. Has the applicant ever received a government grant or contract
(Federal, State, or local )?

Yes No

8\. Is the applicant a local affiliate of a national\
organization?

Yes No

# Survey Instructions on Ensuring Equal Opportunity for Applicants

**Provide the applicant's (organization) name and DUNS number and the
grant name and CFDA number.**

1\. 501(c)(3) status is a legal designation provided on application to
the Internal Revenue Service by eligible organizations. Some grant
programs may require nonprofit applicants to have 501(c)(3) status.
Other grant programs do not.

2\. For example, two part-time employees who each work half-time equal
one full-time equivalent employee. If the applicant is a local affiliate
of a national organization, the responses to survey questions 2 and 3
should reflect the staff and budget size of the local affiliate.

3\. Annual budget means the amount of money your organization spends
each year on all of its activities.

4\. Self-identify.

5\. An organization is considered a community-based organization if its
headquarters/service location shares the same zip code as the clients
you serve.

6\. An "intermediary" is an organization that enables a group of small
organizations to receive and manage government funds by administering
the grant on their behalf.

7.  Self-explanatory.

8.  Self-explanatory.

**Paperwork Burden Statement**

According to the Paperwork Reduction Act of 1995, no persons are
required to respond to a collection of information unless such
collection displays a valid OMB control number. The valid OMB control
number for this information collection is 1890-0014. The time required
to complete this information collection is estimated to average five (5)
minutes per response, including the time to review instructions, search
existing data resources, gather the data needed, and complete and review
the information collection. **If you have any comments concerning the
accuracy of the time estimate(s) or suggestions for improving this form,
please write to:** U.S. Department of Education, Washington, D.C.
2202-4651.

**If you have comments or concerns regarding the status of your
individual submission of this form, write directly to:** Joyce I. Mays,
Application Control Center, U.S. Department of Education, 7^th^ and D
Streets, SW, ROB-3, Room 3671, Washington, D.C. 20202-4725

> OMB No. 1890-0014 Exp. 1/31/2008