Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

**Linking Adolescents at Risk for Suicide to Mental Health Services
Program Supplements**

**(Short title: Adolescents at Risk Supplements)**

**(Initial Announcement)**

**Request for Applications (RFA) No. SM-07-015**

[]{.mark}

[]{.mark}

**Catalogue of Federal Domestic Assistance (CFDA) No**.: 93.243

**Key Dates:**

+----------------------+-----------------------------------------------+
| **Application        | **Applications are due by May 1, 2007**       |
| Deadline**           |                                               |
+----------------------+-----------------------------------------------+
| **Intergovernmental  | **Letters from State Single Point of Contact  |
| Review**             | (SPOC) are due no later than 60 days after    |
|                      | the application deadline.**                   |
| **(E.O. 12372)**     |                                               |
+----------------------+-----------------------------------------------+
| **Public Health      | **Applicants must send the PHSIS to           |
| System Impact        | appropriate State and local health agencies   |
| Statement            | by the application deadline. Comments from    |
| (PHSIS)/Single State | Single State Agency are due no later than 60  |
| Agency               | days after the application deadline.**        |
| Coordination**       |                                               |
+----------------------+-----------------------------------------------+

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

A. Kathryn Power, M.Ed. Terry L. Cline, Ph.D.

Director Administrator

Center for Mental Health Services Substance Abuse and Mental Health

Substance Abuse and Mental Health Services Administration

Services Administration

**Table of Contents**

[**I.** **FUNDING OPPORTUNITY DESCRIPTION**
3](#i.-funding-opportunity-description)

[**II.** **AWARD INFORMATION** 7](#ii.-award-information)

[1. AWARD AMOUNT 7](#award-amount)

[2. FUNDING MECHANISM 7](#funding-mechanism)

[**III.** **ELIGIBILITY INFORMATION** 8](#iii.-eligibility-information)

[1. ELIGIBLE APPLICANTS 8](#eligible-applicants)

[2. COST-SHARING 8](#cost-sharing)

[3. OTHER 8](#other)

[**IV.** **APPLICATION AND SUBMISSION INFORMATION**
8](#iv.-application-and-submission-information)

[1. ADDRESS TO REQUEST APPLICATION PACKAGE
8](#address-to-request-application-package)

[2. CONTENT AND FORM OF APPLICATION SUBMISSION
9](#content-and-form-of-application-submission)

[3. SUBMISSION DATES AND TIMES 11](#submission-dates-and-times)

[4. INTERGOVERNMENTAL REVIEW (E.O. 12372) REQUIREMENTS
11](#intergovernmental-review-e.o.-12372-requirements)

[5. FUNDING RESTRICTIONS 13](#funding-restrictions)

[6. OTHER SUBMISSION REQUIREMENTS 13](#other-submission-requirements)

[**V.** **APPLICATION REVIEW INFORMATION**
15](#v.-application-review-information)

[1. EVALUATION CRITERIA 15](#evaluation-criteria)

[2. REVIEW AND SELECTION PROCESS 19](#review-and-selection-process)

[**VI.** **AWARD ADMINISTRATION INFORMATION**
19](#vi.-award-administration-information)

[1. AWARD NOTICES 19](#award-notices)

[2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS
19](#administrative-and-national-policy-requirements)

[3. REPORTING REQUIREMENTS 20](#reporting-requirements)

[**VII.** **AGENCY CONTACTS** 21](#vii.-agency-contacts)

[**Appendix A -- Checklist for Formatting Requirements and Screenout
Criteria for SAMHSA Grant Applications**
22](#appendix-a-checklist-for-formatting-requirements-and-screenout-criteria-for-samhsa-grant-applications)

[**Appendix B -- Guidance for Electronic Submission of Applications**
24](#appendix-b-guidance-for-electronic-submission-of-applications)

[Appendix C -- Confidentiality and Participant Protection
27](#appendix-c-confidentiality-and-participant-protection)

[Appendix D -- Funding Restrictions
31](#appendix-d-funding-restrictions)

[Appendix E -- Sample Budget and Justification
33](#appendix-e-sample-budget-and-justification)

### **I. FUNDING OPPORTUNITY DESCRIPTION** {#i.-funding-opportunity-description .unnumbered}

The Substance Abuse and Mental Health Services Administration (SAMHSA),
Center for Mental Health Services announces the availability of funds
for fiscal year (FY) 2007 to expand/enhance grant activities funded
under the Linking Adolescents at Risk for Suicide to Mental Health FY
2005 grant announcement.

The purpose of these program supplements is to expand and enhance
activities established under the initial grant. These activities include
the evaluation of existing voluntary school-based practices that focus
on identifying high school youth at risk for suicide or suicide
attempts, the processes by which these youth are referred to appropriate
mental health treatment and/or other services, and the outcomes of these
processes. Comprehensive evaluation of these elements is expected to
strengthen the evidence base of the programs so they will *move toward*
readiness for review by SAMHSA's National Registry of Effective Programs
and Practices (NREPP). In addition, these supplements will enable
grantees to investigate two key issues that are essential to
implementing suicide prevention programs in schools:

-   Engagement of youth, parents/legal guardians/other caregivers in the
    overall suicide prevention program; and

-   Schools' organizational and contextual factors that impact the
    delivery and evaluation of the suicide prevention practice.

Adolescents at Risk Supplements are authorized under Section 520A of the
Public Health Service Act, as amended. This announcement addresses
Healthy People 2010 focus area 18 (Mental Health and Mental Disorders).

**1. Allowable Activities**

At a minimum, the funds awarded will be used to conduct the following
activities:

-   Evaluate a suicide prevention practice that has been in place and
    operated by the local educational agency or its designee for at
    least one year prior to the due date of the application.

-   Evaluate the processes by which these youth are referred to
    appropriate mental health treatment and/or other services.

-   Evaluate the outcomes of these processes.

-   Identify effective activities/practices to engage youth,
    parents/legal guardians/other caregivers in the school-based suicide
    prevention activities.

-   Evaluate the organizational and contextual factors of the school
    that impact the delivery and evaluation of the suicide prevention
    practice.

Grantees may use grant funds for the following allowable activities:

-   Convening relevant stakeholder meetings.

-   Alignment of management information systems with data collection
    needs.

-   Measurement instrument development/selection.

-   Data collection.

-   Database management.

-   Data and cost analysis.

-   Dissemination of results.

-   Refinement of logic model and practice manual based on evaluation
    results.

-   Continuing implementation of school-based suicide prevention
    practices that identify, assess, and refer youth at risk for suicide
    or suicide attempts. \[For example, grant funds may be used for
    staff doing the gatekeeper training, screening, or other functions
    related to the prevention practice itself. However, grant funds may
    **[not]{.underline}** be used to pay for the direct mental health
    treatment services to which a student identified as at-risk might be
    referred.\]

-   Working with practice developers on adaptations to ensure the
    cultural competence of the program while minimizing threats to
    fidelity.

-   Training personnel who will be involved in implementing the
    school-based suicide prevention program.

-   Identifying and documenting the school organizational and contextual
    factors that impact the delivery and evaluation of the suicide
    prevention practice.

-   Engaging parents/legal guardians/other caregivers in a
    culturally-sensitive manner in school-based suicide prevention
    activities, including, but not limited to, the following:

    -   Identifying and documenting the factors (e.g., cultural
        sensitivity, how parents/legal guardians/other caregivers are
        approached, previous experience with the school and/or person
        who approaches them, risk factors of parents/legal
        guardians/other caregivers, etc.) that influence the
        parental/legal guardian/other caregiver engagement.

    -   Ensuring that the families/legal guardians/other caregivers
        receive education about risk and protective factors for suicide
        and suicide attempts.

    -   Ensuring that families/legal guardians/other caregivers and
        youth receive assistance in accessing the mental health system.

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-   Obtaining active consent from parents/legal guardians for their
    children to participate in school-based suicide prevention
    activities.

-   Refining the memoranda of understanding (MOUs) submitted with the
    application. The MOU(s) that facilitate referral of at-risk youth
    and their parents/legal guardians/other caregivers to mental health
    treatment and/or other services should include, but are not limited
    to, the following:

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-   A description of the process for linking at-risk youth to mental
    health or other services.

-   Documentation for how emergency mental health intervention will be
    provided for youth at imminent risk for suicide.

-   Documentation of how youth with parental/legal guardian/caregiver
    permission to receive mental health services will receive those
    services without being placed on a waiting list.

-   A description of how uninsured youth referred for mental health
    services with parental/legal guardian/caregiver permission will
    receive services.

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-   Development of a structured and feasible policy for making decisions
    about response, referral, and further assessment when youth are
    identified to be at risk.

**2**. **Data Collection and Performance Measurement**

[GPRA]{.underline}

The Government Performance and Results Act of 1993 (P.L.103-62, or
"GPRA") requires all Federal agencies to set program performance targets
and report annually on the degree to which the previous year's targets
were met.

Agencies are expected to evaluate their programs regularly and to use
the results of these evaluations to explain their successes and failures
and justify requests for funding. To meet the GPRA requirements, SAMHSA
must collect performance data (i.e., "GPRA data") from grantees.
Grantees are required to report these GPRA data to SAMHSA on a timely
basis. Specifically, grantees will be required to report performance
data on the following SAMHSA National Outcome Measures (NOMs) for
Services:

1\. Increased access to services/number of persons served by age,
gender, race and ethnicity.

2\. Clients reporting positively about outcomes.

In addition, grantees will be required to report performance data on
relevant NOMs for Infrastructure which are currently under development.
The infrastructure measures will be drawn from the following domains:
policy development; workforce development (number trained and level of
satisfaction with training -- CMHS training satisfaction form is under
development); financing; organizational restructuring; accountability;
types/targets of practices; and cost efficiency. In your application,
you must demonstrate your ability to collect and report on these
measures, and you may be required to provide some baseline data.

Grantees must collect and report data using a GPRA measures data
collection tool which is under development. The frequency of the data
collection will be finalized at a later date, but at a minimum, will be
required on an annual basis. Training data will be expected within 30
days from the date of the training. CMHS is in the final stages of
implementing a Web-based GPRA data collection and reporting system.
Grantees of SAMHSA's Adolescents at Risk grant program may be asked in
the future to submit their GPRA data electronically using this Web-based
system. When development of the system is complete, grantees will be
provided initial training and ongoing technical assistance in order to
ensure a smooth transition to the electronic system and continued user
support. Applicants must agree to comply with the Web-based submission
of performance data in Section C: Evaluation Design and Analysis of
their applications.

The terms and conditions of the grant award also will specify the data
to be submitted and the schedule for submission. Grantees will be
required to adhere to these terms and conditions of award.

[Data Collection Specific to this Grant Program]{.underline}

No cross-site evaluation will be conducted at this time. The evaluations
done by each grantee will focus on assessing the effectiveness of
existing voluntary school-based practices that aim to identify high
school youth at risk for suicide or suicide attempts, the processes by
which these youth are referred to appropriate mental health and/or other
services, and the outcomes of these processes. In addition, grantees
will evaluate practice support issues related to school-related
organization and context and engaging parents/legal guardians/other
caregivers in the school-based suicide prevention activities. Factors to
be considered include, but are not limited to, the following:

[The School-Based Suicide Prevention Practice]{.underline}

-   Evaluation will vary by school-based suicide prevention practice.

    [Student Identification and Referral]{.underline}

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-   The extent to which the practice successfully identifies high school
    youth who are at risk for suicide or suicide attempts.

-   The extent to which gatekeepers, once they are trained, follow
    through with identifying, assessing, and referring at-risk students.

-   The processes by which identified high-risk students are assessed as
    being in need of mental health and/or other services.

-   The characteristics of high-risk students referred for mental health
    and/or other services.

-   The processes by which identified high-risk students are referred
    for mental health and/or other services.

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```
-   The process by which parents/legal guardians/other caregivers are
    informed that their children are at risk, and how they react to the
    information.

-   The percentage of high-risk students referred for mental health
    and/or other services that are successfully linked to services.

    [Service Linkage and Enrollment]{.underline}

-   The characteristics of high-risk students who are successfully
    linked to mental health and/or other services following referral. If
    possible, compare these students to the referred students who are
    not successfully linked.

-   How long students remain in mental health and/or other services
    following initial linkage.

-   The types of services students receive following identification and
    referral.

-   The extent to which parents/legal guardians/other caregivers of
    at-risk youth accept recommendations for mental health and/or other
    services.

-   The extent to which parents/legal guardians/other caregivers are
    satisfied with mental health and/or other services received.

-   The factors that determine whether a parent/legal guardian/other
    caregiver does or does not accept recommendations for mental health
    and/or other services.

-   The extent to which parents/legal guardians/other caregivers are
    involved in a student's mental health treatment and/or other
    services.

-   The types of barriers to receiving mental health and/or other
    services encountered by students and their parents/legal
    guardians/other caregivers and activities helpful in overcoming
    those barriers.

    [School Organization/Context]{.underline}

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-   Elements of the school culture that facilitate or hinder the suicide
    prevention activities.

-   Administrative and staff buy-in and participation in the suicide
    prevention activities.

-   Integration of practices being evaluated into ongoing school
    activities.

-   Stigma surrounding mental health and suicide prevention.

    [Engagement of Parents/Legal Guardians/Other Caregivers]{.underline}

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-   Factors involved in the successful or unsuccessful engagement of
    parents/legal guardians/other caregivers in school-based suicide
    prevention activities.

-   The most (and least) effective activities to engage parents/legal
    guardians/other caregivers in school-based suicide prevention
    activities.

-   The extent to which parents/legal guardians/other caregivers are
    satisfied with school-based suicide prevention activities.

-   Factors that influence whether a parent/legal guardian/other
    caregiver decides to provide active consent for his/her child to
    participate in school-based suicide prevention activities.

3.  **Grantee Meetings**

Grantees must plan to send a minimum of two people (including the
Project Director) to at least one joint grantee meeting during the
one-year grant period, and you must include funding for this travel in
your budget. At these meetings, grantees will present the results of
their projects and Federal staff will provide technical assistance. Each
meeting will be 3 days. These meetings will usually be held in the
Washington, D.C., area and attendance is mandatory.

### II. AWARD INFORMATION {#ii.-award-information .unnumbered}

# 1. AWARD AMOUNT {#award-amount .unnumbered}

The estimated funding available is \$1,858,000. Support for individual
projects funded under this announcement is not to exceed \$232,250 for
this one-year supplemental program. This amount includes both direct and
indirect costs. Proposed budgets cannot exceed the allowable amount. It
is expected that approximately 8 projects will be funded.

# 2. FUNDING MECHANISM {#funding-mechanism .unnumbered}

Awards will be made as grants.

### III. ELIGIBILITY INFORMATION {#iii.-eligibility-information .unnumbered}

# 1. ELIGIBLE APPLICANTS {#eligible-applicants .unnumbered}

Eligibility for this funding opportunity is limited to the entities
specified in the cover letter. Eligibility is limited because in working
on the activities in the FY 2005 grant program, these entities have made
substantial progress (and identified significant challenges) in the
evaluation of existing voluntary school-based suicide practices that
focus on identifying high school youth at risk for suicide or suicide
attempts, the processes by which these youth are referred to appropriate
mental health treatment and/or other services, and the outcomes of these
processes. They are in the best position to enhance these evaluations
and to investigate the school context in which the practice is
implemented and how best to engage parents/legal guardians/other
caregivers. It would not be possible for other entities to carry out the
activities of this grant announcement without having accomplished the
activities the eligible applicants have accomplished.

# 2. COST-SHARING  {#cost-sharing .unnumbered}

Cost-sharing is not required in this program.

# 3. OTHER {#other .unnumbered}

The applicant must use the PHS 5161-1 application package and comply
with the formatting requirements in Appendix A of this document and
certain program requirements, such as provisions relating to participant
protection and the protection of human subjects specified in Section V,
and Appendix C of this document.

### IV. APPLICATION AND SUBMISSION INFORMATION  {#iv.-application-and-submission-information .unnumbered}

# 1. ADDRESS TO REQUEST APPLICATION PACKAGE  {#address-to-request-application-package .unnumbered}

Required application forms and guidelines are included in this mailing.
You may download additional copies of the application forms from the
SAMHSA Web site at
[www.samhsa.gov/grants/index.aspx](http://www.samhsa.gov/grants/index.aspx).

Additional materials available on the SAMHSA web site include:

-   a technical assistance manual for potential applicants;

-   standard terms and conditions for SAMHSA grants;

-   guidelines and policies that relate to SAMHSA grants (e.g.,
    guidelines on cultural competence, consumer and family
    participation, and evaluation); and

-   list of certifications and assurances referenced in item 21 of the
    (SF) 424 v2.

# 2. CONTENT AND FORM OF APPLICATION SUBMISSION {#content-and-form-of-application-submission .unnumbered}

**2.1 Application Kit**

SAMHSA application kits include the following documents:

-   PHS 5161-1 (revised July 2000) -- Includes the application face
    page, budget forms, assurances, certification, and checklist. You
    must use the PHS 5161-1.

-   Cover Letter -- Invites applications from eligible applicant(s).

-   Request for Applications (RFA) -- Includes instructions for the
    grant application. This document is the RFA.

You must use all of the above documents in completing your application.

**2.2 Required Application Components**

Applications should be complete and contain all information needed for
review. In order for your application to be complete, it must include
the following 10 sections.

-   **Face Page --** Use Standard Form (SF) 424 v2, which is part of the
    PHS 5161-1. \[Note:

    Applicants must provide a Dun and Bradstreet (DUNS) number to apply
    for a grant or cooperative agreement from the Federal Government.
    SAMHSA applicants are required to provide their DUNS number on the
    face page of the application. Obtaining a DUNS number is easy and
    there is no charge. To obtain a DUNS number, access the Dun and
    Bradstreet Web site at
    [www.dunandbradstreet.com](http://www.dunandbradstreet.com/) or call
    1-866-705-5711. To expedite the process, let Dun and Bradstreet know
    that you are a public/private nonprofit organization getting ready
    to submit a Federal grant application.\]

-   **Abstract** -- Your total abstract should not be longer than 35
    lines. It should include the project name, population to be served
    (demographics and clinical characteristics),
    strategies/interventions, project goals and measurable objectives,
    including the number of people to be served annually and throughout
    the lifetime of the project, etc. In the first five lines or less of
    your abstract, write a summary of your project that can be used in
    publications, reporting to Congress or press releases.

-   **Table of Contents** -- Include page numbers for each of the major
    sections of your application and for each attachment.

-   **Budget Form** -- Use the SF 424A, which is part of the PHS 5161-1.
    Fill out Sections B, C, and E of the SF 424A. If you are requesting
    supplemental funding for one year, complete Section B only. A sample
    budget and justification is included in Appendix E of this document.

-   **Project Narrative and Supporting Documentation** -- The Project
    Narrative describes your project. It consists of Sections A
    through D. Sections A through D may not exceed 25 pages. More
    detailed instructions for completing each section of the Project
    Narrative are provided in Section V of this document under
    "Evaluation Criteria."

> The Supporting Documentation provides additional information necessary
> for the review of your application. This supporting documentation
> should be provided immediately following your Project Narrative in
> Sections E through G. There are no page limits for these sections,
> except for Section E, the Biographical Sketches/Job Descriptions.
> Additional instructions for completing these sections are included in
> Section V under "Supporting Documentation."

####### Attachments 1 through 3 -- In your application, include the attachments listed below. 

• *Attachment 1*: Data Collection Instruments/Interview Protocols

####### • *Attachment 2*: Sample Consent Forms {#attachment-2-sample-consent-forms .unnumbered}

####### • *Attachment 3*: Letter to the SSA (if applicable; see Section IV.4) {#attachment-3-letter-to-the-ssa-if-applicable-see-section-iv.4 .unnumbered}

-   **Assurances** -- Non-Construction Programs. Use Standard Form 424B
    found in the PHS 5161-1. You are also required to complete the
    Assurance of Compliance with SAMHSA Charitable Choice Statutes and
    Regulations Form SMA 170. This form will be provided in the
    application kit you receive.

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-   **Certifications** -- You must read the list of certifications
    provided on the SAMHSA Web site or in the application kit before
    signing the face page of the application.

-   **Disclosure of Lobbying Activities** -- Use Standard Form LLL found
    in the PHS 5161-1. Federal law prohibits the use of appropriated
    funds for publicity or propaganda purposes, or for the preparation,
    distribution, or use of the information designed to support or
    defeat legislation pending before the Congress or State
    legislatures. This includes "grass roots" lobbying, which consists
    of appeals to members of the public suggesting that they contact
    their elected representatives to indicate their support for or
    opposition to pending legislation or to urge those representatives
    to vote in a particular way.

-   **Checklist** -- Use the Checklist found in the PHS 5161-1. The
    Checklist ensures that you have obtained the proper signatures,
    assurances and certifications and is the last page of your
    application.

2.3 Application Formatting Requirements

Applications must comply with basic application requirements. Failure to
comply with these requirements may affect the ability of your
application to be funded. See Appendix A of this document for a list of
the specific formatting requirements and screenout criteria for SAMHSA
grant applications.

# 3. SUBMISSION DATES AND TIMES  {#submission-dates-and-times .unnumbered}

Applications are due by close of business on **May 1, 2007.**

Hand carried applications will not be accepted. Applications may be
shipped using only DHL, Federal Express (FedEx), United Parcel Service
(UPS), or the United States Postal Service (USPS).

> • **For packages submitted via DHL, Federal Express (FedEx), or United
> parcel Service (UPS), proof of timely submission shall be the date on
> the tracking label affixed to the package by the carrier upon receipt
> by the carrier. That date must be at least 24 hours prior to the
> application deadline. The date affixed to the package by the applicant
> will not be sufficient evidence of timely submission.**
>
> • For packages submitted via the United States Postal Service (USPS),
> proof of timely submission shall be a postmark not later than 1 week
> prior to the application deadline, and the following upon request by
> SAMHSA:
>
> ○ proof of mailing using USPS Form 3817 (Certificate of Mailing), or
>
> ○ a receipt from the Post Office containing the post office name,
> location, and date and time of mailing.

You will be notified by postal mail that your application has been
received.

**Failure to meet the timely submission requirements above may affect
the ability of your application to be reviewed.** Please remember that
mail sent to Federal facilities undergoes a security screening prior to
delivery. Allow sufficient time for your package to be delivered.

If an application is mailed to a location or office (including room
number) that is not designated for receipt of the application, and that
results in the designated office not receiving your application in
accordance with the requirements for timely submission, it may affect
the ability of your application to be funded.

SAMHSA will not accept or consider any applications sent by facsimile.

SAMHSA is collaborating with [www.Grants.gov](http://www.Grants.gov/) to
accept electronic submission of applications only for select funding
opportunities. Please refer to Appendix B for "Guidance for Electronic
Submission of Applications".

# 4. INTERGOVERNMENTAL REVIEW (E.O. 12372) REQUIREMENTS {#intergovernmental-review-e.o.-12372-requirements .unnumbered}

This grant program is covered under Executive Order 12372, as
implemented through Department of Health and Human Services (DHHS)
regulation at 45 CFR Part 100. Under this Order, States may design their
own processes for reviewing and commenting on proposed Federal
assistance under covered programs. Certain jurisdictions have elected to
participate in the EO process and have established State Single Points
of Contact (SPOCs). A current listing of SPOCs is included in the
application kit and can be downloaded from the Office of Management and
Budget (OMB) Web site at
[www.whitehouse.gov/omb/grants/spoc.html](http://www.whitehouse.gov/omb/grants/spoc.html).

-   Check the list to determine whether your State participates in this
    program. You **do not** need to do this if you are an American
    Indian/Alaska Native tribe or tribal organization.

    -   If your State participates, contact your SPOC as early as
        possible to alert him/her to the prospective application and to
        receive any necessary instructions on the State's review
        process.

    -   For proposed projects serving more than one State, you are
        advised to contact the SPOC of each affiliated State.

    -   The SPOC should send any State review process recommendations to
        the following address within 60 days of the application
        deadline. **For United States Postal Service:** Crystal
        Saunders, Director of Grant Review, Office of Program Services,
        Substance Abuse and Mental Health Services Administration, Room
        3-1044, 1 Choke Cherry Road, Rockville MD **20857**. Change the
        zip code to **20850** if you are using another delivery service.

In addition, if you are a community-based, non-governmental service
provider and you are not transmitting your application through the
State, you must submit a Public Health System Impact Statement
(PHSIS)[^1] to the head(s) of appropriate State or local health agencies
in the area(s) to be affected no later than the application deadline.
The PHSIS is intended to keep State and local health officials informed
of proposed health services grant applications submitted by
community-based, non-governmental organizations within their
jurisdictions. If you are a [State or local government or American
Indian/Alaska Native tribe or tribal organization, you are not subject
to these requirements]{.underline}.

This PHSIS consists of the following information:

-   a copy of the face page of the application (SF 424 v.2); and

-   a summary of the project, no longer than one page in length, that
    provides: 1) a description of the population to be served, 2) a
    summary of the services to be provided, and 3) a description of the
    coordination planned with appropriate State or local health
    agencies.

For SAMHSA grants, the appropriate State agencies are the Single State
Agencies (SSAs) for substance abuse and mental health. A listing of the
SSAs can be found on SAMHSA's web site at
[www.samhsa.gov](http://www.samhsa.gov/). If the proposed project falls
within the jurisdiction of more than one State, you should notify all
representative SSAs.

If applicable, you [must]{.underline} include a copy of a letter
transmitting the PHSIS to the SSA in **Attachment 3, "Letter to the
SSA**." The letter must notify the State that, if it wishes to comment
on the proposal, its comments should be sent not later than 60 days
after the application deadline to the following address. **For United
States Postal Service:** Crystal Saunders, Director of Grant Review,
Office of Program Services, Substance Abuse and Mental Health Services
Administration, Room 3-1044, 1 Choke Cherry Road, Rockville MD
**20857**. Change the zip code to **20850** if you are using another
delivery service.

In addition:

-   Applicants may request that the SSA send them a copy of any State
    comments.

-   The applicant must notify the SSA within 30 days of receipt of an
    award.

# 5. FUNDING RESTRICTIONS {#funding-restrictions .unnumbered}

Cost principles describing allowable and unallowable expenditures for
Federal grantees, including SAMHSA grantees, are provided in the
following documents, which are available at

<http://www.hhs.gov/grantsnet> (Grants Policies and Regulations):

-   Institutions of Higher Education: OMB Circular A-21

-   State and Local Governments and

> Federally Recognized Indian Tribal Governments: OMB Circular A-87

-   Nonprofit Organizations: OMB Circular A-122

-   Hospitals: 45 CFR Part 74, Appendix E

In addition, SAMHSA's Adolescents at Risk supplemental grant recipients
must comply with the following funding restriction:

> No more than 15% of the total grant award may be used for developing
> the infrastructure necessary for expansion of services.

**SAMHSA grantees must also comply with SAMHSA's standard funding
restrictions, which are included in** **Appendix D**.

# 6. OTHER SUBMISSION REQUIREMENTS {#other-submission-requirements .unnumbered}

You may submit your application in either electronic or paper format:

**[Submission of Electronic Applications]{.underline}**

SAMHSA is collaborating with [www.Grants.gov](http://www.Grants.gov/) to
accept electronic submission of applications. Electronic submission is
voluntary. No review points will be added or deducted, regardless of
whether you use the electronic or paper format.

To submit an application electronically, you must use the
[www.Grants.gov](http://www.Grants.gov/) apply site. You will be able to
download a copy of the application package from
[www.Grants.gov](http://www.Grants.gov/), complete it off-line, and then
upload and submit the application via the Grants.gov site. E-mail
submissions will not be accepted.

**Please refer to Appendix B for detailed instructions on submitting
your application electronically.**

**[Submission of Paper Applications]{.underline}**

You must submit an original application and 2 copies (including
appendices). The original and copies must not be bound. Do not use
staples, paper clips, or fasteners. Nothing should be attached, stapled,
folded, or pasted.

Send applications to the address below:

**For United States Postal Service:**

> Crystal Saunders, Director of Grant Review
>
> Office of Program Services
>
> Substance Abuse and Mental Health Services Administration
>
> Room 3-1044
>
> 1 Choke Cherry Road
>
> Rockville, MD **20857**

Change the zip code to **20850** if you are using another delivery
service.

Do not send applications to other agency contacts, as this could delay
receipt. Be sure to include "**Adolescents at Risk-SM-07-015**" in item
number 12 on the face page of any paper applications. If you require a
phone number for delivery, you may use (240) 276-1199.

**Hand carried applications will not be accepted. Applications may be
shipped using only DHL, Federal Express (FedEx), United Parcel Service
(UPS), or the United States Postal Service (USPS).**

**SAMHSA will not accept or consider any applications sent by
facsimile.**

### V. APPLICATION REVIEW INFORMATION {#v.-application-review-information .unnumbered}

# 1. EVALUATION CRITERIA {#evaluation-criteria .unnumbered}

-   The Project Narrative describes what you intend to do with your
    project and includes the Evaluation Criteria in Sections A-D below.
    Your application will be reviewed and scored according to the
    [quality]{.underline} of your response to the requirements in
    Sections A-D.

-   In developing the Project Narrative section of your application, use
    these instructions. **These are to be used instead of the "Program
    Narrative" instructions found in the PHS 5161-1**.

-   Independent reviewers will review and score your application and
    report to SAMHSA on the quality of your response to the requirements
    listed below, on issues that may impede the effective implementation
    of your project, and on participant protection issues that may need
    to be addressed. Deficiencies in your application may delay or
    prevent grant award or lead to special terms and conditions being
    placed on your award. In Sections A-D of the Project Narrative, you
    must clearly describe how you intend to use grant funds. Sections
    A-D of your application may not exceed 25 pages.

-   The Supporting Documentation you provide in Sections E-G and
    Attachments 1-3 will be considered by reviewers in assessing your
    response, along with the material in the project narrative.

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-   The number of points after each heading is the maximum number of
    points a review committee may assign to that section of your Project
    Narrative. Although scoring weights are not assigned to individual
    bullets, applicants are encouraged to respond to each bulleted
    statement.

**Section A**: **Progress to Date (20 points)**

> Describe your organization's experience with the existing grant
> program. Report on accomplishments to date. Discuss any
> obstacles/problems that have been encountered and actions taken
> towards their resolution.
>
> []{.mark}

**Section B:** **Proposed Approach for Program Expansion/Enhancement (30
points)**

> Describe your plans to expand or enhance your existing program and how
> your planned activities will meet the expected goals and objectives of
> the supplemental program. Clearly describe all activities that will be
> supported with the supplemental grant funds. With the goal of engaging
> youth, parents/legal guardians/caregivers, describe your plans to:

-   Involve youth, parents/legal guardians/caregivers in all suicide
    prevention activities from the outset;

-   Gain acceptance of the overall project among students, teachers,
    parents and other caregivers;

-   Obtain active consent from parents/legal guardians;

-   Inform youth, parents/legal guardians/caregivers about suicide risk
    and protective factors;

-   Assess and identify students at risk for suicide or suicide
    attempts;

-   Refer high-risk students for mental health treatment and/or other
    services; and

-   Assess how parents/legal guardians/caregivers decide whether to
    accept and/or participate in mental health treatment and/or other
    services.

> Identify any special issues you anticipate, especially any related to
> cultural competence, which may impact the willingness of youth,
> parents/legal guardians/caregivers to engage in the suicide prevention
> activities and to allow their children to participate in the
> activities.
>
> Discuss how the supplemental activities will be integrated into the
> ongoing project. Describe roles and responsibilities of collaborating
> organizations, where applicable. Where applicable, provide the
> projected number of persons to be served, along with a clinical and
> demographic description of the projected number of persons to be
> served. Demonstrate how the proposed approach appropriately addresses
> factors such as age, race, ethnicity, culture, and language of the
> target population.

**Section C:** **Implementation Plan and Staffing (15 points)**

> Present your plan for implementing and managing the supplemental
> activities. Include a timeline for implementation showing key
> activities, milestones and responsible staff. Identify any cash or
> in-kind contributions that will be made to the project by the
> applicant or other partnering organizations.

**Section D:** **Evaluation and Data Collection (35 points)**

> Describe how you will incorporate individuals served as a result of
> the supplemental activities into your ongoing Government Performance
> and Results Act (GPRA) activities. Remember to include evaluation and
> data collection costs in your requested budget.
>
> Provide an updated evaluation plan that incorporates the new
> activities to be funded with the supplemental funds. Identify data
> that will be collected to provide regular feedback to the project to
> determine if the goals of the supplemental program are being met.
> Include, as **Attachment 1** to your application, copies of the
> instruments and/or protocols you will use and include, in **Attachment
> 2**, copies of consent forms.
>
> Explicitly state your willingness to: 1) comply with all necessary
> GPRA requirements, including your willingness to collect any required
> NOMs data; 2) submit performance data to SAMHSA's Web-based data
> collection system when it becomes available; and 3) collaborate with
> Federal suicide prevention resources, as appropriate.
>
> []{.mark}

\[Note: If there is other information about your proposed project that
you deem important to the application, discuss it in the appropriate
section(s) above, while staying within the 25 page limit.\]

Although the budget for the proposed project is not an evaluation
criterion, the Review Group will be asked to comment on the
appropriateness of the budget after the merits of the application have
been considered.

SUPPORTING DOCUMENTATION

The supporting documentation for your application is made up of Sections
E through G. This documentation provides additional information
necessary for the review of your application. The supporting
documentation should be included immediately following Sections A
through D of the Project Narrative of your application. There are no
page limits for the supporting documentation, except for Section E,
Biographical Sketches/Job Descriptions. (There is no requirement to
conduct a literature review or to cite literature in your application.
However, if literature is cited, provide references, including titles
and authors.)

**Section E:** Biographical Sketches and Job Descriptions.

-   Include a biographical sketch for the Project Director and other key
    positions. Each sketch should be 2 pages or less. If the person has
    not been hired, include a position description and/or letter of
    commitment with a current biographical sketch from the individual.

-   Include job descriptions for key personnel. Job descriptions should
    be no longer that 1 page each.

-   Information on what should be included in biographical sketches and
    job descriptions can be found on page 22, Item 6, in the Program
    Narrative of the PHS 5161-1 instruction page, available at
    [www.hhs.gov/forms/PHS-5161-1.doc](http://www.hhs.gov/forms/PHS-5161-1.doc)
    .

**Section F:** Budget Justification, Existing Resources, Other Support.
Provide a narrative justification of the items included in your proposed
budget, as well as a description of existing resources and other
support, including any cost-sharing arrangements, you expect to receive
for the proposed project. An illustration of a budget and narrative
justification is included in Appendix E of this document.

**Section G:** Confidentiality and SAMHSA Participant Protection/Human
Subjects. You must describe and provide an update of your procedures
relating to Confidentiality, Participant Protection and the Protection
of Human Subjects Regulations in Section G of your application, using
the guidelines provided below. Number range CHAPTERProblems with
confidentiality, participant protection, and protection of human
subjects identified during peer review of your application may result in
the need to request additional information and may delay funding.

**[Confidentiality and Participant Protection]{.underline}:**

Because of the confidential nature of the work in which many SAMHSA
grantees are involved, it is important to have safeguards protecting
individuals from risks associated with their participation in SAMHSA
projects. All applicants must address the eight bullets below. If some
are not applicable or relevant to the proposed project, simply state
that they are not applicable and indicate why. In addition to addressing
these eight bullets, read the section that follows entitled Protection
of Human Subjects Regulations to determine if the regulations may apply
to your project. If so, you are required to describe the process you
will follow for obtaining Institutional Review Board (IRB) approval.
While we encourage you to keep your responses brief, there are no page
limits for this section and no points will be assigned by the Review
Committee. Problems with confidentiality, participant protection, and
the protection of human subjects identified during peer review of the
application may result in the delay of funding.

-   Identify foreseeable risks or adverse effects due to participation
    in the project and/or in the data collection (performance
    assessment) activities (including physical, medical, psychological,
    social, legal, and confidentiality) and provide your procedures for
    minimizing or protecting participants from these risks.

-   Identify plans to provide guidance and assistance in the event there
    are adverse effects to participants.

-   Describe the target population and explain why you are including or
    excluding certain subgroups. Explain how and who will recruit and
    select participants.

-   State whether participation in the project is voluntary or required.
    If you plan to provide incentives/compensate participants, specify
    the type (e.g., money, gifts, coupons), and the value of any such
    incentives.

-   Describe data collection procedures, including sources (e.g.,
    participants, school records) and the data collecting setting (e.g.,
    clinic, school). Provide copies of proposed data collection
    instruments and interview protocols in **Attachment 1** of your
    application, "Data Collection Instruments/Interview Protocols."
    State whether specimens such as urine and/or blood will be obtained
    and the purpose for collecting. If applicable, describe how the
    specimens and process will be monitored to ensure the safety of
    participants.

-   Explain how you will ensure privacy and confidentiality of
    participants' records, data collected, interviews, and group
    discussions. Describe where the data will be stored, safeguards
    (e.g., locked, coding systems, storing identifiers separate from
    data), and who will have access to the information.

-   Describe the process for obtaining and documenting consent from
    adult participants and assent from minors along with consent from
    their parents or legal guardians. Provide copies of all consent
    forms in **Attachment 2** of your application, "Sample Consent
    Forms." If needed, give English translations.

-   Discuss why the risks are reasonable compared to expected benefits
    from the project.

    **[Protection of Human Subjects Regulations]{.underline}**

    SAMHSA expects that most grantees funded under this announcement
    will not have to comply with the Protection of Human Subjects
    Regulations (45 CFR 46), which requires Institutional Review Board
    (IRB) approval. However, in some instances, the applicant's proposed
    performance assessment design may meet the regulation's criteria of
    research involving human subjects. Applicants whose projects must
    comply with the Human Subjects Regulations must, in addition to the
    bullets above, fully describe the process for obtaining IRB
    approval. While IRB approval is not required at the time of grant
    award, these grantees will be required, as a condition of award, to
    provide documentation that an Assurance of Compliance is on file
    with the Office for Human Research Protections (OHRP). IRB approval
    must be received in these cases prior to enrolling clients in the
    project. General information about Human Subjects Regulations can be
    obtained through OHRP at http://www.hhs.gov/ohrp, or
    ohrp@osophs.dhhs.gov, or (240) 453-6900. SAMHSA--specific questions
    should be directed to the program contact listed in Section VII of
    this announcement.

# 2. REVIEW AND SELECTION PROCESS {#review-and-selection-process .unnumbered}

SAMHSA applications are reviewed according to the evaluation criteria
listed in Section V. For those programs where the individual award is
over \$100,000, applications must also be reviewed by the appropriate
National Advisory Council.

Decisions to fund a grant are based on:

-   the strengths and weaknesses of the application as identified by the
    independent reviewers and, when applicable, approval by the Center
    for Mental Health Services' National Advisory Council;

-   availability of funds; and

-   equitable distribution of awards in terms of geography.

### VI. AWARD ADMINISTRATION INFORMATION {#vi.-award-administration-information .unnumbered}

# 1. AWARD NOTICES  {#award-notices .unnumbered}

After your application has been reviewed, you will receive a letter from
SAMHSA through postal mail that describes the general results of the
review, including the score that your application received.

If you are approved for funding, you will receive an **additional**
notice, the Notice of Grant Award, signed by SAMHSA's Grants Management
Officer. The Notice of Grant Award is the sole obligating document that
allows you to receive Federal funding for work on the grant project.

If you are not funded, you may re-apply if there is another receipt date
for the program.

## 2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS  {#administrative-and-national-policy-requirements .unnumbered}

If your application is funded, you must comply with all terms and
conditions of the grant award. SAMHSA's standard terms and conditions
are available on the SAMHSA Web site at
[www.samhsa.gov/grants/management.aspx](http://www.samhsa.gov/grants/management.aspx).

If your application is funded, you must also comply with the
administrative requirements outlined in 45 CFR Part 74 or 45 CFR Part
92, as appropriate. For more information see the SAMHSA Web site
(<http://www.samhsa.gov/grants/generalinfo/grant_reqs.aspx>).

-   Depending on the nature of the specific funding opportunity and/or
    your proposed project as identified during review, SAMHSA may
    negotiate additional terms and conditions with you prior to grant
    award. These may include, for example:

    -   actions required to be in compliance with confidentiality and
        participant protection/human subjects requirements;

    -   requirements relating to additional data collection and
        reporting;

    -   requirements relating to participation in a cross-site
        evaluation; or

    -   requirements to address problems identified in review of the
        application.

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-   If your application is funded, you will be held accountable for the
    information provided in the application relating to performance
    targets. SAMHSA program officials will consider your progress in
    meeting goals and objectives, as well as your failures and
    strategies for overcoming them, when making an annual recommendation
    to continue the grant and the amount of any continuation award.
    Failure to meet stated goals and objectives may result in suspension
    or termination of the grant award, or in reduction or withholding of
    continuation awards.

-   Grant funds cannot be used to supplant current funding of existing
    activities. "Supplant" is defined as replacing funding of a
    recipient's existing program with funds from a Federal grant.

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```
-   In an effort to improve access to funding opportunities for
    applicants, SAMHSA is participating in the U.S. Department of Health
    and Human Services "Survey on Ensuring Equal Opportunity for
    Applicants." This survey is included in the application kit for
    SAMHSA grants and is posted on the SAMHSA Web site. You are
    encouraged to complete the survey and return it, using the
    instructions provided on the survey form.

# 3. REPORTING REQUIREMENTS {#reporting-requirements .unnumbered}

You must comply with the following reporting requirements:

1.  **Progress and Financial Reports**

You will be required to submit semi-annual (i.e., twice a year) progress
and financial reports and a Financial Status Report at the end of the
one-year funding period. The format and requirements for completing and
submitting the reports will be provided to you by your Government
Project Officer (GPO).

**3.2 Publications**

Grantees funded under this program are required to notify the Government
Project Officer (GPO) and SAMHSA's Publications Clearance Officer
(240-276-2130) of any materials based on the SAMHSA-funded grant project
that are accepted for publication.

In addition, SAMHSA requests that grantees:

-   Provide the GPO and SAMHSA Publications Clearance Officer with
    advance copies of publications.

-   Include acknowledgment of the SAMHSA grant program as the source of
    funding for the project.

-   Include a disclaimer stating that the views and opinions contained
    in the publication do not necessarily reflect those of SAMHSA or the
    U.S. Department of Health and Human Services, and should not be
    construed as such.

SAMHSA reserves the right to issue a press release about any publication
deemed by SAMHSA to contain information of program or policy
significance to the substance abuse treatment/substance abuse
prevention/mental health services community.

###  {#section .unnumbered}

### VII. AGENCY CONTACTS {#vii.-agency-contacts .unnumbered}

For programmatic issues, contact:

Cynthia K. Hansen, Ph.D.

Center for Mental Health Services

Substance Abuse and Mental Health Services Administration

1 Choke Cherry Road, Room 6-1132

Rockville, Maryland 20857

\(240\) 276-1869

<cynthia.hansen@samhsa.hhs.gov>

For grants management issues, contact:

Kimberly Pendleton

Office of Program Services, Division of Grants Management

Substance Abuse and Mental Health Services Administration

1 Choke Cherry Road, Room 7-1097

Rockville, Maryland 20857

\(240\) 276-1421

<kimberly.pendleton@samhsa.hhs.gov>

### Appendix A -- Checklist for Formatting Requirements and Screenout Criteria for SAMHSA Grant Applications {#appendix-a-checklist-for-formatting-requirements-and-screenout-criteria-for-samhsa-grant-applications .unnumbered}

*SAMHSA's goal is to review all applications submitted for grant
funding. However, this goal must be balanced against SAMHSA's obligation
to ensure equitable treatment of applications. For this reason, SAMHSA
has established certain formatting requirements for its applications.
**If you do not adhere to these requirements, your application will be
screened out and returned to you without review.***

-   Use the PHS 5161-1 application.

-   Applications must be received by the application deadline or have
    proof of timely submission, as detailed in Section IV-3 of the grant
    announcement.

-   Information provided must be sufficient for review.

-   Text must be legible. (For Project Narratives submitted
    electronically in Microsoft Word, see separate requirements in
    Section IV-6 of this announcement under "Submission of Electronic
    Applications.")

• Type size in the Project Narrative cannot exceed an average of 15
characters per

inch, as measured on the physical page. (Type size in charts, tables,
graphs, and

footnotes will not be considered in determining compliance.)

• Text in the Project Narrative cannot exceed 6 lines per vertical inch.

-   Paper must be white paper and 8.5 inches by 11.0 inches in size.

-   To ensure equity among applications, the amount of space allowed for
    the Project Narrative cannot be exceeded. (For Project Narratives
    submitted electronically in Microsoft Word, see separate
    requirements in Section IV-6 of this announcement under "Submission
    of Electronic Applications.")

• Applications would meet this requirement by using all margins (left,
right, top, bottom) of at least one inch each, and adhering to the page
limit for the Project Narrative stated in the specific funding
announcement.

• Should an application not conform to these margin or page limits,
SAMHSA will use the following method to determine compliance: The total
area of the Project Narrative (excluding margins, but including charts,
tables, graphs and footnotes) cannot exceed 58.5 square inches
multiplied by the page limit. This number represents the full page less
margins, multiplied by the total number of allowed pages.

• Space will be measured on the physical page. Space left blank within
the Project Narrative (excluding margins) is considered part of the
Project Narrative, in determining compliance.

*To facilitate review of your application, follow these additional
guidelines. Failure to adhere to the following guidelines will not, in
itself, result in your application being screened out and returned
without review. However, the information provided in your application
must be sufficient for review. Following these guidelines will help
ensure your application is complete, and will help reviewers to consider
your application.*

-   The 10 application components required for SAMHSA applications
    should be included. These are:

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-   Face Page (Standard Form 424 v2, which is in PHS 5161-1)

-   Abstract

-   Table of Contents

-   Budget Form (Standard Form 424A, which is in PHS 5161-1)

-   Project Narrative and Supporting Documentation

-   Appendices

-   Assurances (Standard Form 424B, which is in PHS 5161-1)

-   Certifications

-   Disclosure of Lobbying Activities (Standard Form LLL, which is in
    PHS 5161-1)

-   Checklist (a form in PHS 5161-1)

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```
-   Applications should comply with the following requirements:

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-   Provisions relating to confidentiality and participant protection
    specified in Section V-1 of this announcement.

-   Budgetary limitations as specified in Sections I, II, and IV-5 of
    this announcement.

-   Documentation of nonprofit status as required in the PHS 5161-1.

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-   Pages should be typed single-spaced in black ink, with one column
    per page. Pages should not have printing on both sides.

-   Please number pages consecutively from beginning to end so that
    information can be located easily during review of the application.
    The cover page should be page 1, the abstract page should be page 2,
    and the table of contents page should be page 3. Appendices should
    be labeled and separated from the Project Narrative and budget
    section, and the pages should be numbered to continue the sequence.

-   The page limits for Appendices stated in the specific funding
    announcement should not be exceeded.

-   Send the original application and two copies to the mailing address
    in Section IV-6 of this document. Please do not use staples, paper
    clips, and fasteners. Nothing should be attached, stapled, folded,
    or pasted. Do not use heavy or lightweight paper or any material
    that cannot be copied using automatic copying machines. Odd-sized
    and oversized attachments such as posters will not be copied or sent
    to reviewers. Do not include videotapes, audiotapes, or CD-ROMs.

### Appendix B -- Guidance for Electronic Submission of Applications {#appendix-b-guidance-for-electronic-submission-of-applications .unnumbered}

If you would like to submit your application electronically, you may
search [www.Grants.gov](http://www.Grants.gov/) for the downloadable
application package by the funding announcement number (called the
opportunity number) or by the Catalogue of Federal Domestic Assistance
(CFDA) number. You can find the CFDA number on the first page of the
funding announcement.

You must follow the instructions in the User Guide available at the
[www.Grants.gov](http://www.Grants.gov/) apply site, on the Help page.
In addition to the User Guide, you may wish to use the following sources
for help:

-   By e-mail: <support@Grants.gov>

-   By phone: 1-800-518-4726 (1-800-518-GRANTS). The Customer Support
    Center is open from 7:00 a.m. to 9:00 p.m. Eastern Time, Monday
    through Friday, excluding Federal holidays.

**If this is the first time you have submitted an application through
Grants.gov, you must complete four separate registration processes
before you can submit your application. Allow at least two weeks (10
business days) for these registration processes, prior to submitting
your application.** The processes are: 1) DUNS Number registration; 2)
Central Contractor Registry (CCR) registration; 3) Credential Provider
registration; and 4) Grants.gov registration.

**It is strongly recommended that you submit your grant application
using Microsoft Office products (e.g., Microsoft Word, Microsoft Excel,
etc.).** If you do not have access to Microsoft Office products, you may
submit PDF files. Directions for creating PDF files can be found on the
Grants.gov Web site. Use of file formats other than Microsoft Office or
PDF may result in your file being unreadable by our staff.

The Project Narrative must be a separate document in the electronic
submission. Formatting requirements for SAMHSA grant applications are
described in Appendix A of this announcement. These requirements also
apply to applications submitted electronically, with the following
exceptions only for Project Narratives submitted electronically in
Microsoft Word. These requirements help ensure the accurate transmission
and equitable treatment of applications.

-   *Text legibility*: Use a font of Times New Roman 12, line spacing of
    single space, and all margins (left, right, top, bottom) of one inch
    each. Adhering to these standards will help to ensure the accurate
    transmission of your document. If the type size in the Project
    Narrative of an electronic submission exceeds 15 characters per
    inch, or the text exceeds 6 lines per vertical inch, SAMHSA will
    reformat the document to Times New Roman 12, with line spacing of
    single space. Please note that this may alter the formatting of your
    document, especially for charts, tables, graphs, and footnotes.

-   *Amount of space allowed for Project Narrative*: The Project
    Narrative for an electronic submission may not exceed 12,875 words.
    If the Project Narrative for an electronic submission exceeds the
    word limit and exceeds the allowed space as defined in Appendix A,
    then **any part of the Project Narrative in excess of these limits
    will not be submitted to review**. To determine the number of words
    in your Project Narrative document in Microsoft Word, select
    file/properties/statistics.

While keeping the Project Narrative as a separate document, please
consolidate all other materials in your application to ensure the fewest
possible number of attachments. Ensure all pages in your application are
numbered consecutively, with the exception of the standard forms in the
PHS-5161 application package. Please name and number your attachments,
indicating the order in which they should be assembled. Failure to
comply with these requirements may affect the successful transmission
and consideration of your application.

Applicants are strongly encouraged to submit their applications to
Grants.gov early enough to resolve any unanticipated difficulties prior
to the deadline. You may also submit a back-up paper submission of your
application. Any such paper submission must be received in accordance
with the requirements for timely submission detailed in Section IV-3 of
this announcement. The paper submission must be clearly marked:
**"Back-up for electronic submission."** The paper submission must
conform with all requirements for non-electronic submissions. If both
electronic and back-up paper submissions are received by the deadline,
the electronic version will be considered the official submission.

After you electronically submit your application, you will receive an
automatic acknowledgement from Grants.gov that contains a Grants.gov
tracking number. It is important that you retain this number. **Include
the Grants.gov tracking number in the top right corner of the face page
for any paper submission. Receipt of the tracking number is the only
indication that Grants.gov has successfully received and validated your
application. If you do not receive a Grants.gov tracking number, you may
want to contact the Grants.gov help desk for assistance.**

The Grants.gov Web site does not accept electronic signatures at this
time. Therefore, you must submit a signed paper original of the face
page (SF 424 v2), the assurances (SF 424B), and hard copy of any other
required documentation that cannot be submitted electronically. **You
must include the Grants.gov tracking number for your application on
these documents with original signatures, on the top right corner of the
face page, and send the documents to the following address. The
documents must be received at the following address within 5 business
days after your electronic submission.** Delays in receipt of these
documents may impact the score your application receives or the ability
of your application to be funded.

**For United States Postal Service:**

Crystal Saunders, Director of Grant Review

Office of Program Services

Substance Abuse and Mental Health Services Administration

Room 3-1044

1 Choke Cherry Road

Rockville, MD **20857**

ATTN: Electronic Applications

**For other delivery services, change the zip code to 20850.**

If you require a phone number for delivery, you may use (240) 276-1199.

## Appendix C -- Confidentiality and Participant Protection {#appendix-c-confidentiality-and-participant-protection .unnumbered}

1.  [Protect Clients and Staff from Potential Risks]{.underline}

-   Identify and describe any foreseeable physical, medical,
    psychological, social, and legal risks or potential adverse effects
    as a result of the project itself or any data collection activity.

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-   Describe the procedures you will follow to minimize or protect
    participants against potential risks, **including risks to
    confidentiality**.

-   Identify plans to provide guidance and assistance in the event there
    are adverse effects to participants.

-   Where appropriate, describe alternative treatments and procedures
    that may be beneficial to the participants. If you choose not to use
    these other beneficial treatments, provide the reasons for not using
    them.

2.  [Fair Selection of Participants]{.underline}

-   Describe the target population(s) for the proposed project. Include
    age, gender, and racial/ethnic background and note if the population
    includes homeless youth, foster children, children of substance
    abusers, pregnant women, or other targeted groups.

-   Explain the reasons for including groups of pregnant women,
    children, people with mental disabilities, people in institutions,
    prisoners, and individuals who are likely to be particularly
    vulnerable to HIV/AIDS.

-   Explain the reasons for [including or excluding]{.underline}
    participants.

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-   Explain how you will recruit and select participants. Identify who
    will select participants.

3.  [Absence of Coercion]{.underline}

-   Explain if participation in the project is voluntary or required.
    Identify possible reasons why participation is required, for
    example, court orders requiring people to participate in a program.

-   If you plan to compensate participants, state how participants will
    be awarded incentives (e.g., money, gifts, etc.).

-   State how volunteer participants will be told that they may receive
    services intervention even if they do not participate in or complete
    the data collection component of the project.

4.  [Data Collection]{.underline}

-   Identify from whom you will collect data (e.g., from participants
    themselves, family members, teachers, others). Describe the data
    collection procedures and specify the sources for obtaining data
    (e.g., school records, interviews, psychological assessments,
    questionnaires, observation, or other sources). Where data are to be
    collected through observational techniques, questionnaires,
    interviews, or other direct means, describe the data collection
    setting.

-   Identify what type of specimens (e.g., urine, blood) will be used,
    if any. State if the material will be used just for evaluation or if
    other use(s) will be made. Also, if needed, describe how the
    material will be monitored to ensure the safety of participants.

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-   Provide in **Attachment 1, "Data Collection Instruments/Interview
    Protocols,"** copies of [all]{.underline} available data collection
    instruments and interview protocols that you plan to use.

5.  [Privacy and Confidentiality]{.underline}

-   Explain how you will ensure privacy and confidentiality. Include who
    will collect data and how it will be collected.

-   Describe:

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-   How you will use data collection instruments.

-   Where data will be stored.

-   Who will or will not have access to information.

-   How the identity of participants will be kept private, for example,
    through the use of a coding system on data records, limiting access
    to records, or storing identifiers separately from data.

    **NOTE:** If applicable, grantees must agree to maintain the
    confidentiality of alcohol and drug abuse client records according
    to the provisions of **Title 42 of the Code of Federal Regulations,
    Part II.**

6.  [Adequate Consent Procedures]{.underline}

-   List what information will be given to people who participate in the
    project. Include the type and purpose of their participation.
    Identify the data that will be collected, how the data will be used
    and how you will keep the data private.

-   State:

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-   Whether or not their participation is voluntary.

-   Their right to leave the project at any time without problems.

-   Possible risks from participation in the project.

-   Plans to protect clients from these risks.

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-   Explain how you will get consent for youth, the elderly, people with
    limited reading skills, and people who do not use English as their
    first language.

    **NOTE:** If the project poses potential physical, medical,
    psychological, legal, social or other risks, you **must** obtain
    [written]{.underline} informed consent.

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-   Indicate if you will obtain informed consent from participants or
    assent from minors along with consent from their parents or legal
    guardians. Describe how the consent will be documented. For example:
    Will you read the consent forms? Will you ask prospective
    participants questions to be sure they understand the forms? Will
    you give them copies of what they sign?

-   Include, as appropriate, sample consent forms that provide for: (1)
    informed consent for participation in service intervention; (2)
    informed consent for participation in the data collection component
    of the project; and (3) informed consent for the exchange (releasing
    or requesting) of confidential information. The sample forms must be
    included in **Attachment 2, "Sample Consent Forms"**, of your
    application. If needed, give English translations.

    **NOTE:** Never imply that the participant waives or appears to
    waive any legal rights, may not end involvement with the project, or
    releases your project or its agents from liability for negligence.

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-   Describe if separate consents will be obtained for different stages
    or parts of the project. For example, will they be needed for both
    participant protection in treatment intervention and for the
    collection and use of data?

-   Additionally, if other consents (e.g., consents to release
    information to others or gather information from others) will be
    used in your project, provide a description of the consents. Will
    individuals who do not consent to having individually identifiable
    data collected for evaluation purposes be allowed to participate in
    the project?

7.  [Risk/Benefit Discussion]{.underline}

    Discuss why the risks are reasonable compared to expected benefits
    and importance of the knowledge from the project.

    **[Protection of Human Subjects Regulations]{.underline}**

Applicants may also have to comply with the Protection of Human Subjects
Regulations (45 CFR 46), depending on the evaluation and data collection
procedures proposed and the population to be served.

Applicants must be aware that even if the Protection of Human Subjects
Regulations do not apply to all projects funded, the specific evaluation
design proposed by the applicant may require compliance with these
regulations.

Applicants whose projects must comply with the Protection of Human
Subjects Regulations must describe the process for obtaining
Institutional Review Board (IRB) approval fully in their applications.
While IRB approval is not required at the time of grant award, these
applicants will be required, as a condition of award, to provide the
documentation that an Assurance of Compliance is on file with the Office
for Human Research Protections (OHRP) and that IRB approval has been
received prior to enrolling any clients in the proposed project.

General information about Protection of Human Subjects Regulations can
be obtained on the Web at <http://www.hhs.gov/ohrp>. You may also
contact OHRP by e-mail (<ohrp@osophs.dhhs.gov>[)]{.underline} or by
phone (240/453-6900). SAMHSA-specific questions related to Protection of
Human Subjects Regulations should be directed to the program contact
listed in Section VII of this RFA.

###  {#section-1 .unnumbered}

###  {#section-2 .unnumbered}

## Appendix D -- Funding Restrictions {#appendix-d-funding-restrictions .unnumbered}

SAMHSA grant funds must be used for purposes supported by the program
and may not be used to:

-   Pay for any lease beyond the project period.

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-   Provide services to incarcerated populations (defined as those
    persons in jail, prison, detention facilities, or in custody where
    they are not free to move about in the community).

-   Pay for the purchase or construction of any building or structure to
    house any part of the program. (Applicants may request up to
    \$75,000 for renovations and alterations of existing facilities, if
    necessary and appropriate to the project.)

-   Provide residential or outpatient treatment services when the
    facility has not yet been acquired, sited, approved, and met all
    requirements for human habitation and services provision. (Expansion
    or enhancement of existing residential services is permissible.)

-   Pay for housing other than residential mental health and/or
    substance abuse treatment.

-   Provide inpatient treatment or hospital-based detoxification
    services. Residential services are not considered to be inpatient or
    hospital-based services.

-   Make direct payments to individuals to induce them to enter
    prevention or treatment services. However, SAMHSA discretionary
    grant funds may be used for non-clinical support services (e.g., bus
    tokens, child care) designed to improve access to and retention in
    prevention and treatment programs.

-   Make direct payments to individuals to encourage attendance and/or
    attainment of prevention or treatment goals. However, SAMHSA
    discretionary grant funds may be used for non-cash incentives of up
    to \$25 to encourage attendance and/or attainment of prevention or
    treatment goals when the incentives are built into the program
    design and when the incentives are the minimum amount that is deemed
    necessary to meet program goals. A grantee or treatment or
    prevention provider may also provide up to \$20 or equivalent
    (coupons, bus tokens, gifts, child care, and vouchers) to
    individuals as incentives to participate in required data collection
    follow up. This amount may be paid for participation in each
    required interview.

-   Implement syringe exchange programs, such as the purchase and
    distribution of syringes and/or needles.

-   Pay for pharmacologies for HIV antiretroviral therapy, sexually
    transmitted diseases (STD)/sexually transmitted illnesses (STI), TB,
    and hepatitis B and C, or for psychotropic drugs.

SAMHSA will not accept a "research" indirect cost rate. The grantee must
use the "other sponsored program rate" or the lowest rate available.

## Appendix E -- Sample Budget and Justification {#appendix-e-sample-budget-and-justification .unnumbered}

**Illustration of a Sample Detailed Budget and**

**Narrative Justification to Accompany**

**SF 424A: Section B for 01 Budget Period**

**[OBJECT CLASS CATEGORIES]{.underline}**

**[Personnel]{.underline}**

**Job Annual Level of Salary being**

**Title** **Name Salary Effort Requested**

Project

Director J. Doe \$30,000 1.0 \$30,000

Secretary Unnamed \$18,000 0.5 \$ 9,000

Counselor R. Down \$25,000 1.0 \$25,000

> **Enter Personnel subtotal on 424A, Section B, 6.a. \$64,000**

**[Fringe Benefits]{.underline}** (24%) \$15,360

> **Enter Fringe Benefits subtotal on 424A, Section B, 6.b. \$15,360**

**[Travel]{.underline}**

2 trips for SAMHSA Meetings for 2 Attendees

(Airfare @ \$600 x 4 = \$2,400) + (per diem

@ \$120 x 4 x 6 days = \$2,880) \$5,280

Local Travel (500 miles x .24 per mile) 120

\[Note: Current Federal Government per diem rates are available at
www.gsa.gov\]

> **Enter Travel subtotal on 424A, Section B, 6.c. \$ 5,400**

**[Equipment]{.underline}** (List Individually)

> \"Equipment\" means an article of nonexpendable, tangible personal
> property having a useful life of more than one year and an acquisition
> cost which equals the lesser of (a) the capitalization level
> established by the governmental unit or nongovernmental applicant for
> financial statement purposes, or (b) \$5000.

**Enter Equipment subtotal on 424A, Section B, 6.d.**

**[Supplies]{.underline}**

Office Supplies \$500

Computer Software - 1 WordPerfect 500

**Enter Supplies subtotal on 424A, Section B, 6.e. \$1,000**

ILLUSTRATION OF DETAILED BUDGET AND NARRATIVE JUSTIFICATION (cont'd.)

**[Contractual Costs]{.underline}**

**Evaluation**

Job Name Annual Salary being Level of

Title Salary Requested Effort

Evaluator J. Wilson \$48,000 \$24,000 0.5

Other Staff \$18,000 \$18,000 1.0

Fringe Benefits (25%) \$10,500

**Travel**

2 trips x 1 Evaluator

(\$600 x 2) \$ 1,200

per diem @ \$120 x 6 720

Supplies (General Office) 500

Evaluation Direct \$54,920

Evaluation Indirect Costs (19%) \$10,435

Evaluation Subtotal \$65,355

**Training**

Job Name Level of Salary being

Title Effort Requested

Coordinator M. Smith 0.5 \$ 12,000

Admin. Asst. N. Jones 0.5 \$ 9,000

Fringe Benefits (25%) \$ 5,250

**Travel**

2 Trips for Training

Airfare @ \$600 x 2 \$ 1,200

Per Diem \$120 x 2 x 2 days 480

Local (500 miles x .24/mile) 120

**Supplies**

Office Supplies \$ 500

Software (WordPerfect) 500

**Other**

Rent (500 Sq. Ft. x \$9.95) \$ 4,975

Telephone 500

Maintenance (e.g., van) \$ 2,500

Audit \$ 3,000

Training Direct \$ 40,025

Training Indirect \$ -0-

**Enter Contractual subtotal on 424A, Section B, 6.f. \$105,380**

ILLUSTRATION OF DETAILED BUDGET AND NARRATIVE JUSTIFICATION (cont'd.)

**[Other]{.underline}**

Consultants = Expert @ \$250/day X 6 day \$ 1,500

(If expert is known, should list by name)

**Enter Other subtotal on 424A, Section B, 6.h. \$ 1,500**

**Total Direct Charges (sum of 6.a-6.h)**

**Enter Total Direct on 424A, Section B, 6.i. \$192,640**

**[Indirect Costs]{.underline}**

15% of Salary and Wages (copy of negotiated

indirect cost rate agreement attached)

**Enter Indirect subtotal of 424A, Section B, 6.j. \$ 9,600**

**[TOTALS]{.underline}**

**Enter TOTAL on 424A, Section B, 6.k. \$202,240**

**[JUSTIFICATION]{.underline}**

PERSONNEL - Describe the role and responsibilities of each position.

FRINGE BENEFITS - List all components of the fringe benefit rate.

EQUIPMENT - List equipment and describe the need and the purpose of the
equipment in relation to the proposed project.

SUPPLIES - Generally self-explanatory; however, if not, describe need.
Include explanation of how the cost has been estimated.

TRAVEL - Explain need for all travel other than that required by SAMHSA.

CONTRACTUAL COSTS - Explain the need for each contractual arrangement
and how these components relate to the overall project.

OTHER - Generally self-explanatory. If consultants are included in this
category, explain the need and how the consultant's rate has been
determined.

INDIRECT COST RATE - If your organization has no indirect cost rate,
please indicate whether your organization plans to a) waive indirect
costs if an award is issued, or b) negotiate and establish an indirect
cost rate with DHHS within 90 days of award issuance.

[CALCULATION OF FUTURE BUDGET PERIODS]{.underline}

[(based on first 12-month budget period)]{.underline}

Review and verify the accuracy of future year budget estimates.
Increases or decreases in the future years must be explained and
justified and no cost of living increases will be honored. (NOTE: new
salary cap of \$186,600 is effective for all FY 2007 awards.) \*

First Second Third

12-month 12-month 12-month

Period Period Period

Personnel

Project Director 30,000 30,000 30,000

Secretary\*\* 9,000 18,000 18,000

Counselor 25,000 25,000 25,000

TOTAL PERSONNEL 64,000 73,000 73,000

\*Consistent with the requirement in the most recent Appropriations
legislation.

\*\*Increased from 50% to 100% effort in 02 through 03 budget periods.

Fringe Benefits (24%) 15,360 17,520 17,520

Travel 5,400 5,400 5,400

Equipment -0- -0- -0-

Supplies\*\*\* 1,000 520 520

\*\*\*Increased amount in 01 year represents costs for software.

Contractual

Evaluation\*\*\*\* 65,355 67,969 70,688

Training 40,025 40,025 40,025

\*\*\*\*Increased amounts in 02 and 03 years are reflected of the
increase in client data collection.

Other 1,500 1,500 1,500

Total Direct Costs 192,640 205,934 208,653

Indirect Costs 9,600 9,600 9,600

(15% S&W)

TOTAL COSTS 202,240 216,884 219,603

The Federal dollars requested for all object class categories for the
first 12-month budget period are entered on Form 424A, Section B, Column
(1), lines 6a-6i. The [total]{.underline} Federal dollars requested for
the second up to the fifth 12-month budget periods are entered on Form
424A, Section E, Columns (b) -- (e), line 20. The RFA will specify the
maximum number of years of support that may be requested.

[^1]: approved by OMB under control no. 0920-0428; Public reporting
    burden for the Public Health System Reporting Requirement is
    estimated to average 10 minutes per response, including the time for
    copying the face page of SF 424 v2 and the abstract and preparing
    the letter for mailing. 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 OMB
    control number for this project is 0920-0428. Send comments
    regarding this burden to CDC Clearance Officer, 1600 Clifton Road,
    MS D-24, Atlanta, GA 30333, ATTN: PRA (0920-0428).