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

**Health Resources and Services Administration**

*Maternal and Child Health Bureau*

> *Genetic Services Branch*

*Division of Services for Children with Special Health Care Needs*

> ***Sickle Cell Disease and Newborn Screening Program***
>
> *New Competition*
>
> *HRSA-08-013*
>
> **Catalog of Federal Domestic Assistance (CFDA) No. 93.110**

**PROGRAM GUIDANCE**

Fiscal Year *2008*

Letter of Intent Due Date: October 12, 2007

**Application Due Date: December 4, 2007**

**Release Date: *September 28, 2007 ***

**Date of Issuance*: September 28, 2007***

> *Judith Hagopian, M.S.W., M.P.H.*
>
> *Project Officer*
>
> *Genetics Services Branch*
>
> *Telephone: 301-443-1080*

*Fax: 301-443-8604*

> Authority: Section 501(a)(2) of the Social Security Act, the Maternal
> and Child Health Federal set-Aside Program: Special Projects of
> Regional and National Significance (SPRANS) (42 U.S.C. 701)

[]{#__RefHeading___Toc175616962 .anchor}**Executive Summary**

The purpose of the Sickle Cell Disease and Newborn Screening program is
to enhance the follow-up services of state sickle cell disease newborn
screening programs and support community-based efforts that provide
hemoglobinopathy counseling, sickle cell disease related education,
referrals to a medical home and support services. As stated in House
Report107-229, of the Departments of Labor, Health and Human Services,
and Education, and Related Agencies Appropriation Bill of 2002, the
purpose of the program is "... to enhance the sickle cell disease
newborn screening program and its locally based outreach and counseling
efforts." This program's intent is to develop models that will enhance
access to comprehensive care for newborns diagnosed with sickle cell
disease or as carriers of sickle cell disease and their families,
relying on partnerships among State Title V and newborn screening
programs, local community-based sickle cell disease organizations,
sickle cell disease treatment centers and community-based primary care
providers.

HRSA will fund up to 17 demonstration grants for a period of three (3)
years subject to the availability of funding for years two (2) to three
(3), satisfactory grantee performance, and a determination that
continued funding is in the best interest of the government. No more
than two (2) applicants will be funded from any one state. These
demonstration grants will provide support to infants identified with
sickle cell disease or as carriers of sickle cell or other abnormal
hemoglobins and their families as well as work cooperatively with each
other and their other State and local partners and the funded SCD
National Coordinating and Evaluation Center (NCEC) to implement a model
program of SCD support services, counseling and carrier follow-up to
include notification, extended family testing, counseling and education
of affected individuals and families. The model should provide for a
seamless system for the early detection and proper management and
treatment of sickle cell disease and other complications of sickle cell
disease and assure ready access to a medical home and hospital care for
medical emergencies.

HRSA expects grantees to collaborate with the National Newborn Screening
Coordination and Evaluation Center to: (1) build upon the existing
knowledge base developed under previous Sickle Cell Disease and Newborn
Screening Grant cycles including beta testing and evaluating previous
developed tools/educational resources/brochures in multiple, diverse and
geographic separate communities. (No new materials need be developed
only adapted where necessary); (2) provide outreach and education to
emerging populations in a way that is culturally sensitive and work with
local groups that represent these emerging populations; (3) build upon
existing minimal data sets including collecting information regarding
carrier follow-up; (4) participate in a national evaluation of the
program; (5) work with State Medicaid agencies to implement the Medicaid
requirements of the Jobs Creation Act of 2004 as it relates to outreach
and education; and (6) strengthen the role of primary care providers to
incorporate sickle cell disease and newborn screening and carrier
follow-up as part of the standard continuum of care. Work with community
health centers and their health care providers, if available, to educate
about newborn screening and sickle cell disease; and (7) identify
best/promising practices.

**Guidance Table of Contents**

[Executive Summary 2](#__RefHeading___Toc175616962)

[I. Funding Opportunity Description 2](#__RefHeading___Toc175616964)

[**A.** **Purpose** 2](#__RefHeading___Toc175616965)

[**B. Background** 2](#__RefHeading___Toc175616966)

[**1.** **Health Resources and Services Administration**
2](#__RefHeading___Toc175616967)

[**2.** **Maternal and Child Health Bureau**
2](#__RefHeading___Toc175616968)

[**3.** **Division of Services for Children with Special Health Needs**
2](#__RefHeading___Toc175616969)

[**4.** **Genetic Services Branch** 2](#__RefHeading___Toc175616970)

[**5.** **Sickle Cell Disease** 2](#__RefHeading___Toc175616971)

[II. Award Information 2](#__RefHeading___Toc175616972)

[**1.** **Type of Award** 2](#__RefHeading___Toc175616973)

[**2.** **Summary of Funding** 2](#__RefHeading___Toc175616974)

[III. Eligibility Information 2](#__RefHeading___Toc175616975)

[**1.** **Eligible Applicants** 2](#Eligibility_who)

[**2.** **Cost Sharing/Matching** 2](#__RefHeading___Toc175616977)

[**3.** **Other** 2](#__RefHeading___Toc175616978)

[IV. Application and Submission Information
2](#__RefHeading___Toc175616979)

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

[**2.** **Content and Form of Application Submission**
2](#__RefHeading___Toc175616981)

[**i.** **Application Face Page** 2](#__RefHeading___Toc175616982)

[**ii.** **Table of Contents** 2](#__RefHeading___Toc175616983)

[**iii.** **Application Checklist** 2](#__RefHeading___Toc175616984)

[**iv.** **Budget** 2](#__RefHeading___Toc175616985)

[**v.** **Budget Justification** 2](#__RefHeading___Toc175616986)

[**vi.** **Staffing Plan and Personnel Requirements**
2](#__RefHeading___Toc175616987)

[**vii.** **Assurances** 2](#__RefHeading___Toc175616988)

[**viii.** **Certifications** 2](#__RefHeading___Toc175616989)

[**ix.** **Project Abstract** 2](#__RefHeading___Toc175616990)

[**x.** **Program Narrative** 2](#__RefHeading___Toc175616991)

[**xi.** **Program Specific Forms** 2](#__RefHeading___Toc175616992)

[**3. Submission Dates and Times** 2](#__RefHeading___Toc175616993)

[**4. Intergovernmental Review** 2](#Application_materials)

[**5. Funding Restrictions** 2](#__RefHeading___Toc175616995)

[**6. Other Submission Requirements** 2](#__RefHeading___Toc175616996)

[V. Application Review Information - Required
2](#__RefHeading___Toc175616997)

[**1. Review Criteria** 2](#Review_ReviewCriteria)

[**2.** **Review and Selection Process**
2](#__RefHeading___Toc175616999)

[**3.** **Anticipated Announcement and Award Dates**
2](#__RefHeading___Toc175617000)

[VI. Award Administration Information 2](#__RefHeading___Toc175617001)

[VII. Agency Contacts 2](#__RefHeading___Toc175617002)

[VIII. Other Information 2](#__RefHeading___Toc175617003)

[ix. Tips for Writing a Strong Application
2](#__RefHeading___Toc175617004)

[APPENDIX A: HRSA's Electronic Submission User Guide
2](#__RefHeading___Toc175617005)

[1. Introduction 2](#introduction)

[1.1 Document Purpose and Scope 2](#document-purpose-and-scope)

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

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

[2.1 Process Overview 2](#process-overview)

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

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

[2.4 Apply through Grants.gov 2](#apply-through-grants.gov)

[2.4.1 Find Funding Opportunity 2](#find-funding-opportunity)

[2.4.2 Download Application Package 2](#download-application-package)

[2.4.3 Complete Application 2](#complete-application)

[2.4.4 Submit Application 2](#submit-application)

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

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

[2.5.1 Verify Status of Application 2](#verify-status-of-application-1)

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

[2.5.3 Check Validation Errors 2](#check-validation-errors)

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

[2.5.5 Submit Application 2](#submit-application-1)

[3. Competing Application 2](#competing-application)

[3.1 Process Overview 2](#process-overview-1)

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

[3.3 Apply through Grants.gov 2](#apply-through-grants.gov-1)

[3.3.1 Find Funding Opportunity 2](#find-funding-opportunity-1)

[3.3.2 Download Application Package 2](#download-application-package-1)

[3.3.3 Complete Application 2](#complete-application-1)

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

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

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

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

[4.1.1 Font 2](#font)

[4.1.2 Paper Size and Margins 2](#paper-size-and-margins)

[4.1.3 Names 2](#names)

[4.1.4 Section Headings 2](#section-headings)

[4.1.5 Page Numbering 2](#page-numbering)

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

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

[4.3 Page Limit 2](#page-limit)

[5. Customer Support Information 2](#customer-support-information)

[5.1.1 Grants.gov Customer Support 2](#grants.gov-customer-support)

[5.1.2 HRSA Call Center 2](#hrsa-call-center)

[5.1.3 HRSA Program Support 2](#hrsa-program-support)

[6. FAQs 2](#faqs)

[6.1 Software 2](#software)

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

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

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

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

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

[6.2 Application Receipt 2](#application-receipt)

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

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

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

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

[6.3 Application Submission 2](#application-submission)

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

[6.4 Grants.gov 2](#grants.gov)

[Appendix B -- Registering and Applying Through Grants.gov
2](#__RefHeading___Toc175617065)

[APPENDIX C: MCHB Discretionary Grant Performance Measures
2](#__RefHeading___Toc175617066)

**APPENDIX D: FINANCIAL AND DEMOGRAPHIC
FORMS........................................................72**

[]{#__RefHeading___Toc175616964 .anchor}**I.** Funding Opportunity
Description

A.  []{#__RefHeading___Toc175616965 .anchor}**Purpose**

Authority: Section 501(a)(2) of the Social Security Act, the Maternal
and Child Health Federal set-Aside Program: Special Projects of Regional
and National Significance (SPRANS)(42 U.S.C. 701).

The purpose of the Sickle Cell Disease and Newborn Screening program is
to enhance the follow-up services of state sickle cell disease newborn
screening programs and support local community-based efforts that
provide hemoglobinopathy counseling, sickle cell disease related
education, referrals to health and support services and strengthen the
provision of medical home for affected persons. As stated in House
Report 107-229 of the Departments of Labor, Health and Human Services,
and Education, and Related Agencies Appropriation Bill, 2002, the
purpose of this program is ..."to enhance the sickle cell disease
newborn screening program and its locally based outreach and counseling
efforts." The program's intent is to develop models that will enhance
access to comprehensive care for newborns diagnosed with sickle cell
disease or as carriers of sickle cell disease and their families,
relying on partnerships among State Title V and newborn screening
programs, local community-based sickle cell disease organizations,
sickle cell disease treatment centers and community-based primary care
providers.

HRSA will fund up to 17 demonstration grants for a period of three (3)
years subject to the availability of funding for years two and three,
satisfactory grantee performance, and a determination that continued
funding is in the best interest of the government. No more than two (2)
applicants will be funded from any one state. These demonstration grants
will provide support to infants identified with sickle cell disease or
as carriers of sickle cell or other abnormal hemoglobins and their
families as well as work cooperatively with each other and their other
State and local partners and the funded national coordinating center to
implement a model program of SCD support services, counseling and
carrier follow-up to include notification, extended family testing,
counseling and education of affected individuals and families. The model
should provide for a seamless system for the early detection and proper
management and treatment of sickle cell disease and other complications
of sickle cell disease and assure ready access to a medical home and
hospital care for medical emergencies.

HRSA expects grantees to collaborate with the National Newborn Screening
Coordination and Evaluation Center to: (1) build upon the existing
knowledge base developed under previous Sickle Cell Disease and Newborn
Screening Grant cycles including beta testing and evaluating previous
developed tools/educational resources/brochures in multiple, diverse and
geographic separate communities.(No new materials need be developed only
adapted where necessary); (2) provide outreach and education to emerging
populations, working with local organizations that represent these
populations; (3) build upon existing data sets including collecting
information regarding carrier status and follow-up; (4) participate in a
national evaluation of the program; (5) work with State Medicaid
agencies to implement the Medicaid requirements of section 712 of the
Jobs Creation Act that relates to outreach and education; (6) strengthen
the role of primary care providers in sickle cell disease and newborn
screening and carrier follow-up as part of the standard continuum of
care. Work with federally qualified health center providers if possible;
and (7) identify best practices/promising practices.

1.  **Requirements:**

> The project must exhibit the following in the narrative section of the
> application:

-   [Documentation of the demographics, characteristics and needs of the
    population to be served, paying particular emphasis on the needs of
    emerging populations. An estimate of the number of individuals with
    sickle cell disease/carriers in the project catchment area by age,
    race, ethnicity and gender and the projected numbers to be
    served.]{.underline}

```{=html}
<!-- -->
```
-   Evidence of collaborative relationships with requisite stakeholders
    through memoranda of understanding, memoranda of agreement,
    contracts, or letters of agreement. Collaborative relationships
    should be reflected in the budget plan and/or quantitative and
    qualitative work matrix

-   Evidence of an effective partnership between a local community-based
    sickle cell disease organization and a comprehensive sickle cell
    treatment center that is apparent and in existence with sufficient
    funding provided to the sickle cell disease community-based
    organization. **[There must be a line item in the budget for funding
    a local community-based organization.]{.underline}**

```{=html}
<!-- -->
```
-   A collaborative relationship with their State's Title V and newborn
    screening program, and if there is one in existence, their state's
    sickle cell disease program. It is essential that there is a
    mechanism in place with the State Newborn Screening program that
    allows for the sharing of data (in compliance with HIPPA guidelines)
    to ensure follow-up, education and counseling by members of the
    Network regarding sickle cell disease and carrier status.

```{=html}
<!-- -->
```
-   A willingness to collaborate with community-based primary care
    providers, including federally qualified health centers to ensure
    that each client diagnosed with SCD and his/her family has access to
    services through a medical home;

-   A commitment to collaborate with the national sickle cell disease
    coordinating and evaluation center funded by this initiative and
    fellow grantees to collect and share information, and standardize
    education and counseling activities offered by the network of local,
    community-based projects. It is expected that the grantees implement
    or demonstrate effectiveness of emerging practices developed through
    the NCEC in its work with the previously funded NBS grantees as well
    as participate in the collection of information relevant to
    demonstrating the effectiveness of the program; and

-   A willingness to collaborate with the National Newborn Screening and
    Genetics Resources Center (NNSGRC), the Regional Genetics and
    Newborn Screening Collaboratives and with the Sickle Cell Disease
    Treatment Demonstration program (SCDTDP) whenever possible.

**[Supplemental Requirements]{.underline}**

-   The applicant should provide a description of the organizational
    structure and the decision-making process and approaches that will
    be employed to work cooperatively with its partners and MCHB. The
    applicant must include an effective communication plan that ensures
    regular meetings amongst the Network.

-   The applicant should describe the project's advisory body which
    should be multidisciplinary, multicultural and reflective of the
    public-private partnerships and community-based partners. The
    advisory board should include an adequate number of patients and
    family members of those affected

-   The applicant should propose a dissemination plan for materials
    produced by the project and develop marketing strategies to educate
    a variety of stakeholders and their constituents about sickle cell
    disease and newborn screening

-   The applicant should provide a qualitative and quantitative work
    matrix with timeframes that are tied to the tasks in the project
    proposal.

-   The applicant should have guidelines in place to assure privacy and
    confidentiality practices exercised in accordance with HIPPA. The
    applicant should be willing to obtain IRB approval if necessary.

-   If conducting newborn screening testing, the applicant must be
    compliant with the Clinical laboratory Improvement Act (CLIA) or CAP
    guidelines and show proof of certification.

-   The applicant should be aware of and compliant with the Clinical
    Laboratories Standard Institute's (CLSI LA27) Guidelines on Newborn
    Screening and Follow-up.

-   The applicant must **be aware of** the proponents of the Consensus
    Group of Public Health and clinical professionals and families)
    guidelines (CORN) that were published in a peer review journal.

-   The applicant should meet the General Instructions and Requirements
    in Section III.

2.  **Geographic Consideration**

-   No more than two (2) applicants will be funded from any one state.

    []{#__RefHeading___Toc175616966 .anchor}**B. Background**

    []{#__RefHeading___Toc175616967 .anchor}**1. Health Resources and
    Services Administration**

> The Health Resources and Services Administration (HRSA) envisions
> optimal health for all, supported by a health care system that assures
> access to comprehensive, culturally competent, quality care. HRSA
> provides national leadership, program resources and services needed to
> improve access to culturally competent, quality health care. The goal
> for all HRSA programs is to assure access to quality health care and
> reduce disparities in health outcomes for recipients of services in
> HRSA funded programs.
>
> As regards the Sickle Cell Disease program, House Report 107-229 of
> the Departments of Labor, Health and Human Services, and Education,
> and Related Agencies Appropriation Bill, 2002, the purpose of the
> Sickle Cell Disease and Newborn Screening Program is "... to enhance
> the sickle cell disease newborn screening program and its locally
> based outreach and counseling efforts."

2.  []{#__RefHeading___Toc175616968 .anchor}**Maternal and Child Health
    Bureau**

> The Maternal and Child Health Bureau (MCHB) is a component of HRSA
> within the U.S. Department of Health and Human Services. The mission
> of MCHB is to improve the health and well-being of all of America's
> women, infants, children, adolescents and their families, including
> women of reproductive age, fathers, persons with hemophilia, and
> children with special health care needs with specific focus on
> individuals and families with low income levels, those with diverse
> racial and ethnic heritages and those living in rural or isolated
> areas without access to care.
>
> With the Omnibus Budget Reconciliation Act (OBRA) of 1989, Public Law
> 101-239 amended Title V of the Social Security Act to extend the
> authority and responsibility of MCHB to address fully the needs of all
> children. AOBRA 89\" refocuses the mission of the State Programs for
> Children with Special Health Care Needs (CSHCN) under the Maternal and
> Child Health Services Block Grant, to provide leadership in building
> and promoting a community-based system of services that is
> family-centered, comprehensive, coordinated and culturally competent.
> This mission is also reflected in *Healthy People 2010*, which
> addresses the goal of having community-based system of care for CSHCN.
> The purpose of this focus on system development is to assure that
> children with special health care needs and their families have access
> to appropriate, adequate and timely services. The Bureau, through the
> Division of Services for Children with Special Health Needs (DSCSHN),
> continues to carry forward its mission of assuring the health of
> children with special health care needs and their families. Children
> with special health care needs are defined as "those children who have
> or are at increased risk for a chronic physical, developmental,
> behavioral, or emotional condition and who also require health and
> related services of a type or amount beyond that required by children
> generally" (American Academy of Pediatrics, 1998).

[]{#__RefHeading___Toc175616969 .anchor}**3. Division of Services for
Children with Special Health Needs**

> The Division's mission is to assure access to care through systems
> improvement as reflected in both the *Healthy People 2010 Objectives*,
> and the *President's New Freedom Initiative*. Through these national
> initiatives, MCHB, through the Division, is specifically charged with
> developing and implementing a plan to achieve appropriate
> Community-Based Systems of Services for children and youth with
> special health care needs and their families.
>
> Components of the plan include:

-   Family/professional partnership at all levels of decision-making.

-   Access to comprehensive health and related services through the
    medical home.

-   Early and continuous screening, evaluation and diagnosis.

-   Adequate public and/or private financing of needed services.

-   Organization of community services so that families can use them
    easily.

-   Successful transition to all aspects of adult health care, work, and
    independence.

    []{#__RefHeading___Toc175616970 .anchor}**4. Genetic Services
    Branch**

> The Genetic Services Branch (GSB), located in DSCSHN, facilitates
> health promotion through early identification of heritable conditions,
> the development of comprehensive, culturally competent,
> family-centered genetic services, and an understanding of how genetics
> affects peoples' health.
>
> Genetic services include a broad range of clinical and public health
> activities, such as individual and community assessment; genetic
> screening and counseling for heritable conditions; measuring
> susceptibility and prevalence of gene-related conditions that result
> from specific environmental exposures; and helping individuals with
> genetic conditions manage their health. Currently, these and other
> services are provided in a variety of community-based health care
> settings such as community health clinics, academic health centers,
> public health departments, public and private laboratories, and by
> private health care providers.
>
> The GSB, through grants, cooperative agreements, contracts, and
> partnerships, has implemented projects in the following program areas:

-   Public health infrastructure for the incorporation of genetic
    information and technology

-   Emerging issues and technologies in genetics and newborn screening

-   Training and education in genetics for health professionals

-   Consumer initiatives and genetic literacy for the public

-   Community genetic services, such as the Thalassemia comprehensive
    care centers, the National Hemophilia Program, community-based
    Sickle Cell Disease Newborn Screening Program and the new Sickle
    Cell Treatment Demonstration Program.

> In addition, GSB strives to develop programs that assure genetic
> screening will be performed with appropriate counseling and
> sensitivity to ethno cultural issues, and that such screening is
> accompanied with proper and timely interventions.

[]{#__RefHeading___Toc175616971 .anchor}**5. Sickle Cell Disease**

> Sickle cell disease is an inherited red blood cell condition. In
> affected individuals, the abnormal red blood cells break easily and
> clog blood vessels to block blood flow to organs and tissues. This
> process results in anemia, periodic pain episodes (at times severe),
> and ultimately can damage tissues and vital organs and lead to
> increased infections and early death. In the United States, most cases
> of sickle cell disease occur among people of African ancestry (one in
> 400 African American births) but those of Mediterranean, Middle
> Eastern, Latino and Indian background or from countries to which
> people from these regions have migrated are also affected. It is
> estimated that more than 2 million Americans are carriers or
> heterozygotes for sickle cell disease and over 70,000 have the
> disorder. Annually approximately 1,000 newborns are identified with
> sickle cell disease through State newborn screening programs.
>
> Early diagnosis of sickle cell disease is critical so that children
> who have the disorder can receive proper interventions. Newborn
> screening for sickle cell disease followed by parental health
> education, enrollment in comprehensive care, initiation of penicillin
> prophylaxis and anti-pneumococcal vaccination within the first two
> months of life can prevent death from severe infections.
>
> The Federal MCHB has long recognized the significance of sickle cell
> disease. In the mid 1960s, the Federal MCH programs developed and
> disseminated sickle cell disease educational materials nationally.
> Following passage of the National Sickle Cell Anemia Control Act in
> 1972, the MCH program, with initial funding from the National
> Institutes of Health (NIH), provided support for community based
> sickle cell clinics to conduct testing, counseling, and education. In
> the mid 1980s, the Federal MCH program supported the development and
> implementation of State newborn screening programs for sickle cell
> disease. By 1990, 30 States and jurisdictions had implemented programs
> with direct Federal support. Currently all States mandate universal
> screening as recommended by the 1987 Consensus Development Conference
> on Newborn Screening for Sickle Cell and Other Hemoglobinopathies
> However the quality of follow-up for Sickle Cell Disease is dependent
> upon the state's resources and often families of infants with Sickle
> Cell Disease are lost to follow-up. Not all states screen for carrier
> status and often individuals at the time of conception are unaware of
> their carrier status or of its implications. To fill in the gaps of
> the State Newborn Screening Programs, in 2002, MCHB funded 15
> community-based grants and one cooperative agreement through its
> Sickle Cell Disease and Newborn Screening Program. As stated in House
> Report 3061 of the Department of Labor, Health and Human Services, and
> Education, and Related Agencies Appropriation Bill 2002, the purpose
> of this program is ..."to enhance the sickle cell disease newborn
> screening program and its locally based outreach and counseling
> efforts."
>
> These one-year community-based awards were established to enhance
> follow-up services for infants who screen positive for sickle cell
> disease or trait and support local community-based efforts to provide
> sickle cell disease-related education and counseling. In Fiscal Year
> 2003, Congress appropriated \$4 million to fund 17 community-based
> sickle cell disease projects and one national sickle cell disease and
> newborn screening coordinating and evaluation center for two years. In
> Fiscal Year 2005, Congress appropriated \$4 million to fund 17
> community-based sickle cell disease projects for 3 years and one
> cooperative agreement for a national Sickle Cell Disease and Newborn
> Screening Coordinating and Evaluation Center for 3 years. The budget
> period ends May 31, 2008.
>
> In FY 2004 Congress enacted and the President signed into Law P.L.
> 108-357, the American Jobs Creation Act of 2004. Section 712 of P.L.
> 108-357 authorized the Sickle Cell disease Treatment Demonstration
> Program (SCTDP). It aims to improve access to services for individuals
> with Sickle Cell Disease by providing an opportunity for Federally
> Qualified Health Centers (FQHCs), FQHC Look-Alikes, and other primary
> care clinics to partner with comprehensive sickle cell disease centers
> and local community-based sickle cell disease organizations to deliver
> high quality clinical services. It was expected that these programs
> also provide newborn screening and follow-up for SCD and trait and
> work with the state SCD newborn screening program.

[]{#__RefHeading___Toc175616972 .anchor}**II. Award Information**

[]{#__RefHeading___Toc175616973 .anchor}**1. Type of Award**

Funding will be provided in the form of a grant.

[]{#__RefHeading___Toc175616974 .anchor}**2. Summary of Funding**

[]{.mark}

> In FY 2008, Congress appropriated approximately \$4,000,000 for the
> Sickle Cell Disease and Newborn Screening program including a national
> sickle cell disease newborn screening evaluation and coordinating
> center. Up to \$185,000 per grant will be used to fund up to 17
> community-based sickle cell disease and newborn screening grants.
> Funding beyond the first year is dependent on the availability of
> appropriated funds for the Sickle Cell Disease and Newborn Screening
> Program in subsequent fiscal years, grantee satisfactory performance,
> and a decision that funding is in the best interest of the Federal
> government. If additional resources are made available for the program
> during subsequent fiscal years, for purpose of continuity,
> efficiencies of funds during a limited time period, the additional
> funds will be used to support this program and its activities.

[]{#__RefHeading___Toc175616975 .anchor}**III. Eligibility Information**

[]{#Eligibility_who .anchor}

**1. Eligible Applicants**

[]{.mark}

> As cited in 42 CFR Part 51a.3(a), any public or private entity,
> including an Indian tribe or tribal organization (as those terms are
> defined at 25 U.S.C. 450(b)), is eligible to apply for this federal
> funding. Under the president's initiative, community-based and
> faith-based organizations that are otherwise eligible and believe they
> can contribute to HRSA's program objectives are urged to consider this
> initiative.

[]{#__RefHeading___Toc175616977 .anchor}**2. Cost Sharing/Matching**

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

[]{#__RefHeading___Toc175616978 .anchor}**3. Other**

> Applications that exceed the ceiling amount of \$185,000 will be
> considered non-responsive and will not be considered for funding under
> this announcement. Any application that fails to satisfy the deadline
> requirements referenced in *Section IV.3* will be considered
> non-responsive and will not be considered for funding under this
> announcement.
>
> This program's grant funds shall not be used to take place of current
> funding for activities described in the application

[]{#__RefHeading___Toc175616979 .anchor}**IV. Application and Submission
Information**

[]{#Application_materials .anchor}

1.  **Address to Request Application Package**

**Application Materials**

> The application and submission process has changed significantly. HRSA
> is ***requiring*** applicants for this funding opportunity to apply
> electronically through Grants.gov. All applicants ***must*** submit in
> this manner unless the applicant is granted a written exemption from
> this requirement in advance by the Director of HRSA's Division of
> Grants Policy. Grantees must request an exemption in writing from
> <DGPWaivers@hrsa.gov>, and provide details as to why they are
> technologically unable to submit electronically though the Grants.gov
> portal. Make sure you specify the announcement number for which you
> are seeking relief. As indicated in this guidance, **HRSA and its
> Grants Application Center (GAC) will only accept paper applications
> from applicants that received prior written approval. Applicants
> technologically unable to scan the signed face sheet should also
> contact the DGPWaivers mailbox to provide information and request
> further instructions. However, the application must still be submitted
> under the deadline.**
>
> Refer to Appendix A for detailed application and submission
> instructions. Pay particular attention to Section 3, which provides
> detailed information on the competitive application and submission
> process.
>
> Applicants must submit proposals according to the instructions in
> Appendix A, using this guidance in conjunction with Public Health
> Service (PHS) Application Form 5161-1. These forms contain additional
> general information and instructions for grant applications, proposal
> narratives, and budgets. These forms may be obtained from the
> following sites by:
>
> []{.mark}

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

> Or

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

> The Legin Group, Inc.
>
> 910 Clopper Road
>
> Suite 155 South
>
> Gaithersburg, MD 20878
>
> Telephone: 877-477-2123
>
> <HRSAGAC@hrsa.gov>
>
> []{.mark}
>
> Instructions for preparing portions of the application that must
> accompany Application Form 5161-1 appear in the "Application Format"
> section below.

[]{#__RefHeading___Toc175616981 .anchor}**2. Content and Form of
Application Submission**

**Application Format Requirements**

> See Appendix A, Section 4 for detailed application submission
> instructions. These instructions must be followed.
>
> The total size of all uploaded files **may not exceed the equivalent
> of 80 pages when printed by HRSA, approximately 10 MB.** **This
> 80-page limit includes the abstract, project and budget narratives,
> attachments, and letters of commitment and support.** Standard forms
> are NOT included in the page limit.
>
> **Applications that exceed the specified limits (approximately 10 MB,
> or that exceed 80 pages when printed by HRSA) will be deemed
> non-compliant. All non-compliant applications will be returned to the
> applicant without further consideration.**
>
> **Application Format**
>
> Applications for funding must consist of the following documents in
> the following order:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  -----------------------------------------------------------------------
  **Attachment        **Attachment Description (Program Guidelines)**
  Number**            
  ------------------- ---------------------------------------------------
  Attachment 1        Copy of Signed SF-424/5161 Face Sheet

  Attachment 2        Relevant Maps, Charts, Tables, etc.

  Attachment 3        Job Descriptions for Key Personnel

  Attachment 4        Biographical Sketches of Key Personnel

  Attachment 5        Letters of Agreement &/or Descriptions of
                      Proposed/Existing Contracts

  Attachment 6        Project Organization Chart

  Attachment 7        Other Relevant Documents to include letters of
                      support and memoranda of understanding
  -----------------------------------------------------------------------

> Note the following specific information related to your submission.

i.  []{#__RefHeading___Toc175616982 .anchor}**Application Face Page**

> Public Health Service (PHS) Application Form 5161-1, provided with the
> application package. Prepare this page according to instructions
> provided in the form itself. For information pertaining to the Catalog
> of Federal Domestic Assistance, the Catalog of Federal Domestic
> Assistance Number is 93.*110*.
>
> **DUNS Number**
>
> All applicant organizations are required to have a Data Universal
> Numbering System (DUNS) number in order to apply for a grant from the
> Federal Government. The DUNS number is a unique nine-character
> identification number provided by the commercial company, Dun and
> Bradstreet. There is no charge to obtain a DUNS number. Information
> about obtaining a DUNS number can be found at
> <http://www.hrsa.gov/grants/dunsccr.htm> or call 1-866-705-5711.
> Please include the DUNS number in item 8c on the application face
> page. Applications ***will not*** be reviewed without a DUNS number.
>
> Additionally, the applicant organization is required to register with
> the Federal Government's Central Contractor Registry (CCR) in order to
> do electronic business with the Federal Government. Information about
> registering with the CCR can be found at
> <http://www.hrsa.gov/grants/dunsccr.htm>.

ii. []{#__RefHeading___Toc175616983 .anchor}**Table of Contents**

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

iii. []{#__RefHeading___Toc175616984 .anchor}**Application Checklist**

Refer to Application Form 5161-1, provided with the application package.

iv. []{#__RefHeading___Toc175616985 .anchor}**Budget**

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

v.  []{#__RefHeading___Toc175616986 .anchor}**Budget Justification**

> Provide a narrative that explains the amounts requested for each line
> in the budget. The budget justification should specifically describe
> how each item will support the achievement of proposed objectives. The
> budget period is for ONE year. However, the applicant must submit
> one-year budgets for each of the subsequent project period years
> (usually one to three years or more) at the time of application. Line
> item information must be provided to explain the costs entered in
> appropriate form, Application Form 5161-1. **The budget justification
> must clearly describe each cost element and explain how each cost
> contributes to meeting the project's objectives/goals.** Be very
> careful about showing how each item in the "other" category is
> justified. The budget justification MUST be concise. Do NOT use the
> justification to expand the project narrative.
>
> **Budget for Multi-Year Grant Award-Required, if applicable**
>
> This announcement is inviting applications for project periods up to
> three (3) years. Awards, on a competitive basis, will be for a
> one‑year budget period, although project periods may be for three (3)
> years. Applications for continuation grants funded under these awards
> beyond the one-year budget period but within the three (3) year
> project period will be entertained in subsequent years on a
> noncompetitive basis, subject to availability of funds, satisfactory
> progress of the grantee and a determination that continued funding
> would be in the best interest of the Government.
>
> []{.mark}

Include the following in the Budget Justification narrative:

> [Personnel Costs]{.underline}: Personnel costs should be explained by
> listing each staff member who will be supported from funds, name (if
> possible), position title, percent full time equivalency, and annual
> salary.
>
> [Indirect Costs:]{.underline} Indirect costs are those costs incurred
> for common or joint objectives which cannot be readily identified but
> are necessary to the operations of the organization, e.g., the cost of
> operating and maintaining facilities, depreciation, and administrative
> salaries. For institutions subject to OMB Circular A-21, the term
> "facilities and administration" is used to denote indirect costs. If
> an organization applying for an assistance award does not have an
> indirect cost rate, the applicant may wish to obtain one through HHS's
> Division of Cost Allocation (DCA).  Visit DCA's website at:
> <http://rates.psc.gov/> to learn more about rate agreements, the
> process for applying for them, and the regional offices which
> negotiate them.
>
> [Fringe Benefits]{.underline}: List the components that comprise the
> fringe benefit rate, for example health insurance, taxes, unemployment
> insurance, life insurance, retirement plan, tuition reimbursement. The
> fringe benefits should be directly proportional to that portion of
> personnel costs that are allocated for the project.
>
> [Travel]{.underline}: List travel costs according to local and long
> distance travel. For local travel, the mileage rate, number of miles,
> reason for travel and staff member/consumers completing the travel
> should be outlined. The budget should also reflect the travel expenses
> associated with participating in meetings and other proposed trainings
> or workshops.
>
> [Equipment]{.underline}: List equipment costs and provide
> justification for the need of the equipment to carry out the program's
> goals. Extensive justification and a detailed status of current
> equipment must be provided when requesting funds for the purchase of
> computers and furniture items that meet the definition of equipment (a
> unit cost of \$5000 and a useful life of one or more years).
>
> [Supplies]{.underline}: List the items that the project will use. In
> this category, separate office supplies from medical and educational
> purchases. Office supplies could include paper, pencils, and the like;
> medical supplies are syringes, blood tubes, plastic gloves, etc., and
> educational supplies may be pamphlets and educational videotapes.
> Remember, they must be listed separately.
>
> [Subcontracts]{.underline}: To the extent possible, all subcontract
> budgets and justifications should be standardized, and contract
> budgets should be presented by using the same object class categories
> contained in the Standard Form 424A. Provide a clear explanation as to
> the purpose of each contract, how the costs were estimated, and the
> specific contract deliverables.
>
> []{.mark}
>
> [Other]{.underline}: Put all costs that do not fit into any other
> category into this category and provide and explanation of each cost
> in this category. In some cases, grantee rent, utilities and insurance
> fall under this category if they are not included in an approved
> indirect cost rate.)

vi. []{#__RefHeading___Toc175616987 .anchor}**Staffing Plan and
    Personnel Requirements**

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

vii. []{#__RefHeading___Toc175616988 .anchor}**Assurances**

> The assurances are included in Application Form 5161-1 provided with
> the application package.

viii. []{#__RefHeading___Toc175616989 .anchor}**Certifications**

> Certification are included in Application Form 5161-1 provided with
> the application package.

ix. []{#__RefHeading___Toc175616990 .anchor}**Project Abstract**

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

[]{.mark}

Please place the following at the top of the abstract:

-   Project Title

-   Applicant Name

-   Address

-   Contact Phone Numbers (Voice, Fax)

-   E-Mail Address

-   Web Site Address, if applicable

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

x.  []{#__RefHeading___Toc175616991 .anchor}**Program Narrative**

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

Use the following section headers for the Narrative:

> **1. [INTRODUCTION/PURPOSE ]{.underline}**

a)  This section should briefly describe the purpose of the proposed
    project.

> **2.** **[NEEDS ASSESSMENT]{.underline}**

a)  This section outlines the needs of the community and population to
    be served.

[]{.mark}

b)  The target population including emerging populations and its unmet
    health needs must be described and documented. Include information
    about the population to be served and the general population in the
    project catchment area for the purposes of comparison or contrast.
    Demographic data including race/ethnicity, gender and age, numbers
    proposed to be served with SCD, numbers proposed to be served as
    carriers should be used and cited whenever possible to support the
    information provided. Description of factors, including primary
    language, education and access to transportation that affect access
    to care should be included. Identify the source of such information.

c)  Describe plan to involve individuals from the population to be
    served in the planning and implementation of the project. Does the
    project advisory board include an adequate number of individuals
    affected by Sickle Cell Disease and their families. The advisory
    committee/s should be multidisciplinary, multicultural and
    reflective of the public private partnerships including
    community-based partners.

> d\) Identify the service delivery system, including location of
> providers, in the project catchment area. A map may be useful.
> Describe gaps and relevant barriers.
>
> **3.** **[METHODOLOGY]{.underline}**

[]{.mark}

a)  Identify goals, objectives and activities which are responsive to
    the needs of the population to be served, as identified in the needs
    assessment and the purpose of the program (See Section 1-Purpose).
    Objectives should be specific, time-framed and measurable.

b)  Provide information about Network coordination, collaboration, and
    communication, individual case management, referral to specialty and
    subspecialty medical, primary care and other health and social
    services, education, counseling and outreach efforts.

c)  Provide evidence of collaborative relationships with requisite
    stakeholders (Network) that clearly defines the roles and
    responsibilities of the Network partners and the special challenges
    to overcome. Provide evidence of collaborative relationships with
    requisite stakeholders through memoranda of understanding, memoranda
    of agreement, contracts and letters of agreement. The extent to
    which collaborative relationships are reflected in the budget plan
    and/or quantitative and qualitative work matrix. Describe the formal
    system in place or a plan to be put in place to facilitate
    referrals, coordination and follow-up of individuals and as carriers
    to the necessary clinical and support services.

d)  Describe if there is an effective partnership between a local
    community-based organization and a comprehensive sickle cell disease
    treatment center with sufficient funding provided to the sickle cell
    disease community based organization. **[There must be a line item
    in the budget for funding a local community-based
    organization]{.underline}**

e)  Provide evidence of a collaborative relationship with their State
    Title V and newborn Screening programs, and if there is one in
    existence, the state sickle cell disease program through memoranda
    of understanding, contracts or letters of agreement. [It is
    essential that there is a mechanism in place with the State Newborn
    Screening program that allows for the sharing of data (in compliance
    with HIPPA guidelines) to ensure follow-up, education and counseling
    by members of the Network regarding sickle cell disease
    and]{.underline} [carrier status.]{.underline}

f)  Describe plan to collaborate with community-based primary care
    providers, including federally qualified health centers to ensure
    that each client diagnosed with Sickle Cell Disease and his/or her
    family has access to services through a medical home.

g)  Demonstrate that there is a commitment to collaborate with the MCHB
    National Sickle Cell Disease and Newborn Screening Coordinating and
    Evaluation Center (NCEC) funded by this initiative and fellow
    grantees to collect and share information and standardize education
    and counseling activities offered by the local, community-based
    projects. It is expected that the grantees implement or demonstrate
    effectiveness of emerging practices developed through the NCEC in
    its work with the previously funded NBS grantees as well as
    participate in the minimum data set, evaluation and other activities
    of the NCEC. Demonstrate that there is willingness to collaborate
    with the National Newborn Screening and Genetics Resources Center,
    the Regional Genetics and Newborn Screening Collaboratives and with
    the Sickle Cell Disease Treatment Demonstration program of HRSA
    whenever possible.

h)  If conducting newborn screening testing, does the applicant
    demonstrate compliance with the Clinical laboratory Improvement Act
    (CLIA) or CAP guidelines and show proof of certification? The
    applicant should be aware of and compliant with the Clinical
    Laboratories Standard Institute's (CLSI LA27) Guidelines on Newborn
    Screening and Follow-up. The applicant must be aware of the
    proponents of the Consensus Group of Public Health and clinical
    professionals and families) guidelines (CORN) that were published in
    a peer review journal.

> **4. [WORKPLAN]{.underline}**
>
> []{.mark}
>
> Describe the activities or steps that will be used to achieve each of
> the activities proposed in the methodology section. Use a time line
> that includes each activity and identifies responsible staff. It may
> be useful to prepare diagrams demonstrating the linkage between the
> project's resources, its activities, and the expected outcomes (a
> logic model). Use of a logic model would have the additional benefit
> of helping to clarify the appropriateness of the performance measures
> used, and the relationship to the proposed evaluation activities. The
> work plan should be a tool that will help to actively manage the
> project by measuring progress, identify barriers and necessary
> changes, and quantify accomplishments.
>
> []{.mark}
>
> Outline a work plan in Appendix F of your application; this should
> include each activity, the timeline to achieve each activity, the
> identified responsible staff, indicators/measures,
> outcome(s)/output(s), and the data source used. This can be presented
> in a table, or any other format that clearly describes the work plan.

5.  **[RESOLUTION OF CHALLENGES]{.underline}**

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

6.  **[EVALUATION AND TECHNICAL SUPPORT CAPACITY]{.underline}**

```{=html}
<!-- -->
```
a)  Describe current experiences, skills, and knowledge, including
    individuals on staff, materials published, and previous work of a
    similar nature.

b)  It is expected that evaluation of the program will be coordinated
    through the National Coordination and Evaluation Center (NCEC). The
    funded projects will be required to participate in the collection of
    relevant information/data. Describe the current information system
    and its capacity to manage and report the required data.

Provide documentation of privacy and confidentiality practices exercised
with all records and health information regarding clients and show
accountability to its partners in ensuring the confidentiality of health
information to the extent to which applicants address informed consent,
ethical, legal and social issues related to grant activities. Describe
is there is a formal system in place to address privacy protection and
security issues related to information collection and sharing and
compliance with HIPPA requirements. Describe willingness to obtain IRB
approval, if necessary.

c)  Describe willingness to participate and a need to participate in an
    evaluation through the NCE and a willingness to comply with
    reporting requirements of the program.

d)  Describe organizational capability and the approach in evaluative
    activities, including the collection of data previously developed by
    the National Coordinating Center and beta testing previously
    developed materials by the NCEC.

e)  Describe the steps to be taken to facilitate continuous quality
    monitoring of the project, including the effectiveness of
    partnerships and communication

    5.  **[ORGANIZATIONAL INFORMATION]{.underline}**

```{=html}
<!-- -->
```
a)  Provide information on the applicant agency's current mission and
    structure, scope of current activities, and an organizational chart;
    and describe how these all contribute to the ability of the
    organization to conduct the program requirements and meet program
    expectations.

b)  Provide information on the Network structure and the role of the
    advisory board, and describe how the network entities will relate to
    each other including the local community-based program,
    comprehensive sickle cell disease center, State Title V and Newborn
    Screening Program, medical home and other relevant partners at the
    community, state, and national levels.

> []{.mark}

xi. []{#__RefHeading___Toc175616992 .anchor}**Program Specific Forms**

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

xii. ***Attachments***

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

[]{.mark}

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

[]{.mark}

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

> To give further details about the proposal.

[]{.mark}

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

> Keep each to one page in length as much as is possible. Item 6 in the
> Program Narrative section of the PHS 5161-1 Form provides some
> guidance on items to include in a job description. To prepare
> applicants for reporting requirements, administrative data collection
> requirements are presented in the appendices of this guidance.

[]{.mark}

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

> Include biographical sketches for persons occupying the key positions
> described in Attachment 2, not to exceed two pages in length. In the
> event that a biographical sketch is included for an identified
> individual who is not yet hired, please include a letter of commitment
> from that person with the biographical sketch.
>
> []{.mark}

4)  **Attachment 5: Letters of Agreement and/or Description(s) of
    Proposed/Existing** Contracts (project specific). Provide any
    documents that describe working relationships between the applicant
    agency and other agencies and programs cited in the proposal.
    Documents that confirm actual or pending contractual agreements
    should clearly describe the roles of the subcontractors and any
    deliverable. Letters of agreements must be dated.

5)  **Attachment 6: Project Organizational Chart**

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

6)  **Attachment 7: Other Relevant Documents**

> Include here any other documents that are relevant to the application
> including letters of support which are dated and specifically indicate
> a commitment to the project/program (in-kind services, dollars, staff,
> space, equipment, etc.) List all other support letters on one page.

[]{#__RefHeading___Toc175616993 .anchor}**3. Submission Dates and
Times**

**Application Due Date**

The due date for applications under this grant announcement is
***December 4, 2007** at **8:00 P.M. ET***. Applications will be
considered as meeting the deadline if they are E marked on or before the
due date. Please consult Appendix A, Section 3 for detailed instructions
on submission requirements.

> The Chief Grants Management Officer (CGMO) or a higher level designee
> may authorize an extension of published deadlines when justified by
> circumstances such as acts of God (e.g. floods or hurricanes),
> widespread disruptions of mail service, or other disruptions of
> services, such as a prolonged blackout. The authorizing official will
> determine the affected geographical area(s).
>
> Applications must be submitted by 8:00 P.M. ET. **To ensure that you
> have adequate time to follow procedures and successfully submit the
> application, we recommend you register immediately in Grants.gov (see
> Appendix B) and complete the forms as soon as possible, as this is a
> new process and may take some time.**
>
> Please refer to Appendix B for important specific information on
> registering, and Appendix A, Section 3 for important information on
> applying through Grants.gov.
>
> **Late applications:**
>
> Applications which do not meet the criteria above are considered late
> applications. Health Resources and Services Administration (HRSA)
> shall notify each late applicant that its application will not be
> considered in the current competition.

**4. Intergovernmental Review**

> []{.mark}
>
> The Sickle Cell Disease and Newborn Screening program is not a program
> subject to the provisions of Executive Order 12372, as implemented by
> 45 CFR 100.

[]{#__RefHeading___Toc175616995 .anchor}**5. Funding Restrictions**

> []{.mark}
>
> Applicants responding to this announcement may request funding for a
> project period of up to three (3) years, at no more than \$185,000 per
> year. Awards to support projects beyond the first budget year will be
> contingent upon Congressional appropriation, satisfactory progress in
> meeting the project's objectives, and a determination that continued
> funding would be in the best interest of the government.
>
> *Funds under this announcement may not be used for the following
> purposes:*

Research registries, research activities or inpatient services

[]{#__RefHeading___Toc175616996 .anchor}**6. Other Submission
Requirements**

> As stated in Section IV.1, except in rare cases HRSA will no longer
> accept applications for grant opportunities in paper form. Applicants
> submitting for this funding opportunity are ***required*** to submit
> ***electronically*** through Grants.gov. To submit an application
> electronically, please use the
> [http://www.Grants.gov](http://www.Grants.gov/) apply site. When using
> Grants.gov you will be able to download a copy of the application
> package, complete it off-line, and then upload and submit the
> application via the Grants.gov site.
>
> As soon as you read this, whether you plan on applying for a HRSA
> grant later this month or later this year, it is incumbent that your
> organization ***immediately register*** in Grants.gov and become
> familiar with the Grants.gov site application process. If you do not
> complete the registration process you will be unable to submit an
> application. The registration process can take up to one month, so you
> need to begin immediately.
>
> To be able to successfully register in Grants.gov, it is necessary
> that you complete all of the following required actions:
>
> • Obtain an organizational Data Universal Number System (DUNS) number
>
> • Register the organization with Central Contractor Registry (CCR)
>
> • Identify the organization's E-Business POC (Point of Contact)
>
> • Confirm the organization's CCR "Marketing Partner ID Number (M-PIN)"
> password
>
> • Register an Authorized Organization Representative (AOR)
>
> • Obtain a username and password from the Grants.gov Credential
> Provider
>
> Instructions on how to register, tutorials and FAQs are available on
> the Grants.gov web site at [www.grants.gov](http://www.grants.gov/).
> Assistance is also available from the Grants.gov help desk at
> <support@grants.gov> or by phone at 1-800-518-4726.
>
> More specific information, including step-by-step instructions on
> registering and applying, can be found in Appendix B of this guidance.
>
> **Formal submission of the electronic application:** Applications
> completed online are considered formally submitted when the
> Authorizing Official electronically submits the application to HRSA
> through Grants.gov. You must, however, ensure that a copy of the
> SF-424/5161 Face Sheet is printed, [signed]{.underline}, scanned, and
> included with your electronic application as Attachment 1. The face
> page **must** be printed from Grants.gov.
>
> Applications will be considered as having met the deadline if: (1) the
> application has been successfully transmitted electronically by your
> organization's Authorizing Official through Grants.gov on or before
> the deadline date and time, and (2) the signed SF-424/5161 Face Sheet
> is included in the electronic application submission.
>
> **It is incumbent on applicants to ensure that the AO is available to
> submit the application to HRSA by the application due date. We will
> [not]{.underline} accept submission or re-submission of incomplete,
> rejected, or otherwise delayed applications after the deadline.**
>
> **Again, please understand that we will not consider additional
> information and/or materials submitted after your initial application.
> You must therefore ensure that all materials are submitted together.
> Further information on the HRSA electronic submission policy can be
> obtained at <http://www.hrsa.gov/grants/electronicsubmission.htm>.**

[]{#__RefHeading___Toc175616997 .anchor}

**V. Application Review Information - Required**

> []{#Review_ReviewCriteria .anchor}

**1. Review Criteria**

> Procedures for assessing the technical merit of grant applications
> have been instituted to provide for an objective review of
> applications and to assist the applicant in understanding the
> standards against which each application will be judged. Critical
> indicators have been developed for each review criterion to assist the
> applicant in presenting pertinent information related to that
> criterion and to provide the reviewer with a standard for evaluation.
> Review criteria are outlined below with specific detail and scoring
> points.
>
> Review Criteria are used to review and rank applications. The Sickle
> Cell Disease and Newborn Screening Program has 6 review criteria:
>
> **1. NEED *(10 points)***
>
> The extent to which the applicant describes the problem and associated
> contributing factors:

-   Is there adequate documentation of the demographics, characteristics
    and needs of the population to be served, including emerging
    populations?

-   Does the application provide an estimate of the number of
    individuals with sickle cell disease/carriers in the project
    catchment area by age, race, ethnicity and gender and the projected
    number to be served?

-   Is there a description of factors including primary language,
    education and access to transportation that affect access to care?

-   Is there a description of the service delivery system, including
    location of providers, in the project catchment area. A map may be
    useful. Describe gaps and relevant barriers.

2.  **RESPONSE *(45 points)***

> The extent to which the proposed project responds to the Purpose
> included in the program description, the clarity of the proposed goals
> and objectives and their relationship to the identified project
> objectives.

-   The extent to which there is evidence of collaborative relationships
    with requisite stakeholders (Network) that clearly defines the roles
    and responsibilities of the Network partners and the special
    challenges to overcome. The extent to which there is evidence of
    collaborative relationships with requisite stakeholders through
    memoranda of understanding, memoranda of agreement, contracts and
    letters of agreement. The extent to which collaborative
    relationships are reflected in the budget plan and/or quantitative
    and qualitative work matrix. The extent to which there is a formal
    system in place or a plan to be put in place to facilitate
    referrals, coordination and follow-up of individuals and as carriers
    to the necessary clinical and support services. (5 points)

-   The extent to which there is an effective partnership between a
    local community-based organization and a comprehensive sickle cell
    disease treatment center with sufficient funding provided to the
    sickle cell disease community based organization. **[There must be a
    line item in the budget for funding a community-based
    organization]{.underline}**.(5 points)

[]{.mark}

-   The extent to which the application provides evidence of a
    collaborative relationship with their State Title V and newborn
    Screening programs, and if there is one in existence, the state
    sickle cell disease program through memoranda of understanding,
    contracts or letters of agreement. [It is essential that there is a
    mechanism in place with the State Newborn Screening program that
    allows for the sharing of data (in compliance with HIPPA guidelines)
    to ensure follow-up, education and counseling by members of the
    Network regarding sickle cell disease and]{.underline} [carrier
    status.]{.underline} (5 points)

-   The extent to which the application involves individuals from
    populations to be served in the planning and implementation of the
    project. The extent to which the project advisory board includes an
    adequate number of individuals affected by Sickle Cell Disease and
    their families. The advisory committee/s should be multidisciplined,
    multicultural and reflective of the public/private partnerships
    including community-based partners. It is important that the
    consumers not all be professional consumers but those being served
    by the project. (5 points)

-   The extent to which the applicant agrees to collaborate with
    community-based primary care providers, including federally
    qualified health centers to ensure that each client diagnosed with
    Sickle Cell Disease and his/or her family has access to services
    through a medical home. (5 points)

-   The extent to which there is a commitment to collaborate with the
    MCHB National Sickle Cell Disease and Newborn Screening Coordinating
    and Evaluation Center (NCEC) funded by this initiative and fellow
    grantees to collect and share information and standardize education
    and counseling activities offered by the local, community-based
    projects. It is expected that the grantees implement or demonstrate
    effectiveness of emerging practices developed through the NCEC in
    its work with the previously funded NBS grantees as well as
    participate in the minimum data set, evaluation and other activities
    of the NCEC. The extent to which the applicant is willing to
    collaborate with the National Newborn Screening and Genetics
    Resources Center, the Regional Genetics and Newborn Screening
    Collaboratives and with the Sickle Cell Disease Treatment
    Demonstration program of HRSA whenever possible. (5 points)

[]{.mark}

-   The extent to which the application's proposed activities improve
    and compliment but do not duplicate existing activities and
    services. Does the application provide intent to disseminate and
    test materials developed under the previous funding cycle? (5
    points)

-   The extent to which the application provides documentation of
    privacy and confidentiality practices exercised with all records and
    health information regarding clients and shows accountability to its
    partners in ensuring the confidentiality of health information to
    the extent to which applicants address informed consent, ethical,
    legal and social issues related to grant activities. The extent to
    which there is a formal system in place to address privacy
    protection and security issues related to information collection and
    sharing and compliance with HIPPA requirements. The extent to which
    the applicant is willing to obtain IRB approval, if necessary. (5
    points)

-   If conducting newborn screening testing, does the applicant
    demonstrate compliance with the Clinical laboratory Improvement Act
    (CLIA) or CAP guidelines and show proof of certification? The
    applicant should be aware of and compliant with the Clinical
    Laboratories Standard Institute's (CLSI LA27) Guidelines on Newborn
    Screening and Follow-up. The applicant must be aware of the
    proponents of the Consensus Group of Public Health and clinical
    professionals and families) guidelines (CORN) that were published in
    a peer review journal. (5 points)

3.  **EVALUATIVE MEASURES *(10 points)***

> The extent to which the application responds to the application
> guidance for project evaluation.

-   Does the application acknowledge the need for evaluation and a
    willingness to comply with reporting requirements of the program?

-   Does the application describe organizational capability and the
    approach in evaluative activities, including the collection of data
    previously developed by the National Coordinating Center and beta
    testing previously developed materials by the NCEC?

-   Is there a description of the steps to be taken to facilitate
    continuous quality monitoring of the project, including the
    effectiveness of partnerships and communication?

-   Does the application include a systematic plan for monitoring and
    assessing successful completion of program tasks?

-   The extent to which the applicant acknowledges and demonstrates an
    understanding of the expected commitment in participation through
    the National Coordination and Evaluation Center (NCEC). The funded
    projects will be required to participate in the collection of
    relevant information/data. Is there an adequate description the
    current information system and its capacity to manage and report the
    required data

-   Provide documentation of privacy and confidentiality practices
    exercised with all records and health information regarding clients
    and show accountability to its partners in ensuring the
    confidentiality of health information to the extent to which
    applicants address informed consent, ethical, legal and social
    issues related to grant activities. Describe is there is a formal
    system in place to address privacy protection and security issues
    related to information collection and sharing and compliance with
    HIPPA requirements. Describe willingness to obtain IRB approval, if
    necessary.

-   Describe organizational capability and the approach in evaluative
    activities, including the collection of data previously developed by
    the National Coordinating Center and beta testing previously
    developed materials by the NCEC

**4.** **IMPACT *(5 points)***

-   The extent and effectiveness of plans for dissemination of project
    results. (4 points)

-   The extent to which project results may be national in scope. (2
    points)

-   The degree to which the project activities are replicable. (2
    points)

-   The degree to which the applicant presents a plan for sustainability
    of the project beyond the Federal Funding. (2 points)

**5. RESOURCES AND CAPABILITIES *(20 points)***

-   The degree to which the infrastructure includes sound administrative
    and management components necessary to carry out the proposed
    activities; whether the administrative structure of the program is
    organized so there is ease in communication and decision making. (10
    points)

-   The degree to which the applicant has experience in providing
    outreach, education, and support to parents of newborns identified
    through newborn screening to have sickle cell disease, or be
    carriers of sickle cell or other abnormal hemoglobinopathies. (10
    pts)

**6. SUPPORT REQUESTED *(10 points)***

-   The reasonableness of the proposed budget in relation to the
    objectives, the complexity of the activities, and the anticipated
    results. Funding should be available to support family involvement
    and address barriers to care for the medically underserved
    population, for example translation and transportation services.

-   The extent to which the proposed expenditures are allowable and
    appropriately related to the project goals building upon the
    identified needs. Does the budget include adequate funding for
    community-based organizations?

```{=html}
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```
-   Whether the administrative costs and travel are related objectively
    to the program needs of the project. Whether the project
    incorporates travel funds for two individuals to attend two
    mandatory grantee technical assistance meetings in the Washington,
    D.C. area.

    []{#__RefHeading___Toc175616999 .anchor}**2. Review and Selection
    Process**

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

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

**Funding Priorities**

A funding priority is defined as the favorable adjustment of combined
review scores of individually approved applications when applications
meet specified criteria. An adjustment is made by a set, pre-determined
number of points. The Sickle Cell Disease and Newborn Screening Program
has 2 funding priorities.

**Priority 1:** An application will be granted a funding priority of 5
points if the applicant is a local community-based sickle cell disease
organization with no less than 5 cumulative years experience in
providing outreach services to persons and families affected by sickle
cell disease; other services include providing education and counseling
to parents of infants determined by the newborn screening program to
have sickle cell disease or carriers of sickle cell or other abnormal
hemoglobins; and

**Priority 2:** An application will be granted a funding priority of 5
points if the applicant can demonstrate a collaborative relationship
between the State Title V and newborn screening program as evidenced by
a Memorandum of Understanding, Contract, Memorandum of Agreement,
letters of agreements, a comprehensive sickle cell disease center, and a
local community-based organization.

To be eligible to receive the priority points, the applicant's score
must rank above the 20^th^ percentile.

In order to ensure equitable distribution of awards in terms of
geography, there is a maximum of 2 awards per State.

3.  []{#__RefHeading___Toc175617000 .anchor}**Anticipated Announcement
    and Award Dates**

The announcement and award date for the grants funded under this
guidance is June 1, 2008.

[]{#__RefHeading___Toc175617001 .anchor}**VI. Award Administration
Information**

**1. Award Notices**

> Each applicant will receive written notification of the outcome of the
> objective review process, including a summary of the expert
> committee's assessment of the application's merits and weaknesses, and
> whether the application was selected for funding. Applicants who are
> selected for funding may be required to respond in a satisfactory
> manner to Conditions placed on their application before funding can
> proceed. Letters of notification do not provide authorization to begin
> performance.
>
> The Notice of Grant Award sets forth the amount of funds granted, the
> terms and conditions of the grant, the effective date of the grant,
> the budget period for which initial support will be given, the
> non-Federal share to be provided (if applicable), and the total
> project period for which support is contemplated. Signed by the Grants
> Management Officer, it is sent to the applicant agency's Authorized
> Representative, and reflects the only authorizing document. It will be
> sent prior to the start date of June 1, 2008.

**2. Administrative and National Policy Requirements**

> Successful applicants must comply with the administrative requirements
> outlined in 45 CFR Part 74 (non-governmental) or 45 CFR Part 92
> (governmental), as appropriate.
>
> HRSA grant awards are subject to the requirements of the HHS Grants
> Policy Statement (HHS GPS) that are applicable to the grant based on
> recipient type and purpose of award. This includes, as applicable, any
> requirements in Parts I and II of the HHS GPS that apply to the award,
> as well as any requirements of Part IV. The HHS GPS is available at
> <http://www.hrsa.gov/grants/>. The general terms and conditions in the
> HHS GPS will apply as indicated unless there are statutory,
> regulatory, or award-specific requirements to the contrary (as
> specified in the Notice of Award).

**PUBLIC POLICY ISSUANCE**

[]{.mark}

**HEALTHY PEOPLE 2010**

> **Healthy People 2010** is a national initiative led by HHS that sets
> priorities for all HRSA programs. The initiative has two major goals:
> (1) to increase the quality and years of a healthy life; and (2)
> Eliminate our country's health disparities. The program consists of 28
> focus areas and 467 objectives. HRSA has actively participated in the
> work groups of all the focus areas, and is committed to the
> achievement of the Healthy People 2010 goals.
>
> Applicants must summarize the relationship of their projects and
> identify which of their programs objectives and/or sub-objectives
> relate to the goals of the Healthy People 2010 initiative.
>
> Copies of the Healthy People 2010 may be obtained from the
> Superintendent of Documents or downloaded at the Healthy People 2010
> website: [http://www.health.gov/healthypeople/document]{.underline}/.
>
> The Public Health Service strongly encourages all award recipients to
> provide a smoke-free workplace and to promote the non-use of all
> tobacco products. Further, Public Law 103-227, the Pro-Children Act of
> 1994, prohibits smoking in certain facilities (or in some cases, any
> portion of a facility) in which regular or routine education, library,
> day care, health care or early childhood development services are
> provided to children.
>
> **CULTURAL COMPETENCE**
>
> In order to assure access and cultural competence, it is expected that
> projects will involve individuals from the populations to be served in
> the planning and implementation of the project. MCHB's intent is to
> ensure that project interventions are responsive to the cultural and
> linguistic needs of special populations, that services are accessible
> to consumers, and that the broadest possible representation of
> culturally distinct and historically under represented groups is
> supported through programs and projects sponsored by MCHB.
>
> **FAMILY PARTICIPATION**
>
> It is expected that projects will retain the family -centered approach
> to which MCHB is committed. This approach recognizes that the family
> is the constant in a child's life, while service systems and their
> attendant personnel fluctuate. It facilitates family/professional
> collaboration at all levels of care, including program development,
> implementation, policy formation and evaluation. Family-centered care
> ensures that services and support systems are flexible, accessible,
> and comprehensive in responding to these family-identified needs.

[]{.mark}

**3. Reporting**

> The successful applicant under this guidance must comply with the
> following reporting and review activities:

a.  **Audit Requirements**

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

b.  **Payment Management Requirements**

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

c.  **Status Reports**

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

**2. Performance Reporting**

> Successful applicants receiving grant funds will be required, within
> 120 days of the Notice of Grant Award (NGA), to register in HRSA's
> Electronic Handbooks (EHBs) and electronically complete the program
> specific data forms that appear in the appendices of this
> guidance.** **This requirement entails the provision of budget
> breakdowns in the financial forms based on the grant award amount, the
> project abstract and other grant summary data as well as providing
> objectives for the performance measures.
>
> Performance reporting is conducted for each grant year of the project
> period. Grantees will be required, within 120 days of the NGA, to
> enter HRSA's EHBs and complete the program specific forms. This
> requirement includes providing expenditure data, finalizing the
> abstract and grant summary data as well as finalizing
> indicators/scores for the performance measures.
>
> **3. Final Year Performance Reporting**
>
> Successful applicants receiving grant funding will be required, within
> 120 days from the end of the project period, to electronically
> complete the program specific data forms that appear in the appendices
> of this guidance. The requirement includes providing expenditure data
> for the final year of the project period, the project abstract and
> grant summary data as well as final indicators/scores for the
> performance measures.
>
> e\. **Performance Review**
>
> HRSA's Office of Performance Review (OPR) serves as the agency's focal
> point for reviewing and enhancing the performance of HRSA funded
> programs within communities and States. As part of this agency-wide
> effort, HRSA grantees will be required to participate, where
> appropriate, in an on-site performance review of their HRSA funded
> program(s) by a review team from one of the ten OPR regional
> divisions. Grantees should expect to participate in a performance
> review at some point during their project period. When a grantee
> receives more than one HRSA grant, each of the grantee's HRSA funded
> programs will be reviewed during the same performance review.
>
> The purpose of performance review is to improve the performance of
> HRSA funded programs. Through systematic pre-site and on-site
> analysis, OPR works collaboratively with grantees and HRSA
> Bureaus/Offices to measure program performance, analyze the factors
> impacting performance, and identify effective strategies and
> partnerships to improve program performance, with a particular focus
> on outcomes. Upon completion of the performance review, grantees will
> be required to prepare an Action Plan that identifies key actions to
> improve program performance as well as addresses any identified
> program requirement issues. In addition, performance reviews also
> provide an opportunity for grantees to offer direct feedback to the
> agency about the impact of HRSA policies on program implementation and
> performance within communities and States.
>
> For additional information on performance reviews, please visit:
> <http://www.hrsa.gov/performancereview>.

[]{#__RefHeading___Toc175617002 .anchor}**VII. Agency Contacts**

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

Cheryl Armstead, Grants Management Specialist

Attn.: *Sickle Cell Disease and Newborn Screening Program*

HRSA Division of Grants Management Operations, OFAM

Parklawn Building, Room 11A-16

5600 Fishers Lane

Rockville, MD 20857

Telephone: 301-594-4261

Fax: 301-594-4073

Email: <CArmstead@hrsa.gov>

Additional information related to the overall program issues may be
obtained by contacting:

Judith Hagopian, M.S.W., M.P.H.

Maternal and Child Health Bureau/HRSA

Parklawn Building, Room 18A-19

5600 Fishers Lane

Rockville, MD 20857

Telephone: 301-443-1080

Fax: 301-443-8604

Email: <JHagopian@hrsa.gov>

[]{#__RefHeading___Toc175617003 .anchor}**VIII. Other Information**

> **1. Resources**

a.  National Newborn Screening & Genetics Resource Center (NNSGRC) at:
    <http://genes-r-us.uthscsa.edu/> provides information and resources
    in the area of newborn screening and genetics to benefit health
    professionals, the public health community, consumers and government
    officials. The following information is available from the NNSGRC:

b.  The *Guidelines for Clinical Genetics Services for the Public\'s
    Health* developed by the Council of Regional Networks for Genetic
    Services (CORN).

c.  Meeting proceedings and background information from the November
    1999 technical assistance meeting of State Planning Grantees,
    *"Incorporating Genetic Medicine & Technology into Practice and
    Service"*.

d.  Meeting proceedings and background information from the September
    2000 technical assistance meeting of State Planning Grantees,
    *"Integration of Science and Technology into Public Health"*.

e.  Meeting proceedings and background information from the March 2002
    technical assistance meeting of State Planning Grantees, *"Summary
    of Meeting: State Development Grants for Newborn Screening and
    Infrastructure Development".*

f.  Kaye CI, Laxova R, Livingston JE, Lloyd-Puryear MA, Mann M, McCabe
    ERB, Therrell BL, *Community* *Genetics: Integrating Genetic
    Services into Public Health---Guidance for State and* *Territorial
    Programs from the* *NNSGRC* (Community Genet 2001;4:175-196).

g.  *Serving the Family From Birth to the Medical Home: A Report from
    the Newborn Screening Task Force Convened in Washington DC, May
    10-11, 1999*, Pediatrics, Volume 106, Number 2, August 2000,
    Supplement is available upon request from HRSA Information Center by
    phone: Toll-Free Number: 888-Ask HRSA or on-line, at:
    <http://www.ask.hrsa.gov/Instructions.cfm>. The Inventory Code
    Number is: MCHM065.

h.  NIH, Office of Rare Diseases' Rare Diseases Clinical Research
    Network:
    <http://rarediseases.info.nih.gov/html/resources/extr_res.html>

i.  CDC's Centers of Excellence for Birth Defects Prevention Research:
    [http://www.cdc.gov/ncbddd/bd/bdres.htm -
    State](http://www.cdc.gov/ncbddd/bd/bdres.htm#State)

j.  *Title V Information System (Title V IS)* electronically captures
    data from annual Title V Block Grant applications and reports
    submitted by all 59 U.S. States, Territories, and Jurisdictions and
    provides information on key measures of maternal and child health in
    the United States, at: <http://www.mchdata.net/>[.]{.underline}

k.  The Centers for Medicare & Medicaid Services (CMS), HRSA and CDC
    have joined together to launch a coordinated strategy aimed at
    reducing barriers to sharing data between Medicaid and health
    agencies and supporting innovative approaches to the design and
    implementation of State information systems that foster
    collaboration among these programs. This letter from the
    Administrators of HCFA, HRSA and CDC to State Health Officers and
    State Medicaid Directors provides information on the first set of
    activities conducted to support collaborations for data sharing
    between State Medicaid and health agencies. Available at:
    <http://cms.hhs.gov/states/letters/smd10228.asp>

l.  *Integrated Health Information Systems Investment Analysis Guide,*
    Centers for Disease Control and Prevention/Health Resources and
    Services Administration \-- Implementation Version - April 1, 1998.
    Available at: <http://www.hrsa.gov/investment.htm>. HIPAA and NEDSS
    standards and technical requirements including data types, code
    sets, vocabularies and messages for data exchange technical systems
    standards are available at:
    [www.cdc.gov/nedss](http://www.cdc.gov/nedss).

m.  Title XI of the Children\'s Health Care Act of 2000, \"Screening for
    Heritable Disorders,\" establishes a program to improve the ability
    of States to provide newborn and child screening for heritable
    disorders. Title XI enacts three sections of the Public Health
    Service (PHS) Act: Sections 1109, 1110, and 1111.
    ([**42**](http://www4.law.cornell.edu/uscode/42/index.html) USC
    [**6A**](http://www4.law.cornell.edu/uscode/42/ch6A.html)
    [**IX**](http://www4.law.cornell.edu/uscode/42/ch6AschI.html) Part A
    Sec. 300b-8. Improved newborn and child screening for heritable
    disorders <http://www4.law.cornell.edu/uscode/42/300b-8.html>). If
    you cannot access this URL, to request a copy, please call:
    301-443-1080.

n.  Lists of potential collaborative pediatric health care providers are
    available on the American Academy of Family Physician's website
    ([http://www.aafp.org](http://www.aafp.org/)) and the American
    Academy of Pediatrics' website
    ([http://www.aap.org](http://www.aap.org/)).

o.  *American Academy of Pediatrics' Medical Home definition*: "A
    medical home is not a building, house, or hospital, but rather an
    approach to providing health care services in a high-quality and
    cost-effective manner. Children and their families who have a
    medical home receive the care that they need form a pediatrician or
    physician whom they know and trust. The pediatric health care
    professionals and parents act as partners in a medical home to
    identify and access all the medical and non-medical services needed
    to help children and their families achieve their maximum
    potential." *(*<http://www.medicalhomeinfo.org/>

p.  *National Newborn Screening and Follow-up Evalution Center.
    http://www.ncec.com*

    []{#__RefHeading___Toc175617004 .anchor}**ix. Tips for Writing a
    Strong Application**

[]{.mark}

> **Include DUNS Number.** You must include a DUNS Number to have your
> application reviewed. Applications ***will not*** be reviewed without
> a DUNS number. To obtain a DUNS number, access
> [www.dunandbradstreet.com](http://www.dunandbradstreet.com/) or call
> 1-866-705-5711. Please include the DUNS number in item 8c on the
> application face page.
>
> **Keep your audience in mind.** Reviewers will use only the
> information contained in the application to assess the application. Be
> sure the application and responses to the program requirements and
> expectations are complete and clearly written. Do not assume that
> reviewers are familiar with the applicant organization, service area,
> barriers to health care, or health care needs in your community. Keep
> the review criteria in mind when writing the application.
>
> **Start preparing the application early.** Allow plenty of time to
> gather required information from various sources.
>
> **Follow the instructions in this guidance carefully.** Place all
> information in the order requested in the guidance. Avoid the risk of
> having reviewers hunt through your application for information.
>
> **Be brief, concise, and clear.** Make your points understandable.
> Provide accurate and honest information, including candid accounts of
> problems and realistic plans to address them. If any required
> information or data is omitted, explain why. Make sure the information
> provided in each table, chart, attachment, etc., is consistent with
> the proposal narrative and information in other tables. Your budget
> should reflect back to the proposed activities, and all forms should
> be filled out accurately and completely.
>
> **Be organized and logical.** Many applications fail to receive a high
> score because the reviewers cannot follow the thought process of the
> applicant or because parts of the application do not fit together.
>
> **Be careful in the use of attachments.** Do not use the attachments
> for information that is required in the body of the application. Be
> sure to cross-reference all tables and attachments to the appropriate
> text in the application. Be sure to upload the attachments in the
> order indicated in the forms.
>
> **Carefully proofread the application.** Misspellings and grammatical
> errors will impede reviewers in understanding the application. Be sure
> that page limits are followed. Limit the use of abbreviations and
> acronyms, and define each one at its first use and periodically
> throughout application. Make sure you submit your application in final
> form, without markups.
>
> **Print out and carefully review an electronic application to ensure
> accuracy and completion.** When submitting electronically, print out
> the application before submitting it to ensure appropriate formatting
> and adherence to page limit requirements. **Check to ensure that all
> attachments are included before sending the application forward.**
>
> **Ensure that all information is submitted at the same time. We will
> not consider additional information and/or materials submitted after
> your initial submission, nor will we accept e-mailed applications or
> supplemental materials once your application has been received.**

[]{#__RefHeading___Toc175617005 .anchor}APPENDIX A: HRSA's Electronic
Submission User Guide

> User Guide Table of Contents
>
> 1\. INTRODUCTION
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 1.1. DOCUMENT PURPOSE AND
> SCOPE\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 1.2. DOCUMENT ORGANIZATION AND VERSION
> CONTROL\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 2\. NONCOMPETING CONTINUATION
> APPLICATION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 2.1. PROCESS
> OVERVIEW\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 2.2. GRANTEE ORGANIZATION NEEDS TO REGISTER WITH
> [[GRANTS.GOV]{.underline}](http://GRANTS.GOV/) (IF NOT ALREADY
> REGISTERED)...................................................................................................\...\...\...\...\...
>
> 2.3. PROJECT DIRECTOR AND AUTHORIZING OFFICIAL NEED TO REGISTER WITH
> HRSA EHBS
>
> (IF NOT ALREADY REGISTERED)
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 2.4. APPLY THROUGH [[GRANTS.GOV]{.underline}](http://GRANTS.GOV/)
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 2.4.1 Find Funding
> Opportunity\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 2.4.2 Download Application Package
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 2.4.3 Complete
> Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 2.4.4 Submit
> Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 2.4.5 Verify Status of Application
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 2.5. VERIFY IN HRSA ELECTRONIC HANDBOOKS
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 2.5.1 Verify Status of Application
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 2.5.2 Manage Access to Your Application
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 2.5.3 Check Validation
> Errors\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 2.5.4 Fix Errors and Complete
> Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 2.5.5 Submit
> Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 3\. COMPETING
> APPLICATION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 3.1. PROCESS
> OVERVIEW\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 3.2. GRANTEE ORGANIZATION NEEDS TO REGISTER WITH
> [[GRANTS.GOV]{.underline}](http://GRANTS.GOV/) NOT ALREADY
> REGISTERED)\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 3.3. APPLY THROUGH
> [[GRANTS.GOV]{.underline}](http://GRANTS.GOV/)\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 3.3.1 Find Funding
> Opportunity\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 3.3.2 Download Application
> Package\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 3.3.3 Complete
> Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 3.3.4 Submit
> Application\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 3.3.5 Verify Status of Application
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 4\. GENERAL INSTRUCTIONS FOR APPLICATION
> SUBMISSION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 4.1. NARRATIVE ATTACHMENT
> GUIDELINES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 4.1.1
> Font\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 4.1.2 Paper Size and
> Margins\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 4.1.3
> Names\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 4.1.4 Section Headings
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 4.1.5 Page
> Numbering\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 4.1.6 Allowable Attachment or Document
> Types\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 4.2. APPLICATION CONTENT ORDER (TABLE OF
> CONTENTS)\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 4.3. PAGE
> LIMIT\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 5.0 CUSTOMER SUPPORT INFORMATION
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 5.1.1 Grants.gov Customer
> Support\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 5.1.2 HRSA Call
> Center\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 5.1.3 HRSA Program
> Support\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 6.0
> FAQs\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 6.1.
> SOFTWARE\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 6.1.1 What are the software requirements for using
> Grants.gov?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 6.1.2 Why can\'t I download PureEdge Viewer onto my
> machine?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 6.1.3 I have heard that Grants.gov is not Macintosh compatible. What
> do I do if I use only a
> Macintosh?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
> \...\...\...\...\...\...\....
>
> 6.1.4 What are the software requirements for HRSA
> EHBs?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 6.1.5 What are the system requirements for using HRSA EHBs on a
> Macintosh computer?\...\...\...\...\...\...\....
>
> 6.2. APPLICATION RECEIPT
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
>
> 6.2.1 What will be the receipt date\--the date the application is
> stamped as received by Grants.gov
>
> or the date the data is received by HRSA?
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 6.2.2 When do I need to submit my application?
> \...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 6.2.3 What emails can I expect once I submit my application? Is email
> reliable? \...\...\...\...\...\...\...\...\...\...\...\.....
>
> 6.2.4 If a resubmission is required because of Grants.gov system
> problems, will these be
>
> considered
> \"late\"?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
>
> 6.3. APPLICATION
> SUBMISSION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 6.3.1 How can I make sure that my electronic application is presented
> in the right order for
>
> objective
> review?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
>
> 6.4 GRANT.GOV
> HELP\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...

# 1. Introduction

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

Major changes are coming to HRSA's Grant Application Process. For
guidances released/posted on or after January 1, 2006, HRSA will no
longer accept applications for grant opportunities on paper. Applicants
submitting new and competing continuations and a selected number of
noncompeting continuation applications will be required to submit
electronically through Grants.gov. All applicants must submit in this
manner unless the applicant is granted a written exemption from this
requirement in advance by the Director of HRSA's Division of Grants
Policy.

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

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

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

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

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

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

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

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

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

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

# 2. Noncompeting Continuation Application

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For those applicant organizations still needing to register with
Grants.gov, registration information can be found on the Grants.gov Get
Started website (<http://www.grants.gov/GetStarted>). To be able to
successfully register in Grants.gov, it is necessary that you complete
all of the following required actions:

-   Obtain an organizational Data Universal Number System (DUNS) number

-   Register the organization with Central Contractor Registry (CCR)

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

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

-   Register an Authorized Organization Representative (AOR)

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

-   Register the username and password with Grants.gov

-   Get authorized as an AOR by your organization

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

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

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

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

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

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

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

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

-   Authorizing Official (AO),

-   Business Official (BO), and

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

# 3. Competing Application

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

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

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

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

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

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

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

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

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

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

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

For those applicant organizations still needing to register with
Grants.gov, registration information can be found on the Grants.gov Get
Started website (<http://www.grants.gov/GetStarted>). To be able to
successfully register in Grants.gov, it is necessary that you complete
all of the following required actions:

-   Obtain an organizational Data Universal Number System (DUNS) number

-   Register the organization with Central Contractor Registry (CCR)

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

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

-   Register an Authorized Organization Representative (AOR)

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

-   Register the username and password with Grants.gov

-   Get authorized as an AOR by your organization

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

# 4. General Instructions for Application Submission

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

-   

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

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

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

### 4.1.1 Font  {#font .unnumbered}

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

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

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

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

### 4.1.3 Names {#names .unnumbered}

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

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

Please put all section headings flush left in bold type.

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

**Electronic Submissions**

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

Do not number the standard OMB approved form pages.

**Paper Submissions (When allowed)**

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

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

**Electronic Submissions**

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

.DOC - Microsoft Word

.RTF - Rich Text Format

.TXT - Text

.WPD - Word Perfect Document

.PDF - Adobe Portable Document Format

.XLS - Microsoft Excel

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

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

HRSA uses two standard packages from Grants.gov.

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

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

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

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

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

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

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

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

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

# 5. Customer Support Information

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

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

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

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

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

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

Please visit HRSA EHBs for online help. Go to:

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

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

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

# 6. FAQs

## 6.1 Software {#software .unnumbered}

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

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

**System Requirements:**

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

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

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

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

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

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

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

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

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

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

Grants.gov website states:

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

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

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

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

IE 6.0 and above is the recommended browser.

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

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

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

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

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

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

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

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

**Competing Submissions:**

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

**Noncompeting Submissions:**

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

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

**Competing Submissions:**

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

**Noncompeting Submissions:**

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

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

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

**Competing Submissions:**

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

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

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

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

**Noncompeting Submissions:**

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

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

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

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

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

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

**Competing Submissions:**

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

**Noncompeting Submissions:**

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

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

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

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

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

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

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

[]{#__RefHeading___Toc175617065 .anchor}**Appendix B -- Registering and
Applying Through Grants.gov**

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

HRSA, in providing the grant community a single site to Find and Apply
for grant funding opportunities, is [requiring]{.underline} applicants
for this funding opportunity to apply electronically through Grants.gov.
By using Grants.gov you will be able to download a copy of the
application package, complete it off-line, and then upload and submit
the application via the Grants.gov site. You may [not]{.underline}
e-mail an electronic copy of a grant application to us.

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

Note: Except in rare cases, paper applications will NOT be accepted for
this grant opportunity. If you believe you are technologically unable to
submit an on-line application you MUST contact the Director of the
Division of Grants Policy, at
[DGPWaivers@hrsa.gov](../../../../../../../../C:/Documents%20and%20Settings/GLipton.000/My%20Documents/Grants/guidance/FY06/DGPClearances@hrsa.gov)
and explain why you are technologically unable to submit on-line. Make
sure you specify the announcement number you are requesting relief for.
HRSA and its Grants Application Center (GAC) will only accept paper
applications from applicants that received prior written approval.

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

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

GET STARTED NOW AND COMPLETE THE ONE-TIME REGISTRATION PROCESS TO BEGIN
SUBMITTING GRANT APPLICATIONS AS SOON AS YOU READ THIS.

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

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

Step 1: Register your organization

Step 2: Register yourself as an Authorized Organization Representative

Step 3: Get authorized by your organization to submit grants

These instructions will walk you through the three basic registration
steps. Additional assistance is available at Grants.gov at
[www.grants.gov](../www.grants.gov). Individual assistance is available
at [http://www.grants.gov/Support](http://www.grants.gov/Support  ) or
1-800-518-4726. Grants.gov also provides a variety of support options
through online Help including Context-Sensitive Help, Online Tutorials,
FAQs, Training Demonstration, User Guide, and Quick Reference Guides.

Follow this checklist to complete your registration---

1\. Register Your Organization

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

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

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

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

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

\- Obtain your username and password

\- Register your username and password with Grants.gov

3\. Get Yourself Authorized as an AOR

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

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

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

**REGISTER YOUR ORGANIZATION**

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

**Obtain your organization's DUNS number**

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

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

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

**Register your organization with CCR**

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

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

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

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

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

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

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

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

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

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

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

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

1\. **Obtain your username and password**

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

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

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

**2. Register with Grants.gov**

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

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

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

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

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

a\. [Applying using Grants.gov.]{.underline} Grants.gov has a full set
of instructions on how to apply for funds on its website at
<http://www.grants.gov/CompleteApplication>. The following provides
simple guidance on what you will find on the Grants.gov/Apply site.
Applicants are encouraged to read through the page entitled, "Complete
Application Package" before getting started. See Appendix A for specific
information.

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

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

a\. Electronic Submission. All applications must be received by
www.grants.gov/Apply by 8:00 P.M. Eastern Time on the due date
established for each program.

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

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

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

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

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

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

**Formal Submission of the Electronic Application**

Applications completed online are considered formally submitted when the
Authorizing Official electronically submits the application to HRSA
through Grants.gov. You must, however, ensure that a copy of the
SF-424/5161 Face Sheet is printed, signed, scanned, and included with
your electronic application as Attachment 1. For competitive
applications, the SF-424/5161 must be printed from Grants.gov.

Competitive applications will be considered as having met the deadline
if: (1) the application has been successfully transmitted electronically
by your organization's Authorizing Official through Grants.gov on or
before the deadline date and time, and (2) the signed SF-424/5161 Face
Sheet is included in the electronic application submission.

**Performance Measures for Competitive Applications**

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

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

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

[]{#__RefHeading___Toc175617066 .anchor}**APPENDIX C: MCHB Discretionary
Grant Performance Measures**

**07 PERFORMANCE MEASURE- Provide National Leadership for MCHB**

**(Promote family participation in care)**

**10 PERFORMANCE MEASURE- Eliminate Health Barriers & Disparities**

**(Develop and promote health services and systems of care designed to
eliminate disparities and barriers across MCH populations)**

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

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

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

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

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

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

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

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

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

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

0=Not Met

1=Partially Met

2=Mostly Met

3=Completely Met

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

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

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

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

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

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

0=Not Met

1=Partially Met

2=Mostly Met

3=Completely Met

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

> **APPENDIX D: Financial and Demographic Forms**
>
> FORM 1: MCHB Project Budget Details
>
> FORM 2: Project Funding Profile
>
> FORM 4: Project Budget and Expenditures by Types of Services
>
> FORM 5: Number of Individuals Served
>
> FORM 6: Maternal & Child Health Discretionary Grant Project Abstract
>
> FORM 7: Discretionary Grant Project Summary Data

**FORM 1**

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

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

**INSTRUCTIONS FOR COMPLETION OF FORM 1**

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

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

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

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

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

Line 5. Enter the sum of lines 1 through 4

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

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

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

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

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

**FORM 2**

**PROJECT FUNDING PROFILE**

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

**INSTRUCTIONS FOR THE COMPLETION OF FORM 2**

**PROJECT FUNDING PROFILE**

**Instructions:**

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

**FORM 4**

**PROJECT BUDGET AND EXPENDITURES**

**By Types of Services**

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

**INSTRUCTIONS FOR THE COMPLETION OF FORM 4**

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

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

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

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

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

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

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

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

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

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

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

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

**FORM 5**

**NUMBER OF INDIVIDUALS SERVED (UNDUPLICATED)**

**By Type of Individual and Source of Primary Insurance Coverage**

**[For Projects Providing Direct Health Care, Enabling or
Population-based Services]{.underline}**

**Reporting Year\_\_\_\_\_\_\_\_**

#########  **Table 1** (a) (b) (c) (d) (e) (f)

+-----------+--------+--------+---------+---------+---------+-------+
| *         | **     | **T    | **Title | **Title | **Pri   | **N   |
| *Pregnant | Number | otal** | XIX %** | XXI %** | vate/** | one** |
| Women     | Se     |        |         |         |         |       |
| Served**  | rved** | **Se   |         |         | **Other | **%** |
|           |        | rved** |         |         | %**     |       |
+-----------+--------+--------+---------+---------+---------+-------+
| Pregnant  |        |        |         |         |         |       |
| Women     |        |        |         |         |         |       |
|           |        |        |         |         |         |       |
| (All      |        |        |         |         |         |       |
| Ages)     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 10-14     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 15-19     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 20-24     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 25-34     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 35-44     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 45 +      |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+

**Table 2** (a) (b) (c) (d) (e) (f)

+-----------+--------+--------+---------+---------+---------+-------+
| **C       | **     | *      | **Title | **Title | **Pri   | **N   |
| hildren** | Number | *Total | XIX %** | XXI %** | vate/** | one** |
|           | Se     | Se     |         |         |         |       |
| *         | rved** | rved** |         |         | **Other | **%** |
| *Served** |        |        |         |         | %**     |       |
+-----------+--------+--------+---------+---------+---------+-------+
| Infants   |        |        |         |         |         |       |
| \<1       |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| Children  |        |        |         |         |         |       |
|           |        |        |         |         |         |       |
| 1 to 22   |        |        |         |         |         |       |
| yr        |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 1-4       |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 5-9       |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 10-14     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 15-19     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 20-24     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+

**Table 3** (a) (b) (c) (d) (e) (f)

+-----------+--------+--------+---------+---------+---------+-------+
| **CSHCN** | **     | **T    | **Title | **Title | **Pri   | **N   |
|           | Number | otal** | XIX %** | XXI %** | vate/** | one** |
| *         | Se     |        |         |         |         |       |
| *Served** | rved** | **Se   |         |         | **Other | **%** |
|           |        | rved** |         |         | %**     |       |
+-----------+--------+--------+---------+---------+---------+-------+
| Infants   |        |        |         |         |         |       |
| \<1 yr    |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| Children  |        |        |         |         |         |       |
|           |        |        |         |         |         |       |
| 1 to 22   |        |        |         |         |         |       |
| yr        |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 1-4       |        | []{    | []      | []      | []      | []{.  |
|           |        | .mark} | {.mark} | {.mark} | {.mark} | mark} |
+-----------+--------+--------+---------+---------+---------+-------+
| 5-9       |        | []{    | []      | []      | []      | []{.  |
|           |        | .mark} | {.mark} | {.mark} | {.mark} | mark} |
+-----------+--------+--------+---------+---------+---------+-------+
| 10-14     |        | []{    | []      | []      | []      | []{.  |
|           |        | .mark} | {.mark} | {.mark} | {.mark} | mark} |
+-----------+--------+--------+---------+---------+---------+-------+
| 15-21     |        | []{    | []      | []      | []      | []{.  |
|           |        | .mark} | {.mark} | {.mark} | {.mark} | mark} |
+-----------+--------+--------+---------+---------+---------+-------+

########  **[FORM 5 Continued]{.underline}**

**NUMBER OF INDIVIDUALS SERVED (UNDUPLICATED)**

**By Type of Individual and Source of Primary Insurance Coverage**

######## **[For Projects Providing Direct Health Care, Enabling or Population-based Services]{.underline}**

######## 

**Reporting Year\_\_\_\_\_**

**Table 4** (a) (b) (c) (d) (e) (f)

+-----------+--------+--------+---------+---------+---------+-------+
| **Women** | **     | **T    | **Title | **Title | **Pri   | **N   |
|           | Number | otal** | XIX %** | XXI %** | vate/** | one** |
| *         | Se     |        |         |         |         |       |
| *Served** | rved** | **Se   |         |         | **Other | **%** |
|           |        | rved** |         |         | %**     |       |
+-----------+--------+--------+---------+---------+---------+-------+
| Women 22+ |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 22-24     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 25-29     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 30-34     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 35-44     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 45-54     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 55-64     |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+
| 65+       |        |        |         |         |         |       |
+-----------+--------+--------+---------+---------+---------+-------+

**Table 5** (a) (b) (c) (d) (e) (f)

+-----------+--------+--------+----------+---------+---------+-------+
| **Other** | **Nu   | **T    | **Title  | **Title | **Pri   | **N   |
|           | mber** | otal** | XIX**    | XXI**   | vate/** | one** |
|           |        |        |          |         |         |       |
|           | **Se   | **Se   | **%**    | **%**   | **Other | **%** |
|           | rved** | rved** |          |         | %**     |       |
+-----------+--------+--------+----------+---------+---------+-------+
|           |        |        |          |         |         |       |
+-----------+--------+--------+----------+---------+---------+-------+

###### Table 6 (a) (b) (c) (d) (e) (f)

+-----------+--------+--------+----------+--------+---------+-------+
| ####### * | **Nu   | **T    | **Title  | *      | **Pri   | **N   |
| *TOTALS** | mber** | otal** | XIX**    | *Title | vate/** | one** |
|           |        |        |          | XXI**  |         |       |
|           | **Se   | **Se   | **%**    |        | **Other | **%** |
|           | rved** | rved** |          | **%**  | %**     |       |
+-----------+--------+--------+----------+--------+---------+-------+
|           |        |        |          |        |         |       |
+-----------+--------+--------+----------+--------+---------+-------+

**INSTRUCTIONS FOR THE COMPLETION OF FORM 5**

**NUMBER OF INDIVIDUALS SERVED (UNDUPLICATED)**

**By Type of Individual and Source of Primary Insurance Coverage**

**[For Projects Providing Direct Health Care, Enabling or
Population-based Services]{.underline}**

Enter data into all required (unshaded) data cells. If an actual number
is not available, make an estimate. Please explain all estimates, in a
footnote. Do not enter data into shaded cells.

**[Note]{.underline}** that ages are expressed as either x to y,
[not]{.underline} through y (i.e., 1 to 22, meaning from age 1 [up
to]{.underline} age 22, but not including 22) or x -- y (i.e., 1-4)
meaning age 1 [through]{.underline} age 4. Also, symbols are used to
indicate directions. For example \<1 means less than 1, or from birth up
to, but not including age 1. On the other hand, 45+ means age 45 and
over.

1\. At the top of the Form, on the Line Reporting Year, enter the year
for which the data applies.

2.  In Column (a) for all tables, enter the unduplicated count of
    individuals who received a direct service from the project
    regardless of the primary source of insurance coverage. These
    services would generally be included in the top three levels of the
    MCH pyramid (the fourth, or base level, would generally not contain
    direct services) and would include individuals served by total
    dollars reported on Line 5 of Form 3.

3\. In Column (b), enter the total number of the individuals summed from
Column (a).

4.  In the remaining columns report, for all tables, the percentage of
    those individuals receiving direct health care, enabling or
    population-based services, the percentage who have as their primary
    source of coverage:

> Column (c): Title XIX (includes Medicaid expansion under Title XXI)

Column (d): Title XXI

Column (e): Private or other coverage

Column (f) None

> These may be estimates. If individuals are covered by more than one
> source of insurance, they should be listed under the column of their
> [primary]{.underline} source.
>
> **FORM 6**

**MATERNAL & CHILD HEALTH DISCRETIONARY GRANT**

**PROJECT ABSTRACT**

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

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

**I. PROJECT IDENTIFIER INFORMATION**

1\. Project Title:

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

**II. BUDGET**

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

(Line 1, Form 2)

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

(Line 2, Form 2)

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

> (Line 3, Form 2)

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

> (Line 4, Form 2)

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

> (Line 5, Form 2)

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

\[ \] Direct Health Care Services

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

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

> A. Project Description

1.  Problem (in 50 words, maximum):

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

> Goal 1:

Objective 1:

Objective 2:

Goal 2:

Objective 1:

Objective 2:

Goal 3:

Objective 1:

Objective 2:

Goal 4:

Objective 1:

Objective 2:

Goal 5:

Objective 1:

Objective 2:

3.  Activities planned to meet project goals

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

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

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

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

B.  Continuing Grants ONLY

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

2.  Website URL and annual number of hits

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```
V.  **KEY WORDS**

**VI. ANNOTATION**

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

**PROJECT ABSTRACT**

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

**Section I -- Project Identifier Information**

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

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

E-mail address: Include electronic mail addresses

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

**Section III - Types of Services**

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

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

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

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

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

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

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

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

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

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B.  For continuing projects ONLY:

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

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

**Section V -- Key Words**

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

**Section VI -- Annotation**

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

**FORM 7**

**DISCRETIONARY GRANT PROJECT**

**SUMMARY DATA**

1.  **Project Service Focus**

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

2.  **Project Scope**

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

3.  **Grantee Organization Type**

> \[ \] State Agency

\[ \] Community Government Agency

\[ \] School District

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

\[ \] Academic Medical Center

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

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

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

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

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

\[ \] Independent Research/Planning/Policy Organization

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

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

\[ \] Guidelines/Standards Development And Maintenance

\[ \] Policies And Programs Study And Analysis

\[ \] Synthesis Of Data And Information

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

\[ \] Dissemination Of Information And Resources

\[ \] Quality Assurance

\[ \] Technical Assistance

\[ \] Training

\[ \] Systems Development

\[ \] Other

**5. Products and Dissemination**

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

  Peer reviewed Journal Article                            

  Book/Chapter                                             

  Report/Monograph                                         

  Presentation                                             

  Doctoral Dissertation                                    

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

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

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

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

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

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

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

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

> Answer all that apply.

a.  Characteristics of Primary Intended Audience(s)

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

\[ \] Providers/Professionals

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

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

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

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

f.  Major Type of TA or Training Provided:

> \[ \] continuing education courses,

\[ \] workshops,

\[ \] on-site assistance,

\[ \] distance learning classes

\[ \] other

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

**PROJECT SUMMARY**

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

**Section 1 -- Project Service Focus**

Select all that apply

**Section 2 -- Project Scope**

Choose the one that best applies to your project.

**Section 3 -- Grantee Organization Type**

Choose the one that best applies to your organization.

**Section 4 -- Project Infrastructure Focus**

If applicable, choose all that apply.

**Section 5 -- Products and Dissemination**

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

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

Please fill in each of the cells as appropriate.

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

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

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

Answer all that apply.