![](media/image1.png){width="2.5833333333333335in"
height="0.8208333333333333in"}**Issuance Date:** December 12, 2008

**Closing Date:** February 17, 2009

**Closing Time:** 10:00 AM Eastern Standard Time (EST)

[Subject:]{.underline} Request for Applications (RFA) No.
USAID-M-OAA-GH-09-298

FY-2009 Child Survival and Health Grants Program (CSHGP).

The United States Agency for International Development (USAID) Bureau
for Global Health, Office of Health, Infectious Disease and Nutrition
(GH/HIDN) is seeking applications from U.S. Private and Voluntary
Organizations (PVOs) and Non-Profit, Non-Governmental Organizations
(NGOs), engaged in international health and development, to implement
activities under the Child Survival and Health Grants Program (CSHGP).

For the purposes of this RFA, the term "Grant" is synonymous with
"Cooperative Agreement"; \"Grantee\" is synonymous with \"Recipient\";
and \"Grant Officer\" is synonymous with \"Agreement Officer\".

The authority for the RFA is found in the Foreign Assistance Act of
1961, as amended.

For the purposes of this program, this RFA is being issued and consists
of this cover letter and the following:

1.  Section A -- Program Description;

2.  Section B -- Selection Criteria;

3.  Section C -- Grant Application Guidelines;

4.  Section D -- Required Forms, Certifications, Assurances, and Other
    Statements of Recipient;

5.  Section E -- Standard Provisions for U.S. Nongovernmental
    Recipients;

6.  Annexes.

The preferred method of distribution of USAID procurement information is
via the Internet. This RFA and any future amendments can be downloaded
from the Agency Web Site. The World Wide Web Address is
[http://www.grants.gov](http://www.grants.gov/).

Applications must be received by the closing date and time indicated at
the top of this cover letter at the place designated below for receipt
of applications. Applications and modifications thereof shall be
submitted in sealed envelopes with the name and address of the applicant
and RFA \# (referenced above) inscribed there on, to:

**[U.S. Postal Service Mailing Address]{.underline}:** **[All Other
Means of Delivery]{.underline}:**

USAID/M/OAA Room 7.09-92 Attn: USAID/M/OAA Room 7.09-92

Ronald Reagan Building Ronald Reagan Building

U.S. Agency for International Development U.S. Agency for International
Development

1300 Pennsylvania Avenue, NW 1300 Pennsylvania Avenue, NW

Washington, DC 20523-3100 Washington, DC 20004-3100

**Attention: Mr. Ousmane Faye, Jr.** Please use phone at visitor's desk
to contact:

**Mr. Ousmane Faye, Jr., at x2-0832.**

Additionally, a copy of the complete application must be sent to the
**USAID Mission** in the country of the proposed program by close of
business **February 24, 2009.** It is the responsibility of the
applicant to ensure that the USAID Mission receives a copy. See Annex D
for the current Mission addresses.

[Note:]{.underline} Couriers must enter the building using the 14^th^
Street entrance. At the guard/reception desk, dial Extension 2-0832.

Telegraphic or fax applications are not authorized for this RFA and will
not be accepted.

[A]{.underline}ll applicants delivering applications contained in boxes
through carriers other than UPS, FedEx, and the US Post Office will be
required to complete a Freight Delivery Request Form and provide this
form to the Ronald Reagan Building (RRB) ITC Loading Dock Manager **72
hours in advance** of delivery (contact information is provided in the
form). The form may be obtained from Ousmane Faye, Jr. who may be
reached by telephone at 202-712-0832 or <ofaye@usaid.gov>. Once an RRB
loading dock representative accepts the delivery, this will be
considered the actual time of USAID's acceptance. Electronic submission
of applications is acceptable via the
[www.Grants.gov](http://www.Grants.gov/) website. However, submission of
hard copies is a requirement (see Section C -- Application Guidelines
for more information).

Applicants should retain for their records one copy of all enclosures
which accompany their application.

Pursuant to 22 CFR 226.81, it is USAID policy not to award profit under
assistance instruments. However, all reasonable, allocable and allowable
expenses, both direct and indirect, which are related to the agreement
program and are in accordance with applicable cost standards (22 CFR
226, OMB Circular A-122 for non-profit organization, OMB Circular A-21
for universities, and the Federal Acquisition Regulation (FAR) Part 31
for profit organizations), may be paid under the agreement.

USAID reserves the right to fund any or none of the applications
submitted in response to this RFA. Awards will be made subject to the
availability of funds. This FY 2009 RFA does not commit USAID to funding
a specific number of applications from new or established partners. The
applications funded in the 2009 fiscal year will depend on availability
of funds, the programs' fit within the State Department's strategy on
foreign assistance, and the quality of proposals. Pipeline budgets of
existing programs as well as expected 2009 funding will be taken into
account in determining the amount of funding awarded in 2009.

Issuance of this RFA does not constitute an award commitment on the part
of the Government, nor does it commit the Government to pay for costs
incurred in the preparation and submission of an application. Further,
the Government reserves the right to reject any or all applications
received. In addition, final award of any resultant grant(s) cannot be
made until funds have been fully appropriated, allocated and committed
through internal USAID procedures. While it is anticipated that these
procedures will be successfully completed, potential applicants are
hereby notified of these requirements and conditions for award.
Applications are submitted at the risk of the applicant; should
circumstances prevent award of a cooperative agreement, all preparation
and submission costs are at the applicant\'s expense.

In the event of an inconsistency between the documents comprising this
RFA, it shall be resolved by the following descending order of
precedence:

(a) Section B - Selection Criteria;

(b) Section C - Grant Application Guidelines;

(c) Section A - Program Description;

(d) This Cover Letter.

Any prospective applicant who has questions concerning the contents of
this RFA should submit them **[in writing]{.underline} to** Nazo Kureshy
**(<nkureshy@usaid.gov>) and** Ousmane Faye **(<ofaye@usaid.gov>)** by
5:00 PM EST on **December 29, 2008**. Any additional information
regarding this RFA will be furnished through an amendment to this RFA.

**Important highlights:**

-   The FY09 RFA continues to strengthen the program's primary focus on
    innovation and operations research to generate solutions for
    addressing critical delivery challenges and strengthening health
    systems.

-   The list of eligible countries for all categories has been updated,
    and **all eligible countries are weighted equally.**

-   The ceiling amounts have increased from \$1.25 to \$1.5 million for
    the New Partner Category and \$1.6 to \$1.75 million for the
    Innovation Category.

-   In the Innovation Category, up to \$200,000 may be budgeted for
    Operations Research in order to generate credible evidence that can
    be utilized at the national and global levels.

-   Evaluation criteria and corresponding guidance have been refined for
    all three categories.

-   TB elements, sub-elements, and indicators are provided as an annex. 

Thank you for your consideration of this USAID initiative. We look
forward to your organization's participation.

Sincerely,

Bruce Baltas

Agreement Officer

**TABLE OF CONTENTS**

[ACRONYM LIST 1](#__RefHeading___Toc215899546)

SECTION A: PROGRAM
DESCRIPTION............................................................
3

[I. Introduction 3](#i.-introduction)

[II. CSHGP Objectives 3](#ii.-cshgp-objectives)

[III. Overview of the CSHGP 4](#iii.-overview-of-the-cshgp)

[IV. Technical Interventions 5](#iv.-technical-interventions)

[V. Funding Categories 7](#v.-funding-categories)

[VI. Eligible Country List 8](#vi.-eligible-country-list)

[SECTION B: SELECTION CRITERIA 11](#section-b-selection-criteria)

[I. Eligibility Requirements 11](#i.-eligibility-requirements)

[II. Project Requirements 12](#ii.-project-requirements)

[III. Project Restrictions 14](#iii.-project-restrictions)

[IV. Evaluation Criteria 14](#iv.-evaluation-criteria)

[SECTION C: GRANT APPLICATION GUIDELINES
15](#section-c-grant-application-guidelines)

[I. Instructions for Preparation and Submission of Applications
15](#i.-instructions-for-preparation-and-submission-of-applications)

[II. Technical Application Guidelines
17](#ii.-technical-application-guidelines)

[II.A. Guidelines for New Partner Category
18](#ii.a.-guidelines-for-new-partner-category)

[II.B. Guidelines for Innovation Category
27](#ii.b.-guidelines-for-innovation-category)

[II.C. Guidelines for Tuberculosis Category
36](#ii.c.-guidelines-for-tuberculosis-category)

[III. Cost Application Guidelines 46](#iii.-cost-application-guidelines)

[IV. Additional Documentation 49](#iv.-additional-documentation)

[V. Additional Considerations 50](#v.-additional-considerations)

[SECTION D: REQUIRED FORMS, CERTIFICATIONS, ASSURANCES, AND OTHER
STATEMENTS OF RECIPIENT
52](#section-d-required-forms-certifications-assurances-and-other-statements-of-recipient)

[PART I - CERTIFICATIONS AND ASSURANCES
53](#part-i---certifications-and-assurances)

[PART II - KEY INDIVIDUAL CERTIFICATION NARCOTICS OFFENSES AND DRUG
TRAFFICKING
57](#part-ii---key-individual-certification-narcotics-offenses-and-drug-trafficking)

[PART III - PARTICIPANT CERTIFICATION NARCOTICS OFFENSES & DRUG
TRAFFICKING
57](#part-iii---participant-certification-narcotics-offenses-and-drug-trafficking)

[PART IV - CERTIFICATION OF COMPLIANCE WITH THE STANDARD PROVISIONS
ENTITLED "CONDOMS" AND "PROHIBITION ON THE PROMOTION OR ADVOCACY OF THE
LEGALIZATION OR PRACTICE OF PROSTITUTION OR SEX TRAFFICKING."
58](#part-iv---certification-of-compliance-with-the-standard-provisions-entitled-condoms-and-prohibition-on-the-promotion-or-advocacy-of-the-legalization-or-practice-of-prostitution-or-sex-trafficking.)

[PART V - SURVEY ON ENSURING EQUAL OPPORTUNITY FOR APPLICANTS
59](#part-v---survey-on-ensuring-equal-opportunity-for-applicants)

[PART VI - OTHER STATEMENTS OF RECIPIENT
59](#part-vi---other-statements-of-recipient)

[SECTION E: STANDARD PROVISIONS FOR U.S. Nongovernmental Recipients
63](#section-e-standard-provisions-for-u.s.-nongovernmental-recipients)

[I. MANDATORY STANDARD PROVISIONS FOR US NONGOVERNMENTAL RECIPIENTS
65](#i.-mandatory-standard-provisions-for-us-nongovernmental-recipients)

[II. REQUIRED AS APPLICABLE STANDARD PROVISIONS FOR U.S.,
NONGOVERNMENTAL RECIPIENTS
83](#ii.-required-as-applicable-standard-provisions-for-u.s.-nongovernmental-recipients)

[ANNEXES 112](#annexes)

[Annex A: Conditions of Registration for U.S. Organizations
113](#annex-a-conditions-of-registration-for-u.s.-organizations)

[Annex B: Tuberculosis Element and Sub-Elements
115](#annex-b-tuberculosis-element-and-sub-elements)

[Annex C: TB Indicators 118](#annex-c-tb-indicators)

[Annex D: USAID Mission Contact List & Addresses
121](#annex-d-usaid-mission-contact-list-addresses)

[Annex E: Application Screening Form
133](#annex-e-application-screening-form)

[Annex F: Beneficiary Calculation Guidelines
134](#annex-f-beneficiary-calculation-guidelines)

[Annex G: Program Matrix 136](#annex-g-program-matrix)

[Annex H: SF 424 Forms 137](#annex-h-sf-424-forms)

[]{#__RefHeading___Toc215899546 .anchor}**ACRONYM LIST**

ACSM Advocacy, Communication and Social Mobilization

AIDS Acquired Immune Deficiency Syndrome

BCC Behavior Change Communication

BCG Bacille Calmette-Guérin

CBO Community-based Organization

CORE Child Survival Collaborations and Resources Group

CSHGP Child Survival and Health Grants Program

CSTS+ Child Survival Technical Support Plus Project

DHS Demographic and Health Survey

DIP Detailed Implementation Plan

DOT Directly Observed Therapy

DOTS Directly Observed Therapy, Short-Course

DPT Diphtheria, Pertussis, Tetanus

FAR Federal Acquisition Regulation

FBO Faith-based Organization

FY Fiscal Year

GH Bureau for Global Health

GFATM Global Fund for AIDS, Tuberculosis, and Malaria

HIDN Office of Health, Infectious Diseases, and Nutrition

HIV Human Immunodeficiency Virus

HMIS Health Management Information Systems

IEC Information, Education, and Communication

IMCI Integrated Management of Childhood Illnesses

IPTp Intermittent Preventive Treatment in pregnant women

IRS Indoor Residual Spraying

ITN Insecticide Treated Net

IYCF Infant and Young Child Feeding

KPC Knowledge, Practices, and Coverage Survey

LOE Level of Effort

LLIN Long Lasting Insecticide Treated Net

MAMAN Minimum Package for Mothers and Newborns

MCHIP Maternal and Child Health Integrated Project

MCP Malaria Community Programs

M&E Monitoring and Evaluation

MNCH Maternal, Newborn, and Child Health

MOH Ministry of Health

MOU Memorandum of Understanding

NGO Non governmental Organization

NTP National Tuberculosis Program

ORS Oral Rehydration Salt

OAA Office of Acquisition and Assistance

ORT Oral Rehydration Therapy

PEPFAR U.S. President's Emergency Plan for AIDS Relief

PMI Presidential Malaria Initiative

PMTCT Preventing Mother-to-Child Transmission

PR Program Results

PVO Private Voluntary Organization

RFA Request for Application

RRB Ronald Reagan Building

TB Tuberculosis

TRM Technical Reference Materials

USAID United States Agency for International Development

WHO World Health Organization

XDR TB Extensively Drug Resistant Tuberculosis

**SECTION A: PROGRAM DESCRIPTION**

## I. Introduction 

The fiscal year (FY) 2009 RFA for the Child Survival and Health Grants
Program (CSHGP) focuses on innovation in delivery strategies for high
impact maternal, newborn, and child health (MNCH) interventions. This
focus continues to strengthen a major shift in the program and in the
criteria for selecting grantees and is closely aligned with the USAID
Global Health Bureau's mandate for innovation and technical leadership.
In addition, the RFA is seeking to attract new partners to contribute to
innovation and expand and improve the capacity of partners to contribute
to the Stop Tuberculosis (TB) strategy interventions in targeted
countries to meet global TB targets.

The FY09 RFA will solicit proposals from U.S. Private Voluntary
Organizations (PVOs)/Non Governmental Organizations (NGOs) to be
reviewed and recommended for award in FY 2010. The RFA will make awards
in three grant categories: up to two awards in the New Partner category
(each up to \$1.5 million, 4-5 years; total estimated cost of two
awards: \$3,000,000); approximately five awards in the Innovation
category (each up to \$1.75 million, 4-5 years; total estimated cost of
five awards: \$8,750,000); and one award in the TB category (up to \$1.5
million, 5 years; total estimated cost: \$1,500,000).

## II. CSHGP Objectives

The objectives of the FY09 CSHGP are to:

**1.) Pilot and analyze new approaches to introduce and scale up
interventions in diverse community settings, including urban and
post-conflict settings.**

CSHGP will introduce and analyze innovations that address the most
critical barriers to community access to high impact interventions that
prevent or treat the major causes of maternal and child mortality and
malnutrition, such as antenatal care and skilled birth attendance;
postnatal and newborn care; breastfeeding, appropriate child feeding,
and management of acute severe malnutrition; immunization; vitamin A and
zinc supplementation; and prevention and treatment of diarrhea,
pneumonia, and malaria.

**2.) Contribute to the** **solution of key operational barriers to
scaling up delivery of these interventions through the provision of
technical leadership and specialized technical resources.**

The CSHGP will generate specialized technical resources and tools for
Program Managers and Ministry of Health (MOH) staff that are responsible
for designing and monitoring community oriented programs as well as
systematizing program achievements and learning from multiple country
settings to facilitate global learning and leadership. CSHGP will
leverage the technical resources of a broad network of PVOs/NGOs through
CORE and the technical expertise in the USAID-funded Maternal and Child
Health Integrated Project (MCHIP) and USAID/GH staff and partners in
order to develop state-of-the art technical resources that are widely
used by PVOs/NGOs and their local partners (MOH, local NGOs) in USAID
and larger health and development communities.

**3.) Disseminate evidence and lessons for proven models for the
delivery of high impact integrated interventions.**

CSHGP's partnership model facilitates NGOs to organize into technical
working groups and communities of practice according to their
comparative advantage and technical interests that are responsive to
GH/USAID priorities.

These three CSHGP objectives showcase the importance of implementing
projects that utilize innovative community oriented delivery strategies
and address key operational barriers to scaling up delivery of high
impact MNCH interventions to ensure sustained health outcomes. They
reflect the contributions of communities of practice and collaboration
and specialized technical assistance that contribute to advances in
community oriented programming and policies.

##  III. Overview of the CSHGP

Since 1985, USAID has supported community oriented CSHGP projects
implemented by U.S. PVOs/NGOs and their local partners. The purpose of
this program is to contribute to sustained improvements in child
survival and health outcomes by supporting the innovations of PVOs/NGOs
and their in country partners in reaching vulnerable populations.

The CSHGP is housed in the Bureau for Global Health's Office of Health,
Infectious Diseases and Nutrition (GH/HIDN). For more information about
the CSHGP, refer to:
<http://www.usaid.gov/our_work/global_health/home/Funding/cs_grants/cs_index.html>.

Within the Foreign Assistance Framework, the CSHGP contributes to the
Investing in People objective and its supporting elements, e.g. MCH, TB,
Malaria, and their respective sub-elements.

The three main program components of the CSHGP include:

\(1\) [PVO/NGO Cooperative Agreements]{.underline}: Each year, new
cooperative agreements are awarded to support community oriented health
programs in specific child survival and health technical areas. The
current portfolio consists of approximately 56 projects in 31 countries.

\(2\) [CORE Group]{.underline}: The CSHGP supports the CORE Group
(Collaborations and Resources for Child Survival), a network
organization of 48 NGO members collectively working in over 180
countries. CORE's mission is to strengthen local capacity on a global
scale to measurably improve the health and well-being of children and
women in developing countries through collaborative NGO action and
learning. NGOs participate in CORE's eight working groups in the
following areas: Integrated Management of Childhood Illnesses (IMCI),
Malaria, Monitoring and Evaluation, Nutrition, Safe Motherhood and
Reproductive Health, Social and Behavioral Change, HIV/AIDS, and
Tuberculosis. Organizations interested in participating in CORE Group
activities and learning more about the child survival community should
consider joining the network. For more information, see the CORE
website: <http://www.coregroup.org/>.

\(3\) [Specialized Technical Assistance from the Maternal and Child
Health Integrated Program (MCHIP]{.underline}): CSHGP will receive
specialized technical assistance from MCHIP. MCHIP integrates the
functions of the Child Survival Technical Support Plus (CSTS+) Project
into the Global Health Bureau's flagship project for maternal and child
health.[^1] MCHIP is a Leader with Associates Cooperative Agreement with
a JHPIEGO-led consortium, which includes Macro International, Inc. MCHIP
is designed to support the introduction, scale up, and further
development of high impact MNCH interventions, including program
approaches to effectively deliver those interventions to achieve
measurable reductions in under-five and maternal mortality and
morbidity. MCHIP will form an operations research (OR) committee to
provide consistency in approaches across awards and technical guidance
for research designs. One of MCHIP's strategic objectives focuses on
assisting PVOs/NGOs and their local partners supported by CSHGP and PMI
Malaria Community Programs (MCP) to design, implement, monitor, and
evaluate innovative, effective, and scalable community oriented
strategies.

## IV. Technical Interventions

All technical guidance and relevant tools for designing, implementing,
and evaluating the interventions can be found on
[http://www.childsurvival.com](http://www.childsurvival.com/) \[e.g.
Technical Reference Materials (TRMs), Minimum Package for Mothers and
Newborns (MAMAN) framework, Rapid Health Facility Assessment (RHFA), and
Knowledge, Practice, and Coverage (KPC) survey\]. Applicants should
familiarize themselves with these materials, which provide guidance for
developing strategic high impact intervention packages. For TB
applicants, please consult Annex B for new recommended TB indicators.

Selection and integration of technical interventions should be guided by
the disease burden and the health system capacity.[^2] Evidence-based
technical interventions that support the CSHGP objectives are listed
below.

[Immunization]{.underline}: Strengthening routine immunization (DPT,
BCG, Measles); expanding coverage and assessment; improving surveillance
methods; improving quality and safety of products; strengthening the
cold chain; and support of polio vaccination programs.

[Vitamin A/Micronutrients]{.underline}: Improving coverage and
supplementation of vitamin A for children under five; integrating
vitamin A supplementation with the expanded program for immunization,
deworming, and child health days; promoting dietary intake of
micronutrient-rich foods; strengthening and promoting maternal and/or
child anemia packages that provide iron supplementation in conjunction
with improved dietary intake, deworming, or malaria control as
appropriate.

[Infant and Young Child Feeding (IYCF)]{.underline}:
Promoting exclusive breastfeeding for children 0-5 months; promoting
appropriate feeding for children 6-23 months including continued
breastfeeding, appropriate number of feeds per day, a diverse diet with
nutrient-dense foods, adequate quantity of food with appropriate
consistency, and feeding during and after illness; promoting optimal
nutrition for women; improving nutrition counseling especially during
key contact points such as community-based nutrition activities,
antenatal care, delivery, well-child visits, sick child visits, and
growth promotion; and strengthening community support for optimal IYCF
practices.

[Control of Diarrheal Disease]{.underline}:  Improving family and
community practices for diarrheal disease prevention, including hand
washing with soap, safe transport, correct storage and handling of
drinking water; promotion of point-of-use treatment of water; safe
disposal of feces; hygiene promotion and improving water and sanitation
technologies; strengthening of enabling environments to reduce the
incidence of diarrheal disease; improving recognition and appropriate
treatment of diarrheal disease at the facility and community level;
supporting the revision of policy guidelines to endorse the use of low
osmolarity Oral Rehydration Salt (ORS) with zinc treatment to improve to
improve diarrhea case management for children; and expanding access to
and use of low osmolarity ORS and zinc treatment; and reinvigorating
Oral Rehydration Therapy (ORT) practices.

[Pneumonia Case Management]{.underline}: Ensuring adequate access to
pneumonia case management, which includes high quality facility- and
community-based treatment; promoting timely recognition of pneumonia by
caretakers and prompt care seeking from appropriate health providers;
supporting an integrated package to strengthen case management such as
improving skills of health workers, improving health system support, and
improving family practices and community services.

[Prevention and Treatment of Malaria]{.underline}: Promoting
intermittent preventive treatment in pregnant women (IPTp); expanding
ownership and use of insecticide treated bednets (ITNs), with emphasis
on long-lasting nets (LLINs); improving malaria case management
(including diagnosis) at the facility and community levels; promoting
care-taker recognition of fever in children under five and prompt
care-seeking behavior; applications [should not]{.underline} include
activities related to indoor residual spraying (IRS).[^3]

[Maternal and Newborn Care]{.underline}: Improving birth preparedness
and complication-readiness planning; access to focused antenatal care
(including education and counseling for healthy timing and spacing of
pregnancy); promotion of tetanus toxoid immunization; promoting skilled
attendants for birth and improving skills of providers; promotion of
clean delivery and infection control; employing appropriate household-
and community-based strategies where access to skilled care is
difficult, including referral; promoting active management of third
stage of labor; improving access to quality postnatal (mother and
newborn) care and appropriate postnatal messaging (including education
and counseling for healthy timing and spacing of pregnancy); promoting
essential newborn care practices for all newborns including thermal
care, cord care, and immediate and exclusive breastfeeding; and sick
newborn care including identification and treatment of neonatal
infection and complications, resuscitation, and special care of
premature and low birth weight infants. 

[HIV/AIDS]{.underline}: Grant activities may include the strengthening
or establishment of linkages between MNCH services and HIV/AIDS related
services for women and children, where these linkages will serve to
strengthen both types of service, i.e. strengthening the link of MNCH
services providing antenatal, delivery, and post-partum care with
preventing mother-to-child transmission (PMTCT) services, to produce
improvement in those maternity services as well as increased uptake of
PMTCT and improved follow-up, care, and treatment of HIV-exposed infants
and HIV-positive mothers; strengthening routine child health services,
including community-based services, to support improved detection, care,
and treatment of HIV-positive infants and children; integration of safe
water, hygiene, and sanitation into PMTCT services as well as into the
care and support of HIV-positive mothers and HIV-exposed children. Since
CSHGP funding is not HIV-specific funding, it is important that any
proposed activities related to HIV detection, care, and treatment be
designed in ways that also strengthen routine MNCH services for the
broader population of women and children in the target population.

[Tuberculosis]{.underline}[^4]: Expanding community-based TB
programming; providing care and support to people with TB; improving
detection and diagnosis using quality-assured bacteriology and
standardized treatment with supervision and patient support; ensuring a
reliable drug supply and management system; improving monitoring and
evaluating systems through host country strategic information systems;
improving management of TB/HIV co-infection; addressing multi-drug
resistant TB; and advocating for political commitment. Care and support
includes community participation in TB care and prevention, community
education and social mobilization, empowering communities using the
patient charter for TB care, using enablers to help patients adhere to
treatment, and engagement of civil society organizations.

## V. Funding Categories

The following three funding categories are offered under this RFA to
eligible applicants:

-   New Partner (4-5 years, up to \$1,500,000)

-   Innovation (4-5 years, up to \$1,750,000)

-   Tuberculosis (5 years, up to \$1,500,000)

Interested applicants have the option of submitting up to two
applications in response to this RFA as long as one of the two
applications is submitted under the TB category (see Application
Limitations in Section B: Selection Criteria). Applicants should weigh
the strengths and capabilities of their organizations when considering
which funding category to apply under and the number of applications to
submit. Applications will be competed [within]{.underline} each category
rather than across the three categories.

## 

## VI. Eligible Country List

USAID Missions indicate their interest and add their countries to the
eligible country list annually when they believe U.S. PVOs/NGOs can play
a critical role in reducing infant, child, maternal, and infectious
disease-related morbidity and mortality rates. CSHGP projects serve as
important demonstration sites for influencing programming and policy at
the national and global levels.

**New Partner and Innovation Category Eligible Countries:**[^5]

+---------------+-----------------+---------------+-------------------+
| **Africa**    | **Asia & Near   | **Europe &    | **Latin America & |
|               | East**          | Eurasia**     | Caribbean**       |
+---------------+-----------------+---------------+-------------------+
| Angola        | **Afghanistan** | Armenia       | Dominican         |
|               |                 |               | Republic          |
| **Benin**     | **Bangladesh**  | *             |                   |
|               |                 | *Azerbaijan** | Ecuador           |
| Burkina Faso  | **Cambodia**    |               |                   |
|               |                 | Georgia       | El Salvador       |
| Burundi       | East Timor      |               |                   |
|               |                 | Kyrgyzstan    | **Haiti**         |
| Cameroon      | **India**       |               |                   |
|               |                 | Russia        | Honduras          |
| Cape Verde    | **Indonesia**   |               |                   |
|               |                 | *             | Nicaragua         |
| Chad          | Laos            | *Tajikistan** |                   |
|               |                 |               | Peru              |
| Cote d'Ivoire | **Nepal**       | Turkmenistan  |                   |
|               |                 |               |                   |
| **DR Congo**  | Papua New       | Ukraine       |                   |
|               | Guinea          |               |                   |
| **Ethiopia**  |                 | Uzbekistan    |                   |
|               | **Philippines** |               |                   |
| Equatorial    |                 |               |                   |
| Guinea        | Thailand        |               |                   |
|               |                 |               |                   |
| Gabon         | Vietnam         |               |                   |
|               |                 |               |                   |
| The Gambia    | Yemen           |               |                   |
|               |                 |               |                   |
| **Ghana**     |                 |               |                   |
|               |                 |               |                   |
| Guinea        |                 |               |                   |
|               |                 |               |                   |
| Guinea-Bissau |                 |               |                   |
|               |                 |               |                   |
| **Kenya**     |                 |               |                   |
|               |                 |               |                   |
| **Liberia**   |                 |               |                   |
|               |                 |               |                   |
| *             |                 |               |                   |
| *Madagascar** |                 |               |                   |
|               |                 |               |                   |
| **Malawi**    |                 |               |                   |
|               |                 |               |                   |
| **Mali**      |                 |               |                   |
|               |                 |               |                   |
| Mauritania    |                 |               |                   |
|               |                 |               |                   |
| *             |                 |               |                   |
| *Mozambique** |                 |               |                   |
|               |                 |               |                   |
| Namibia       |                 |               |                   |
|               |                 |               |                   |
| Niger         |                 |               |                   |
|               |                 |               |                   |
| **Nigeria**   |                 |               |                   |
|               |                 |               |                   |
| **Rwanda**    |                 |               |                   |
|               |                 |               |                   |
| Sao           |                 |               |                   |
| Tome/Principe |                 |               |                   |
|               |                 |               |                   |
| Senegal       |                 |               |                   |
|               |                 |               |                   |
| Sierra Leone  |                 |               |                   |
|               |                 |               |                   |
| Somalia       |                 |               |                   |
|               |                 |               |                   |
| South Africa  |                 |               |                   |
|               |                 |               |                   |
| **Sudan**     |                 |               |                   |
|               |                 |               |                   |
| **Tanzania**  |                 |               |                   |
|               |                 |               |                   |
| Togo          |                 |               |                   |
|               |                 |               |                   |
| **Uganda**    |                 |               |                   |
|               |                 |               |                   |
| **Zambia**    |                 |               |                   |
+---------------+-----------------+---------------+-------------------+

[]{.mark}

[]{.mark}

**Tuberculosis Category Eligible Countries:**

+----------------+------------------+----------------+----------------+
| **Africa**     | **Asia & Near    | **Europe &     | **Latin        |
|                | East**           | Eurasia**      | America &      |
|                |                  |                | Caribbean**    |
+----------------+------------------+----------------+----------------+
| DR Congo       | Cambodia         | Russia         | Brazil         |
|                |                  |                |                |
| Ethiopia       |                  | Ukraine        |                |
|                |                  |                |                |
| Mozambique     |                  |                |                |
|                |                  |                |                |
| Nigeria        |                  |                |                |
|                |                  |                |                |
| South Africa   |                  |                |                |
|                |                  |                |                |
| Tanzania       |                  |                |                |
|                |                  |                |                |
| Uganda         |                  |                |                |
+----------------+------------------+----------------+----------------+

# SECTION B: SELECTION CRITERIA

## I. Eligibility Requirements

Organizations must meet the following criteria to apply for a CSHGP
grant.

A. [Status]{.underline}: U.S. PVO (any Category) or U.S. NGO (New
Partner Category only). Please see below for additional information on
organizational status.

1\. U.S. PVOs

A U.S. PVO is defined as a U.S. non governmental organization that meets
the first four Conditions of Registration as outlined in Part 203,
Chapter II, Title 22 of the Code of Federal Regulations in USAID's
Automated Directives System. To be registered, a U.S. PVO also must meet
the second four Conditions of Registration, which establish standards to
be met on an annual basis (see Annex A for a list of these eight
Conditions). **If an organization meets the criteria of a U.S. PVO, the
organization must be registered or in the process of registration with
USAID as a U.S. PVO at the time of application submission** **to be
considered eligible** as a U.S. PVO under this RFA.

To register with USAID as a U.S. PVO, please refer to USAID's website at
[www.usaid.gov](http://www.usaid.gov/), USAID Keyword: PVO Registration,
or
<http://www.usaid.gov/our_work/cross-cutting_programs/private_voluntary_cooperation/regresources.html>
for complete information and guidance.

2\. U.S. NGOs

Other U.S. NGOs that do not meet the definition of a U.S. PVO are
eligible to apply for funding but [only]{.underline} under the New
Partner Category of this RFA.

B. [Financial Restrictions for the New Partner Category:]{.underline}
Only U.S. PVOs and NGOs that have been awarded no more than \$5 million
in total, direct U.S. Government funding over the five fiscal years
prior to the due date for submission of an application under this RFA
are eligible to apply under the New Partner Category. The \$5 million
eligibility limitation does not include: 1) U.S. Government emergency
and disaster assistance, whether domestic or international, or 2) U.S.
Government domestic or international funding received by virtue of a
subcontract or sub-grant. The \$5 million eligibility limitation applies
not only to the principal applicant, but also to any organization with
which the principal applicant may choose to enter into a subcontract or
grant.

C. [25% Cost Share]{.underline}: Each organization must propose to
contribute at least 25% of the cost of the proposed project in non-U.S.
Government resources, in cash or in-kind. **U.S Government resources of
any type or source do not count toward the applicant's cost share
contribution for the CSHGP**.

D. [Documented Legal Presence]{.underline}: Each organization must have
legal presence in the country where the CSHGP project is proposed. This
should be documented by a signed agreement with the host government and
included in the application. Letters of support from the Ministry of
Health, or a legal document recognizing a local partner may
[not]{.underline} be submitted in lieu of the PVO/NGO agreement with the
local government.

E. [Five Years of Experience]{.underline}: Applicants in the Innovation
and TB categories must have five years of experience implementing health
programs in a developing country. Previous health program experience in
the target country, however, is [not]{.underline} required.

F. [Eligible Country]{.underline}: Proposed project must be in a single
eligible country. See the list of Eligible Countries provided in Section
A: Program Description.

G. [Application Submission Limitations]{.underline}: An eligible
applicant may submit up to **two** applications in response to this RFA;
however, one of these two applications must be submitted under the TB
funding category. Only one application under the TB category may be
submitted per organization. In addition, an applicant may have no more
than **[five]{.underline}** (5) cooperative agreement awards with the
CSHGP as of October 1, 2009.

H. [Level of Effort (LOE) Restrictions]{.underline}: An HIV/AIDS
intervention may be proposed **[up to a 30% LOE]{.underline}** under the
New Partner and Innovation funding categories (i.e. 35% LOE for HIV/AIDS
would be deemed ineligible). TB interventions may **[only]{.underline}**
be proposed under the TB Category. For all intervention areas, including
HIV/AIDS, the LOE proposed is an estimate determined by the applicant.
The CSHGP expects that the value proposed reflects the applicant's best
estimate of the amount of time and resources that will be required for
the proposed activities per intervention area over the life of the
project.

I. [Page Limitations]{.underline}: Technical applications with more than
30 pages [will not be reviewed]{.underline}. This page limit restriction
for the body of the technical application does not include attachments,
preliminary matter (title page, table of contents, acronym list), or
project screening form. \[Technical attachments cannot exceed 35 pages
in length.\]

## II. Project Requirements

All proposed projects must address the following components in their
application.

A. [Local Partner]{.underline}: The applicant must work in partnership
with local government, local community- and faith-based organizations
(C/FBO), networks of C/FBOs, local academic or research institutions, or
other local organizations on the implementation of the program. All
applications must be prepared in collaboration with the project partners
in the proposed site or country.

B. [Key Personnel]{.underline}: The following positions must be included
as key personnel in the applications and require USAID approval upon
grant award:

> 1\. Child Survival Headquarters Technical Backstop: Assign at least
> one public health professional at the applicant organization's U.S.
> headquarters to be responsible for CSHGP activities.
>
> 2\. Field Project Manager: Assign to the project, one full-time staff
> person, devoted to the proposed project at 100% LOE, with substantial
> and appropriate experience in implementing community health or child
> survival programs.
>
> 3\. Midterm and Final Evaluation Consultants: External consultants to
> lead Midterm and Final Evaluations. (Candidates and scopes of work for
> these consultants do *not* need to be included in the application
> submission.)

C. [Reporting Requirements]{.underline}: The following are reporting
requirements for CSHGP grantees:

> 1\. Detailed Implementation Plan (DIP): to be submitted in April 2010
> per CSHGP reporting guidelines. The DIP is a requirement for all
> grantees. Grantees must complete an in-depth assessment and analysis
> of the current health situation in the program site through
> qualitative and quantitative baseline surveys. Grantees must establish
> strong partnerships with local counterparts and jointly prepare the
> DIP for submission to USAID for approval. New Partner grantees are
> also required to conduct an organizational assessment as part of the
> DIP process, and Innovation grantees must submit operations research
> (OR) concept papers.
>
> 2\. Annual Reports, including the Midterm Evaluation Report: to be
> submitted within 30 days after the project year per CSHGP reporting
> guidelines.
>
> 3\. Final Evaluation Report: to be submitted within 60 days after the
> expiration or termination of the award per CSHGP reporting guidelines.

D. [Substantial Involvement]{.underline}: Substantial involvement during
the implementation of the program will be limited to approval of the
elements listed below:

> 1\. Approval of the DIP, submitted to USAID/GH/HIDN, and any
> subsequent revisions. GH/HIDN staff and technical specialists will
> review the DIP and meet with the recipient to discuss strengths and
> weaknesses. The DIP will provide a plan for the program, including
> plans for baseline and final surveys and collection of required
> indicators. Substantial changes resulting in any revisions to specific
> activities, locations, beneficiary population, international training
> costs, international travel, indirect cost elements, or the
> procurement plan may require a formal modification to the Agreement by
> the Agreement Officer. The approved DIP will supplement the initial
> Program Description in the Agreement and form part of the official
> documentation.
>
> 2\. Approval of key personnel to include the following positions:
>
> Headquarters Technical Backstop
>
> Field Program Manager
>
> Midterm Evaluation Team Leader
>
> Final Evaluation Team Leader
>
> 3\. USAID involvement in monitoring progress toward the achievement of
> program objectives during the performance of the program, including
> written guidelines for the content of annual reports, and mid-term and
> final evaluations in accordance with 22 CFR 226.51.

## III. Project Restrictions 

**Projects may be deemed ineligible if the review panel determines that
the application proposes any of the following [restricted]{.underline}
activities.**

A. USAID funding for directly supporting income generation or literacy
training activities. [All proposed activities must directly contribute
to child survival and health outcomes.]{.underline} GH/HIDN realizes
that some income generation and literacy training activities may be
critical to achieving project objectives and would support these
activities if funded under the grantee's cost share.

B. Applications for which the main purpose is: research; equipping
hospitals, orphanages, or other residential facilities; curative care in
hospitals; surgical procedures and prosthetics; construction;
manufacturing of pharmaceuticals, or other health aids; evacuation of
children to the U.S. for medical treatment; emergency relief activities;
or adoptions. These activities are beyond the scope of the CSHGP.

C. Please review the USAID Eligibility Rules for Goods and Services in
the Standard Provisions, Section E for a list of goods and services
restricted from purchase with USAID funding.

D. GH/HIDN will **[NOT]{.underline}** review applications that are
otherwise beyond the scope of the CSHGP as determined by USAID.

## IV. Evaluation Criteria

The technical applications will be evaluated in accordance with the
Technical Evaluation Criteria set forth at the conclusion of the
technical guidelines under each grant funding category. The cost
application of all applicants submitting a technically acceptable
application will be evaluated by the Agreement Officer to determine if
costs are reasonable, allowable, and allocable. If an application is
recommended for award following the technical review, cost negotiations
will be conducted.

Applicants should note that the technical evaluation criteria serve to:
(a) identify the significant issues which applicants should address in
their applications; and (b) set the standard against which all
applications will be evaluated. **To facilitate the review of
applications, applicants should organize the narrative sections of their
applications in the same order as the evaluation criteria.** Awards will
be recommended based on the ranking of applications according to the
technical evaluation criteria and the quality of the response to these
criteria.

# SECTION C: GRANT APPLICATION GUIDELINES

## 

## I. Instructions for Preparation and Submission of Applications

Please read the entire RFA. Respond to criteria as appropriate,
including attachments where requested. Depending on the funding category
the applicant is applying for, requirements may vary. It is incumbent on
the applicants to ensure that they respond specifically to
criteria/questions relating to the relevant funding category.

1\. Follow the formatting instructions below. Applications that do not
follow the instructions will not be reviewed favorably.

All applications should be typed on standard, letter-sized paper (8 ½" x
11"). All applicants should submit a maximum 30-page technical
application, including a **one**-**page Executive Summary and** no more
than **29 numbered pages** to respond to the evaluation criteria for New
Partner, Innovation, and TB categories. Technical applications with more
than **30 pages** [will NOT be reviewed]{.underline}. This page number
restriction does not include attachments, preliminary matter (title
page, table of contents, acronym list) or project screening form.

All **Technical** **Attachments** should be 35 pages or less. All
Technical Attachments should be clearly marked, included at the end of
the application, and listed in the table of contents. All attachments
and/or supplementary documents must be in English or accompanied by an
English translation. Supplementary documents in a foreign language do
not count as part of the page limit for attachments. Technical
Attachments must also be presented on standard, letter-sized paper (8 ½"
x 11").

**Cost Application Attachments** have no page limit. All Cost
Application attachments should be clearly marked and listed in the table
of contents. Cost Application attachments should follow the technical
application and technical attachments in page number order. Cost
Application attachments must also be presented on standard, letter-sized
paper (8 ½" x 11").

Type face/characters for applications and attachments must be no smaller
than 12-point font using fixed pitch spacing per inch with one inch
margins. There are two exceptions to the aforementioned instruction: 1)
budgets may be in a slightly smaller font (10 point) with smaller
margins, and 2) tables may use smaller fonts and margins, but must be
easily readable.

2\. An **Application Screening Form** is provided in Annex E for
completion and submission on the **cover** of the application.

3\. The application package must include: **one** electronic version on
CD in Microsoft Word 2000 (or later versions) for the technical
application and Microsoft Excel 2000 (or later versions) for the budget
information, and; **three [unbound]{.underline} double-sided** copies of
the application, each with a complete set of attachments. [Please do
**not** use dividers to separate sections of the
application.]{.underline} Please be sure to provide all parts of the
application, including attachments and all budget information, in the
electronic version.

4\. Applicants should retain for their records one copy of the
application and all enclosures which accompany their application.
Erasures or other changes must be initialed by the person signing the
application.

5\. To facilitate the competitive review of the applications, USAID will
consider only applications conforming to the format prescribed below and
under the Technical and Cost Application sections.

6\. The title page of the application should include:

-   The **[name and address of the PVO/NGO applicant]{.underline}**;

-   The **[RFA number]{.underline}**

-   The **[category]{.underline}** for the application submission

-   The **[country]{.underline}** for which the project is proposed.

7\. The body of the application should respond to each of the evaluation
criteria for the particular application category.

8\. Technical Attachments (cannot exceed 35 pages) can consist of:

-   Legal Authorization to Operate in Target Country

-   Map of Program Area

-   Training Plan

-   Letters of Support

-   Mission Results Framework (if available)

-   Memoranda of Understanding (if applicable)

-   Program Matrix (Monitoring and Evaluation Table)

-   CVs and/or Job Descriptions

-   Management/Human Resource Table

-   Work Plan

-   Organizational Chart and Project Organigram

> The organizational chart should illustrate how the project will be
> managed by the applicant at both the headquarters and field level. The
> organigram should be a broader picture of the working relationship
> between all principal partners involved in project implementation.

9\. Cost Application Attachments (no page limit) can consist of:

-   Standard Form 424 and/or 424A

-   Detailed Budget and Budget Narrative

-   Procurement Plan

-   Certifications

-   List of Federally Funded Contracts and Assistance (if applicable)

-   Current Negotiated Indirect Cost Rate Agreement

10\. Submit the application package on or before to one of the following
addresses:

**[U.S. Postal Service Mailing Address]{.underline}:** **[All Other
Means of Delivery]{.underline}:**

USAID/M/OAA Room 7.09-92 Attn: USAID/M/OAA Room 7.09-92

Ronald Reagan Building Ronald Reagan Building

U.S. Agency for International Development U.S. Agency for International
Development

1300 Pennsylvania Avenue, NW 1300 Pennsylvania Avenue, NW

Washington, DC 20523-3100 Washington, DC 20004-3100

**Attention: Mr. Ousmane Faye, Jr.** Please use phone at visitor's desk
to contact:

**Mr. Ousmane Faye, Jr., at x2-0832.**

11\. Send an exact copy of the complete application to the USAID Mission
in the country of the proposed program by close of business on
**February 24, 2009**. It is the responsibility of the Applicant to
ensure that the USAID Mission receives a copy of the complete
application. See Annex D for the current Mission addresses.

12\. All applications received by the deadline will be reviewed for
responsiveness to the specifications outlined in these guidelines and
the application format. Sections B and C address the selection criteria,
the technical evaluation criteria, and procedures for the applications.
The specific evaluation criteria for each category are found at the end
of the category descriptions. **Applications which are submitted late or
are incomplete will not be considered in the review process.**

## II. Technical Application Guidelines

Guidelines for each of the three funding categories are provided in this
section. Applicants should read the guidance thoroughly for the specific
funding category under which they intend to apply, taking note of the
category description, funding levels, and duration, as well as the
technical guidelines and evaluation criteria. Technical Application
Guidelines for the following funding categories are as follows:

> A. New Partner Category
>
> B. Innovation Category
>
> C. Tuberculosis Category

### II.A. Guidelines for New Partner Category

(Four or five years, up to \$1.5 million)

**Category Purpose and Scope:** This category supports new partner
organizations and their local partners to implement innovative and
effective MNCH projects. New partners are expected to design, implement,
monitor, and evaluate innovative and effective projects that can be
replicated and contribute to the development of local capacity to
address relevant child survival and health issues. In addition, new
partners contribute to the CSHGP portfolio by introducing new,
underused, and high impact MNCH interventions through implementation of
innovative community oriented delivery strategies.

CSHGP reporting requirements (e.g. KPC surveys, annual reports, external
Midterm and Final evaluations) and any additional proposed process
documentation will generate data and lessons for key stakeholders during
the course of the project cycle regarding the effectiveness and
potential for replicating innovative, community oriented delivery
strategies. Additional assessments, such as the Rapid Health Facility
Assessment (RHFA) or the Sustainability Assessment, though not required,
are encouraged if appropriate and relevant to the applicant and proposed
programming as a means of generating additional data and lessons.

+-----------------------------------------------------------------------+
| **Innovation** is defined as a strategy, approach, or methodology     |
| that introduces novel ways to solve the major challenges of           |
| delivering high impact interventions to vulnerable populations and    |
| strengthening health systems, ultimately leading to increased scale   |
| of these interventions and improved health outcomes. Innovative       |
| approaches often require challenging existing paradigms in order to   |
| address an identified and acute need at national and global levels.   |
|                                                                       |
| Applicants will need to integrate the innovation in the context of an |
| effective project strategy, and in coordination with USAID and        |
| national programs in-country. Applicants should propose a single      |
| innovation or a cohesive model of innovation that can include the     |
| following:                                                            |
|                                                                       |
| -   Introduction of a new approach;                                   |
|                                                                       |
| -   Substantial transformation of an existing approach; and/or        |
|                                                                       |
| -   Adaptation of a successful approach for a different context.      |
+-----------------------------------------------------------------------+

**Budget Requests:** New Partner Category applicants may submit budget
requests for four or five year projects for up to \$1.5 million.

**Who Should Apply:** Only U.S. PVOs and NGOs that have been awarded no
more than \$5 million in total, direct U.S. Government funding over the
five fiscal years prior to submission of an application under this RFA
are eligible to apply under the New Partner Category. Under this RFA,
the restrictions for U.S. Government funding for New Partner Category
applicants does not include: 1) U.S. Government emergency and disaster
assistance, whether domestic or international, or 2) U.S. Government
domestic or international funding received by virtue of a subcontract or
sub-grant. The \$5 million eligibility limitation applies not only to
the principal applicant, but to any organization with which the
principal applicant may choose to enter into a subcontract or grant. All
interested applicants must meet the eligibility, organizational and
project requirements identified in the Selection Criteria Section of the
RFA.

**Technical Intervention Restrictions:**

Tuberculosis interventions may **[not]{.underline}** be proposed under
the New Partner Category.

HIV/AIDS interventions may be proposed **[up to a 30% level of
effort]{.underline}.**

**Additional Resources:** Visit the New Partner Portal at
<http://www.childsurvival.com/new_partner/> for more information.

**[Technical Guidance for New Partner Applications]{.underline}**

Applicants must follow the format and guidance described below to
prepare a New Partner Category application in response to this RFA.

> **1. Executive Summary**

This section should be a succinct summary and [must]{.underline} contain
the following information as applicable and any additional information
the Applicant believes necessary to best represent its proposed program.

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Problem statement, including rationale for the proposed project

-   Description of project goals, objectives, and key strategies
    (including estimated LOE devoted to each technical intervention),
    and project location

-   Description of innovative component(s) of delivery strategies and
    capacity to address key barriers to improving health outcomes and
    strengthening health systems

-   Estimated number of total population and beneficiaries, including
    children under five and women of reproductive age

-   Local partners involved in project implementation, including name
    and type of any sub-grantees and total level of USAID funding to be
    sub-granted

-   Level of USAID funding requested for the project and cost-share
    amount

-   Application category

-   Proposed start/end dates

-   Main authors of the proposal and proposal contact at U.S.
    headquarters office

> **2. Project Context**

This section of the application presents an overview of the context in
which the proposed project will operate. It should provide a clear
picture of the health context in the selected project area to serve as
the basis for the selection of interventions, strategies, and key
project partners.

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Provide an overview of the current health status of the target
    population by citing the leading causes of under-five morbidity and
    mortality and maternal morbidity and mortality. Please cite sources
    of data, such as qualitative data; data from secondary sources like
    the Demographic and Health Survey (DHS), USAID MCH Initiative,[^6]
    Countdown to 2015 Country Profiles,[^7] or other data collected by
    an organization other than the applicant.

-   Provide relevant information on pertinent care-seeking practices and
    household-community-level behaviors. The applicant is not expected
    to have conducted qualitative research or a survey, but general
    knowledge of the local population should be evident. Include a
    discussion of characteristics that have an impact on the health
    status of the population (e.g. socioeconomic status, religion,
    gender, ethnicity, literacy, etc.).

```{=html}
<!-- -->
```
-   Provide an overview of the current status of health care services in
    the project site, detailing the quality, equity, and utilization of
    these existing services. Include both formal and informal health
    services (e.g. care provided by the MOH, private sector, NGOs/PVOs,
    and traditional health providers). This information may draw upon
    qualitative and/or quantitative information.

```{=html}
<!-- -->
```
-   Describe existing national policies and strategies in place related
    to the proposed programming (both technical and cross-cutting
    intervention areas). Discuss how the proposed strategy is or is not
    consistent with official MOH policies and/or strategies. This can be
    done in table or narrative format. Provide an explanation of, and
    justification for, any proposed approach that differs from the MOH
    policy in the proposed country.

-   Describe relevant programs that the organization and/or other
    agencies are implementing in the same geographic area to ensure
    there is no duplication of effort. Indicate how the proposed project
    will engage and/or complement existing programs. This includes a
    discussion of relevant programming of the USAID Mission, proposed
    local partner, and global initiatives.

-   Briefly describe the location of the proposed program and provide a
    map(s) with scale in an **attachment**.

-   Estimate the total population, breaking out children under five
    years of age and women of reproductive age (15-49 years) living in
    the program site. Estimate the number of villages or other community
    units that are in the target area. Please refer to Annex F for
    beneficiary calculation guidelines. Please cite the sources of data.

> **3. Innovation**

The Applicant must identify and explain the innovative components of the
project strategy that will contribute to addressing critical bottlenecks
in delivery and discuss their relevance for programming and/or policy.
**The innovation(s) should be highlighted separately, but integrated
within the context of an effective project strategy.**

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Provide a clear and focused description of the innovation. Include a
    strong rationale for the capacity of the innovation to address
    critical delivery challenges and strengthen health systems and
    discuss the program and/or policy relevance of the proposed
    innovation. Discuss the process for identifying the innovation and
    eliciting buy-in from local stakeholders for the proposed
    activities.

-   Describe the mechanism for tracking the project's innovation.
    Include existing project reporting requirements and any additional
    process documentation as relevant.

```{=html}
<!-- -->
```
-   Describe plans to share project data and lessons with key
    stakeholders about the potential for replicating and scaling up
    innovative components of delivery strategies. This should include
    sharing lessons within the organization, throughout the PVO/NGO
    community, and relevant in country stakeholders.

> **4. Project Strategy**

This section provides a clear picture of the proposed project strategy
and implementation plan. Details on the proposed technical interventions
and corresponding activities should be included.

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Provide the goal and supporting objectives of the proposed project.
    Demonstrate how selected interventions and strategies support stated
    goals and objectives.

-   Include a discussion of the decision-making process for the selected
    approach, articulating a strong rationale. The rationale should be
    linked to the project context section and should demonstrate an
    understanding of the population and epidemiology. It should clearly
    explain why the proposed strategies and approaches are appropriate
    for the context.

```{=html}
<!-- -->
```
-   Describe the project strategy and how it contributes to national
    policies and strategies. Include a discussion on the increase in
    demand for and improvements in quality, access, and equity of
    services improvements in quality, access, and equity that the
    project anticipates through activities at the individual, household,
    community, and facility levels. Please address the following
    components of the overall strategy, as applicable:

    -   Behavior change communication (e.g. proposed modes of message
        delivery, important actors in message delivery);

    -   Community mobilization approach (e.g. utilization of community
        development committees, role of key community actors);

    -   Linkages between the community and the facility (e.g. referrals,
        transportation schemes, community-based insurance schemes,
        community role in quality improvement);

    -   Facility-level activities (e.g. Health Management Information
        Systems (HMIS) strengthening, health provider training,
        diagnostic quality, improved supervision).

```{=html}
<!-- -->
```
-   Discuss the approach to each of the selected technical intervention
    areas by outlining proposed activities to address each intervention.
    Include key messages that will be promoted through the
    aforementioned behavior change communication and community
    mobilization approaches. Also, note how the different interventions
    and activities will be integrated.

-   As an **attachment**, please present a brief, one to two page work
    plan in a table format which reflects the overall project approach,
    objectives, timeline, and budget. Also, present the project training
    activities/plan in table format for each intervention with a brief
    description of the training objective, number of participants, and
    timing of training as an **attachment**. Note that the work plan
    should cover all years of project implementation.

> **5. Partnerships**

This section describes the proposed project's relationships with the
USAID Mission in country, the national MOH, and other
national/international stakeholders. Adherence to national
policies/strategies and global initiatives should be clearly stated.

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Demonstrate how the proposed project will complement and/or catalyze
    relevant USAID Mission bilateral delivery strategies, national
    strategies, and global initiatives.

-   Demonstrate how the project will communicate with and incorporate
    input from the USAID Mission and key partners throughout project
    implementation.

-   Describe the organization's operations, current agreements, and
    working relationships with the host country government and other
    organizations within the country proposed in this application.
    Documentation of current legal authorization for the U.S. PVO/NGO or
    its international affiliate to operate in the host country must be
    provided in an **attachment**.

-   Describe relevant and strategic local partnerships for disseminating
    lessons-learned and/or conducting policy advocacy activities.

-   Describe the local partner's role and responsibilities in the
    proposed project and technical intervention areas. Discuss the
    approach the project will take to build the capacity of the local
    partner. Provide objectives and indicators for capacity building and
    sustainability in the local partner.

-   In an **attachment**, include a letter showing specific support for
    the proposed program from each of the cooperating governmental
    and/or other organizations with which the program will establish a
    formal relationship (e.g. MOH, local partner(s), other NGOs). Each
    letter must be dated within three months of the application
    submission and should include the name of the person with whom the
    applicant discussed the proposed project. Letters of support from
    the MOH should also demonstrate that the MOH agrees with the
    proposed PVO/NGO approach.

6\. Organizational Capacity and Development

This section provides evidence that the applicant has the ability to
carry out a successful project and describes how new applicants will use
this grant to strengthen the institutional capacity of the applicant
organization. See TRMs
(<http://www.childsurvival.com/documents/trms/update_trms.cfm>) for
information and resources on organizational development and capacity
building. Also, an assessment of the applicant's organizational capacity
will be required for New Partner grantees as part of the DIP process.

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Describe the U.S. PVO/NGO applicant -- including its general
    purpose, mission statement, goals, annual budget (including funding
    sources), major work and main methods of operation.

-   Discuss the organization's experience in designing, implementing,
    monitoring and evaluating international, community-level projects,
    specifically organizational successes in the proposed intervention
    areas and approaches.

-   In the **attachments**, please provide an organizational chart that
    clearly delineates the key personnel responsible for technically
    backstopping this program in the PVO/NGO U.S. headquarters office
    and managing this program in the in-country office. Describe how
    they fit into the overall organization and the linkages between the
    headquarters, regional (if applicable) and field program personnel.
    **The organizational chart should illustrate how the project will be
    managed by the applicant at both the headquarters and field level.**

-   Describe the proposed management structure for this program and
    provide a project organigram in the **attachments**. **The
    organigram should be a broad picture of the working relationship
    between all principal partners involved in project implementation.**
    Include in the narrative a description of the responsibilities of
    all principal organizations and staff involved, reporting
    relationships, authority and lines of communication within and
    between each of these organizations. Please include job descriptions
    of primary staff and CVs, if available (e.g. headquarters technical
    backstop, training manager, M&E manager, field program manager) as
    **attachments**.

-   Discuss the roles and responsibilities of project staff vis-à-vis
    budgeting, monitoring, and reporting on the financial status of the
    project, to ensure accountability in the use of U.S. Government and
    matching funds.

> In the **attachments**, please provide a table of all individuals who
> will contribute to achieving the results of the program. This may
> include, but is not limited to: PVO/NGO headquarters and field staff,
> local partner staff, MOH staff, community health workers, and private
> sector providers. For each type of worker provide: 1) the number of
> workers in that category, 2) organizational affiliation, 3) main
> responsibilities, 4) percent of effort devoted to project activities,
> and 5) entity responsible for remunerating the worker (e.g. PVO/NGO,
> MOH, community, volunteers), 6) brief description of the role the
> individual will play within the project. This table should reflect the
> budget.

-   Identify specific organizational development needs to be addressed
    by the applicant in order to strengthen its ability to carry out
    this project. Describe how these needs were determined. Reference
    any institutional assessments the organization may have already
    carried out, and/or those it plans to carry out.

-   Outline activities the applicant will use to address organizational
    development needs, and discuss the growth the project anticipates as
    a result of these activities. Propose monitoring plans and
    corresponding indicators to measure progress towards organizational
    development; these should be incorporated into the monitoring and
    evaluation plan/matrix.

> **7. Monitoring and Evaluation**

This section outlines the project's plans for tracking and monitoring
key project indicators.

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Describe the types of baseline assessments, studies, or surveys that
    will be carried out. Include baseline organizational assessments of
    PVO/NGO and local partner capacity, health facility assessments,
    qualitative and population-based assessments (e.g. KPC). This
    information must also be reflected in the budget.

-   Please refer to the guidance provided for the innovation (Section 3)
    and include relevant information in this section regarding the
    process for describing and tracking the innovation. The innovation
    should be integrated in the project's overall monitoring and
    evaluation approach and project reporting requirements.

```{=html}
<!-- -->
```
-   Describe the current data collection systems that already exist in
    the project area, how/if the project's data collection will
    complement or be different from the existing system, and how they
    will link to each other.

```{=html}
<!-- -->
```
-   As an **attachment**, include a monitoring and evaluation table that
    outlines all the proposed project indicators that are linked to
    specific project objectives. This would include indicators related
    to technical intervention outcomes and process indicators used to
    track project progress for training plans and organizational
    development. The table should include the source of the data (e.g.
    KPC, DHS, MOH, CHWs) and the proposed frequency of collection. To
    the extent possible, the indicators should be globally-accepted,
    standard indicators and feed into the USAID reporting system.

**[Technical Evaluation Criteria for New Partner
Applications]{.underline}:**

All sub-criteria are weighted equally.

**[Executive Summary -- 1 page maximum (1 point)]{.underline}**

-   Clear and concise overview of the proposed project that includes all
    elements listed in the Executive Summary guidelines.

**[Project Context (10 points)]{.underline}**

-   Technically sound, appropriate, and comprehensive presentation of
    data related to the leading causes of mortality and morbidity of
    selected population, drawing upon available, and up-to-date national
    and sub-national level data from reputable sources.

-   Discussion of relevant care-seeking practices,
    household-/community-level behaviors, and characteristics that
    impact the health status of the target population.

-   Discussion of the quality, equity, and utilization of the existing
    health care services, both formal and informal, public and private.

-   Discussion of existing national policies and strategies in place
    related to the proposed programming (both technical and
    cross-cutting intervention areas). (Applicant should demonstrate
    consistency with these existing policies and strategies or provide a
    strong rationale for any proposed approach that differs from the MOH
    policy).

-   Description of relevant programming in the project area, as well as
    at the national level, such as other programming done by the
    applicant and the local partner, as well as programming of other
    NGOs, USAID Missions, and global initiatives. (Applicant should
    indicate how the proposed project will engage and/or complement
    these existing programs).

**[Innovation (15 points)]{.underline}**

-   Clear and focused description of the innovation; strong rationale
    for the capacity of the innovation to address critical delivery
    challenges and strengthen health systems.

-   Clear description of process for tracking the innovation.

-   Clear description of plans to share project data and lessons with
    key stakeholders about potential for replicating and scaling-up
    innovative components of delivery strategies.

**[Project Strategy (25 points)]{.underline}**

-   Goals and objectives are appropriate and reasonable for the proposed
    project. Selected strategies and interventions clearly support
    stated goals and objectives.

-   Clear rationale for the project design including the chosen
    strategies/approaches, technical interventions, selected population,
    selected geographic area, chosen levels of implementation (i.e.
    household, community, facility, and/or policy), selection of
    implementing partner(s), and chosen delivery modalities.

```{=html}
<!-- -->
```
-   Clear and technically sound description of overall project strategy
    that addresses quality, access, and equity at the individual,
    household, community, and facility levels.

-   Clear and comprehensive description of how the proposed project will
    address selected technical intervention areas.

-   Proposed workplan reflects the project goal, objectives, activities,
    and budget.

**[Partnerships (15 points)]{.underline}**

-   Demonstration of plans to communicate project activities and key
    results with Mission.

-   Relevant and strategic local partnerships are identified for sharing
    project learning and/or conducting policy advocacy activities.

-   Clear description of the roles of local partners is provided,
    including how the project plans to build capacity of these local
    partners.

-   Letters of support provided that clearly demonstrate partners'
    understanding of their role in the proposed project (note: letter
    from USAID Mission is not required).

**[Organizational Capacity and Development (19 points)]{.underline}**

-   Organization has demonstrated adequate capacity to implement the
    proposed project and activities through discussion of past relevant
    programming experience.

-   Proposed project human resources correspond to and are appropriate
    for the proposed activities.

-   Roles and responsibilities of key project staff are clear.

```{=html}
<!-- -->
```
-   Applicant clearly identifies its organizational needs to implement
    the proposed project.

-   Applicant clearly outlines a plan with specific activities to
    address these organizational needs and indicators for assessing
    progress toward organizational development.

**[Monitoring and Evaluation (15 Points)]{.underline}**

-   Proposed project indicators are globally accepted and are
    appropriate to adequately assess proposed programming. In addition,
    the proposed plan to monitor these indicators is feasible.

-   Process to collect, assess, and use data in management of project is
    clearly articulated and feasible.

-   Proposed project's data collection system complements and
    strengthens the MOH health management and information system.

-   Baseline, midterm, and final assessments are planned and budgeted
    for.

### II.B. Guidelines for Innovation Category

(Four or five years, up to \$1.75 million)

**Category Purpose and Scope:**

The Innovation Category places the primary emphasis on introducing and
transferring new ideas to improve the delivery of high impact MNCH
interventions in community oriented projects in diverse community
settings (e.g. urban, rural, post conflict). Innovation is the most
critical component of the proposed programming. Innovation Category
projects are expected to contribute to the existing evidence base, both
at the national and global levels, and to be catalytic in facilitating
the uptake of successful innovations into national policies and/or
programs.

Applicants must provide a strong rationale for the proposed innovation,
including its contribution to solving relevant public health issues and
influencing national policies and strategies. Applicants must present
the existing evidence base for the innovation and pose the research
questions that will address the identified problem(s). In addition to
project documentation requirements, applicants are expected to conduct
OR to generate credible evidence and lessons for national and global
stakeholders (e.g. feasibility, cost effectiveness, and potential for
replication and scale up of the proposed innovation). Applicants are
encouraged to establish partnerships with local research institutions
for quality data collection and analysis, as necessary.

+-----------------------------------------------------------------------+
| **Innovation** is defined as a strategy, approach, or methodology     |
| that introduces novel ways to solve the major challenges of           |
| delivering high impact interventions to vulnerable populations and    |
| strengthening health systems, ultimately leading to increased scale   |
| of these interventions and improved health outcomes. Innovative       |
| approaches often require challenging existing paradigms in order to   |
| address an identified and acute need at national and global levels.   |
|                                                                       |
| Applicants will need to integrate the innovation in the context of an |
| effective project strategy, and in coordination with USAID and        |
| national programs in-country. Applicants should propose a single      |
| innovation or a cohesive model of innovation that can include the     |
| following:                                                            |
|                                                                       |
| -   Introduction of a new approach;                                   |
|                                                                       |
| -   Substantial transformation of an existing approach; and/or        |
|                                                                       |
| -   Adaptation of a successful approach for a different context.      |
+-----------------------------------------------------------------------+

**Budget Requests:** Innovation Category applicants may submit budget
requests for four or five year projects for up to \$1.75 million.
[Applicants may budget up to \$200,000 for Operations
Research]{.underline}.

**Who Should Apply:** U.S. PVOs who meet the eligibility,
organizational, and program requirements identified in the Selection
Criteria Section of the RFA. The Innovation Category is a highly
competitive funding category, requiring substantial leadership and
experience in child survival and health interventions. Successful
applicants demonstrate a strong ability to implement and replicate
innovative and effective projects and set higher standards for both
their organizations and the PVO/NGO community.

**Technical Intervention Restrictions:**

-   Tuberculosis interventions may **[not]{.underline}** be proposed
    under the Innovation Category;

-   HIV/AIDS may be proposed at **[up to a 30% level of
    effort]{.underline}**

**[Technical Guidance for Innovation Applications]{.underline}**

Applicants must follow the format and guidance described below to
prepare an Innovation Category application in response to this RFA.

**1. Executive Summary**

This section should be a succinct summary and [must]{.underline} contain
the following information as applicable and any additional information
the Applicant believes necessary to best represent its proposed program.

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Problem statement, including rationale for the proposed project

-   Description of project goals, objectives, and key strategies
    (including percentage (%) estimated LOE devoted to each technical
    intervention), and project location

-   Highlight why the proposed innovation is critical to addressing key
    barriers to improving health outcomes and its capacity to strengthen
    the health system and to contribute to national policy and/or
    strategy direction.

-   Proposed method(s) for evaluating the innovation

-   Estimated number of total population and beneficiaries, including
    children under five and women of reproductive age (see beneficiary
    calculation guidelines in Annex F)

-   Local partners involved in project implementation, including name
    and type of any sub-grantees and total level of USAID funding to be
    sub-granted

-   Level of USAID funding requested for the project and cost-share
    amount

-   Application category

-   Proposed start/end dates

-   Main authors of the application and application contact at U.S.
    headquarters office

**2. Project Context**

This section of the application presents an overview of the context in
which the proposed project will operate. It should provide a clear
picture of the health context in the selected project area to serve as
the basis for the selection of interventions, strategies, and key
project partners.

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Provide an overview of the current health status of the target
    population by citing the leading causes of under-five morbidity and
    mortality and maternal morbidity and mortality. Please cite sources
    of data, such as qualitative data; data from secondary sources like
    the Demographic and Health Survey (DHS), USAID MCH Initiative,[^8]
    Countdown to 2015 Country Profiles,[^9] or other data collected by
    an organization other than the applicant.

-   Provide relevant information on pertinent care-seeking practices and
    household-community-level behaviors. The applicant is not expected
    to have conducted qualitative research or a survey, but general
    knowledge of the local population should be evident. Include a
    discussion of characteristics that have an impact on the health
    status of the population (e.g. socioeconomic status, religion,
    gender, ethnicity, literacy, etc.).

```{=html}
<!-- -->
```
-   Provide an overview of the current status of health care services in
    the project site, detailing the quality, equity, and utilization of
    these existing services. Include both formal and informal health
    services (e.g. care provided by the MOH, private sector, NGOs/PVOs,
    and traditional health providers). This information may draw upon
    qualitative and/or quantitative information.

```{=html}
<!-- -->
```
-   Describe existing national policies and strategies in place related
    to the proposed programming (both technical and cross-cutting
    intervention areas). Discuss how the proposed strategy is or is not
    consistent with official MOH policies and/or strategies. This can be
    done in table or narrative format. Provide an explanation of, and
    justification for, any proposed approach that differs from the MOH
    policy in the proposed country.

-   Describe relevant programs that the organization and/or other
    agencies are implementing in the same geographic area to ensure
    there is no duplication of effort. Indicate how the proposed project
    will engage and/or complement existing programs. This includes a
    discussion of relevant programming of the USAID Mission, proposed
    local partner, and global initiatives.

-   Briefly describe the location of the proposed program and provide a
    map(s) with scale in an **attachment**.

-   Estimate the total population, breaking out children under five
    years of age and women of reproductive age (15-49 years) living in
    the program site. Estimate the number of villages or other community
    units that are in the target area. Please refer to **Annex F** for
    beneficiary calculation guidelines. Please cite the sources of data.

> **3. Innovation**

This section outlines the innovation, the most critical component of
proposed programming. Applicants should propose a strategy, approach, or
methodology that introduces novel ways to solve the major challenges of
delivering interventions to vulnerable populations and strengthens
health systems, ultimately leading to increased coverage or scale of
high impact interventions and improved health outcomes. **The innovation
should be highlighted separately, but integrated within the context of
an effective project strategy.**

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Provide a clear and focused description of the innovation. Include a
    strong rationale for the capacity of the innovation to address
    critical delivery challenges and strengthen health systems. Discuss
    the process for identifying the innovation and eliciting buy-in from
    local stakeholders for the proposed activities.

```{=html}
<!-- -->
```
-   Present the existing evidence base for the innovation. Provide a
    brief overview of previous attempts to address the identified public
    health challenge. Explain how the proposed innovation will fill a
    critical knowledge gap; contribute to the global and/or national
    evidence base; and further national policies and/or programs.

-   Describe the OR proposed to assess the innovation (e.g. feasibility,
    cost effectiveness, and potential for replication and scale-up) and
    present an appropriate timeline. Clearly state the research question
    that will address the identified problem and indicate how it will be
    answered through a methodologically sound and feasible design for
    the local context.

-   Describe the capacity of the applicant to conduct the proposed OR.
    If applicable, identify a partner institution that will assist with
    the research design, data collection, and data analysis,
    documentation, and dissemination of findings.

-   Describe processes that the project will engage in to influence
    national policy, scale-up, or uptake of the innovation, based on
    findings. Clearly outline the mechanisms through which the project
    will share evidence and lessons with relevant key stakeholders to
    inform uptake, replication, and scale-up of the innovation.

    4.  **Project Strategy**

This section provides a clear picture of the proposed project strategy
and implementation plan. Details on the proposed technical interventions
and corresponding activities should be included.

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Provide the goal and supporting objectives of the proposed project.
    Demonstrate how selected interventions and strategies support stated
    goals and objectives.

```{=html}
<!-- -->
```
-   Include a discussion of the decision-making process for the selected
    approach, articulating a strong rationale. The rationale should be
    linked to the project context section and should demonstrate an
    understanding of the population and epidemiology. It should clearly
    explain why the proposed strategies and approaches are appropriate
    for the context, including:

    -   Rationale for selected population (e.g. specific communities,
        districts, barriers to health);

    -   Rationale for selected geographic area (e.g. strategic relevance
        of the chosen geographic area, particularly in relation to USAID
        Mission geographic priority areas);

    -   Rationale for chosen technical intervention package; discuss
        reasons for omissions and inclusions, particularly if omissions
        are among the leading causes of morbidity and mortality.

    -   Rationale for chosen levels of implementation (e.g. household,
        community, facility, policy), the role of the implementing
        partner(s) (e.g. what is the comparative advantage of a partner
        chosen to fulfill the outlined role) and;

    -   Rationale for chosen delivery strategies (e.g. what factors in
        the community led to the choice of community mobilization
        approach).

```{=html}
<!-- -->
```
-   Describe the project strategy and how it contributes to national
    policies and strategies. Include a discussion on the increase in
    demand for and improvements in quality, access, and equity of
    services that the project anticipates through activities at the
    individual, household, community, and facility levels. Please
    address the following components of the overall strategy, as
    applicable:

    -   Behavior change communication (e.g. proposed modes of message
        delivery, important actors in message delivery);

    -   Community mobilization approach (e.g. utilization of community
        development committees, role of key community actors);

    -   Linkages between the community and the facility (e.g. referrals,
        transportation schemes, community-based insurance schemes,
        community role in quality improvement);

    -   Facility-level activities (e.g. HMIS strengthening, health
        provider training, diagnostic quality, improved supervision).

```{=html}
<!-- -->
```
-   Discuss the approach to each of the selected technical intervention
    areas by outlining proposed activities to address each intervention.
    Include key messages that will be promoted through the
    aforementioned behavior change communication and community
    mobilization approaches. Also, note how the different interventions
    and activities will be integrated.

-   As an **attachment**, please present a brief, one to two page work
    plan in a table format, which reflects the overall project approach,
    objectives, timeline, and budget. Also, present the project training
    activities/plan in table format for each intervention with a brief
    description of the training objective, number of participants, and
    timing of training as an **attachment**. Note that the work plan
    should cover all years of project implementation.

**5. Partnerships**

This section describes the proposed project's relationships with the
USAID Mission in country, the national MOH, and other
national/international stakeholders. Adherence to national
policies/strategies and global initiatives should be clearly stated.

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Demonstrate how the proposed project will complement and/or catalyze
    relevant USAID Mission bilateral delivery strategies, national
    strategies, and global initiatives.

> []{.mark}

-   Demonstrate how the project will communicate with and incorporate
    input from the USAID Mission and key partners throughout project
    implementation.

```{=html}
<!-- -->
```
-   Describe the organization's operations, current agreements, and
    working relationships with the host country government and other
    organizations within the country proposed in this application.
    Documentation of current legal authorization for the U.S. PVO or its
    international affiliate to operate in the host country must be
    provided in an **attachment**.

```{=html}
<!-- -->
```
-   Describe relevant and strategic local partnerships for disseminating
    lessons-learned and/or conducting policy advocacy activities.

```{=html}
<!-- -->
```
-   Describe the local partner's role and responsibilities in the
    proposed project and technical intervention areas. Discuss the
    approach the project will take to build the capacity of the local
    partner. Provide objectives and indicators for capacity-building and
    sustainability in the local partner.

```{=html}
<!-- -->
```
-   In an **attachment**, include a letter showing specific support for
    the proposed project from each of the cooperating governmental
    and/or other organizations with which the project will establish a
    formal relationship. Each letter must be dated within three months
    of the application submission. The letter must outline the specific
    role in the proposed project of each of the cooperating governmental
    and/or other organizations with which the project will establish a
    formal relationship. In addition, the letter from the MOH must
    demonstrate that the MOH agrees with the proposed PVO/NGO approach.
    Please include references to proposed innovation activities, as
    relevant.

**6. Organizational Capacity**

This section of the application provides information about the
applicant. This section provides evidence that the applicant has the
ability to carry out a successful project.

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Describe the U.S. PVO applicant -- including its general purpose,
    mission statement, goals, annual budget (including funding sources),
    major work and main methods of operation.

-   Discuss the organization's experience in designing, implementing,
    monitoring and evaluating international, community-level projects,
    specifically organizational successes in the proposed intervention
    areas and approaches.

```{=html}
<!-- -->
```
-   In the **attachments**, please provide an organizational chart that
    clearly delineates the key personnel responsible for technically
    backstopping this project in the PVO/NGO U.S. headquarters office
    and managing this project in the in-country office. Describe how
    they fit into the overall organization and the linkages between the
    headquarters, regional (if applicable) and field project personnel.
    **The organizational chart should illustrate how the project will be
    managed by the applicant at both the headquarters and field level.**

```{=html}
<!-- -->
```
-   Describe the proposed management structure for this project and
    provide a project organigram in the **attachments**. **The
    organigram should be a broad picture of the working relationship
    between all principal partners involved in project implementation.**
    Include in the narrative a description of the responsibilities of
    all principal organizations and staff involved, reporting
    relationships, authority and lines of communication within and
    between each of these organizations. Please include job descriptions
    of primary staff and CVs if available (e.g., headquarters technical
    backstop, training manager, M&E manager, field project manager) as
    **attachments**.

-   Discuss the roles and responsibilities of project staff related to
    budgeting, monitoring, and reporting on the financial status of the
    project, to ensure accountability in the use of U.S. Government and
    matching funds.

-   In the **attachments**, please provide a table of all individuals
    who will contribute to achieving the results of the project. This
    may include, but is not limited to: PVO/NGO headquarters and field
    staff, local partner staff, MOH staff, community health workers and
    private sector providers. For each type of worker provide: 1) the
    number of workers in that category; 2) organizational
    affiliation; 3) main responsibilities; 4) percent of effort devoted
    to project activities; and 5) entity responsible for remunerating
    the worker (e.g., the PVO/NGO, MOH, community, volunteer); 6) brief
    description of the role the individual will play within the project.
    This table should reflect the budget.

**7. Monitoring and Evaluation**

This section outlines the project's plans for tracking and monitoring
key project indicators and includes relevant references to activities to
evaluate the innovation.

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Describe the types of baseline assessments, studies, or surveys that
    will be carried out. Include baseline organizational assessments of
    PVO/NGO and local partner capacity, health facility assessments,
    qualitative and population-based assessments (e.g. KPC). This
    information must also be reflected in the budget.

```{=html}
<!-- -->
```
-   Please refer to the guidance provided for evaluating the innovation
    (Section 3) and include relevant information in this section
    regarding the methodology for evaluating the innovation and the use
    of data and lessons generated at the national and global levels, as
    this should be integrated in the project's overall monitoring and
    evaluation approach. [Applicants may budget up to \$200,000 for
    Operations Research]{.underline}.

```{=html}
<!-- -->
```
-   Describe the current data collection systems that already exist in
    the project area, how/if the project's data collection will
    complement or be different from the existing system, and how they
    will link to each other.

```{=html}
<!-- -->
```
-   As an **attachment**, include a monitoring and evaluation table that
    outlines all the proposed project indicators that are linked to
    specific project objectives. This would include indicators related
    to technical intervention outcomes and process indicators used to
    track project progress for training plans and organizational
    development. The table should include the source of the data (e.g.
    KPC, DHS, MOH, CHWs) and the proposed frequency of collection. To
    the extent possible, the indicators should be globally-accepted,
    standard indicators and feed into the USAID reporting system.

**[Technical Evaluation Criteria for Innovation Category
Applications:]{.underline}**

All sub-criteria are weighted equally.

**[Executive Summary -- 1 page maximum (1 point)]{.underline}**

-   Clear and concise overview of the proposed project that includes all
    elements listed in the Executive Summary guidelines.

**[Project Context (10 points)]{.underline}**

-   Technically sound, appropriate, and comprehensive presentation of
    data related to the leading causes of mortality and morbidity of
    selected population, drawing upon available, and up-to-date national
    and sub-national level data from reputable sources.

-   Discussion of relevant care-seeking practices,
    household-/community-level behaviors, and characteristics that
    impact the health status of the target population.

```{=html}
<!-- -->
```
-   Discussion of the quality, equity, and utilization of the existing
    health care services, both formal and informal, public and private.

-   Discussion of existing national policies and strategies in place
    related to the proposed programming (both technical and
    cross-cutting intervention areas). (Applicant should demonstrate
    consistency with these existing policies and strategies or provide a
    strong rationale for any proposed approach that differs from the MOH
    policy).

```{=html}
<!-- -->
```
-   Description of relevant programming in the project area, as well as
    at the national level, such as other programming done by the
    applicant and the local partner, as well as programming of other
    NGOs, USAID Missions, and global initiatives. (Applicant should
    indicate how the proposed project will engage and/or complement
    these existing programs).

**[Innovation (30 points)]{.underline}**

-   Clear and focused description of the innovation; strong rationale
    for the capacity of the innovation to address critical delivery
    challenges and strengthen health systems.

-   Demonstration of innovation's potential contribution to global
    and/or national evidence base; to furthering national policy, and/or
    to be taken to scale by national programs.

-   Proposed Operations Research (OR) design---including research
    question(s)---is adequate and appropriate to assess the innovation.

-   Clear description of processes that applicant will engage in to
    influence national policy or national scale of innovation, based on
    results.

-   Appropriate choice of "OR partner" or demonstrated capacity of
    applicant to conduct OR.

**[Project Strategy (20 points)]{.underline}**

-   Goals and objectives are appropriate and reasonable for the proposed
    project. Selected strategies and interventions clearly support
    stated goals and objectives.

-   Clear rationale for the project design including the chosen
    strategies/approaches, technical interventions, selected population,
    selected geographic area, chosen levels of implementation (i.e.
    household, community, facility, and/or policy), selection of
    implementing partner(s), and chosen delivery modalities.

```{=html}
<!-- -->
```
-   Clear and technically sound description of overall project strategy
    that addresses quality, access, and equity at the individual,
    household, community, and facility levels.

-   Clear and comprehensive description of how the proposed project will
    address selected technical intervention areas.

-   Proposed workplan reflects the project goal, objectives, activities,
    and budget.

**[Partnerships (15 points)]{.underline}**

-   Demonstration of plans to communicate project activities and key
    results with Mission.

-   Relevant and strategic local partnerships are identified for sharing
    project learning and/or conducting policy advocacy activities.

```{=html}
<!-- -->
```
-   Clear description of the roles of local partners is provided,
    including how the project plans to build capacity of these local
    partners.

```{=html}
<!-- -->
```
-   Letters of support provided that clearly demonstrate partners'
    understanding of their role in the proposed project (note: letter
    from USAID Mission is not required).

**[Organizational Capacity (9 points)]{.underline}**

-   Organization has demonstrated adequate capacity to implement the
    proposed project and activities through discussion of past relevant
    programming experience.

-   Proposed project human resources correspond to and are appropriate
    for the proposed activities.

-   Roles and responsibilities of key project staff are clear.

**[Monitoring and Evaluation (15 points)]{.underline}**

-   Proposed project indicators are globally accepted and are
    appropriate to adequately assess proposed programming. In addition,
    the proposed plan to monitor these indicators is feasible.

-   Process to collect, assess, and use data in management of project is
    clearly articulated and feasible.

-   Proposed project's data collection system complements the MOH health
    management and strengthens information system.

```{=html}
<!-- -->
```
-   Baseline, midterm, and final assessments and OR studies are planned
    and budgeted for.

### II.C. Guidelines for Tuberculosis Category

Five years, up to \$1.5 million

**The TB Category has the following objectives:**

-   To capitalize on the PVO's comparative advantage in community-based
    approaches for TB programming;

-   To build the TB technical capacity of U.S. PVOs who already have
    some experience working in TB programming;

-   To expand the number of community-based partners working in TB; and

-   To develop strategies and sustainable models for TB prevention and
    care through local partnerships.

**Category Purpose and Scope**: USAID fully supports the World Health
Organization's (WHO) Stop TB Strategy as the approach for TB prevention
and control through USAID's TB Program element and nine sub-elements
(Annex B). All proposals should program according to these sub-elements,
but the following sub-elements are most applicable to this program: DOTS
Expansion and Enhancement, TB/HIV, and TB Care and Support. Applicants
should apply under this category ONLY if there is a clearly defined role
for the PVO within the context of -- and in coordination with -- a
National TB Control Program's (NTP) Strategic Plan. Given the varied
needs at the country level and specific technical expertise required to
address each of the elements of the Stop TB Strategy, applicants are
encouraged to address only the elements of the Strategy in their
proposal that can be supported with the resources available and using
the organizational comparative advantage.

Applicants need to clearly identify their contribution to the NTP within
the context of the Stop TB Strategy and how other actors are addressing
the key elements. PVOs should focus on underperforming areas, hard to
reach groups, and technical areas or approaches that are within their
organization's comparative advantage. Underperforming areas would be
measured based on the case notification and treatment success.

USAID believes that PVOs have a strategic role to play in TB programs.
It is critical that applicants weigh their comparative advantage and
bring the relevant experience to bear if they propose to work in this
area. Some illustrative issues that may be PVOs' comparative advantage
to address through this program are the following:

-   Improving detection of TB suspects through intensified case finding;

-   Reducing diagnostic delay;

-   Reducing default rates;

-   Improving social mobilization and engaging civil society and local
    organizations in TB care and prevention;

-   Reducing stigma;

-   Improving community-based approaches to TB and TB/HIV diagnosis,
    care and treatment; and

-   Improving linkages to other health interventions.

It is also recognized that many PVOs have limited experience working in
all the technical components of the Stop TB Strategy and may not be
involved in state-of-the-art TB programming and technical issues. If
awarded, USAID will ensure that external technical expertise will be
available to review and comment on the DIP at key moments in the
development process as well as provide the external consultant to serve
as the team leader for the participatory Midterm and Final evaluations
of the project. This will be from a separate budget, outside of the
grant. However, the rest of the evaluation team and all other expenses
for conducting the evaluation must be budgeted for in the application.
In addition, the proposal does need to present the organization's
technical capacity and/or plans to obtain the necessary technical
expertise to implement all of the proposed activities for the project
and budget appropriately for this expertise.

Under the TB Category, 100% of the LOE is to be devoted to TB and/or
TB/HIV care and prevention activities.

**Budget Requests:** TB Category projects may submit budget requests for
five-year projects for up to \$1.5 million.

**Who Should Apply:** U.S. PVOs who meet the eligibility, organizational
and project requirements identified in the Selection Criteria Section of
the RFA.

**[Technical Guidance for Tuberculosis Category
Applications]{.underline}**

**1. Executive Summary**

This section should contain the information that the PVO believes best
represents its proposed project. It should be no longer than one page.

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Problem statement, including rationale for the proposed project

-   Description of project goals, objectives, key strategies (including
    estimated level of effort devoted to each TB sub-element), and
    project location

-   Estimated number of total population and beneficiaries: provide the
    total population that will be covered by the intervention as well as
    the estimated number of TB cases in the geographical area

-   Local partner(s) involved in project implementation, including name
    and type of any subgrantees and total level of USAID funding to be
    subgranted

-   Level of USAID funding requested for the project and cost share
    amount

-   The application category

-   The proposed start and end dates

-   Main authors of the proposal and proposal contact at U.S.
    headquarters office

**2. Project Context**

This section of the application presents a preliminary assessment which
provides relevant data to support the need and approach for reducing the
burden of TB in the proposed project site. This analysis serves as the
basis for rationale for the proposed project including the elements of
the Stop TB Strategy to be addressed and the major strategies and
interventions for the proposed project.

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Briefly describe the location of the proposed project and provide a
    map(s) with scale in an **attachment**. Estimate the total
    population and the number of villages or other community units that
    are in the target area. Please cite the sources of data.

-   Provide an overview of the general health status of the population
    and the health care delivery system in the country and the current
    status of health care services in the proposed project site.

```{=html}
<!-- -->
```
-   The PVO should respond to the following as well as include other
    relevant information which supports the applicants' proposed
    intervention, methodology, etc.

```{=html}
<!-- -->
```
-   Socio-economic characteristics of the population (such as economy,
    religion, gender equity, ethnic groups, literacy or other) that have
    an impact on TB and the use of TB services.

-   Provide relevant information on pertinent household behaviors and
    care seeking practices. The applicant is **[not]{.underline}**
    expected to have conducted a survey, but general knowledge of the
    local population should be evident.

```{=html}
<!-- -->
```
-   Describe the structure of the National TB Program (NTP) including
    the objectives/targets of the national TB policy and strategic plan,
    the government's commitment to the Stop TB Strategy, and the
    structure for the provision of TB services in the country. Provide
    an analysis of the TB epidemiological situation in the country and
    proposed site using recent data. Please cite data sources.

```{=html}
<!-- -->
```
-   Discuss the existing diagnostic TB treatment services available to
    the target population, including: detection of TB cases; type and
    availability of TB diagnostic laboratory services; system for
    providing TB treatment (public and private sector), and availability
    of directly observed treatment; treatment protocols; source and
    availability of TB drug pharmaceuticals; and the monitoring and
    evaluation system**. Discuss the accessibility and quality of these
    services.**

-   Map the current efforts of national and international in-country TB
    partners, including activities not in the proposed project site.
    Describe any geographic or programmatic gaps that justify the
    proposed site and intervention(s) selection ensuring
    complementarities with the other partners and the NTP. Applications
    are not recommended to address all elements of the Stop TB Strategy,
    but should clearly demonstrate that the proposed areas are gaps and
    that other complementary components (that the applicant does not
    plan to address) are being addressed by the NTP and/or other TB
    partners in country, in order to provide a comprehensive approach.
    For example, the applicant proposes interventions to improve
    detection of TB suspects. The application should show how other
    organizations are supporting the facilities to handle the increased
    demand for quality diagnosis.

-   Describe the status of any global initiatives (e.g. Global Fund for
    AIDS, TB and Malaria (GFATM); Stop TB Global Drug Facility) that may
    impact the National TB Program and the existence and membership of
    TB coordinating bodies in the country.

-   Applicants proposing TB/HIV activities should include a description
    of the HIV epidemiologic problem, relevant government policies, a
    description of the type, availability and quality of HIV services
    and the opportunities/obstacles to linking/integrating these
    services with the proposed TB project.

#### 3. Project Strategy

This section should provide a clear picture of the proposed project and
overall strategies, details on the proposed TB intervention and
approaches to implement that intervention, including training and how
sustainability of the project will be addressed. It will be important to
clearly define linkages with other projects and how synergy among
projects will be developed.

-   [Guidance]{.underline}**:**

```{=html}
<!-- -->
```
-   Provide the goal and objectives of the proposed project.

-   Provide an overview of the project strategy; please link the
    strategy with the project context and clearly identify the target
    beneficiaries. In contrast to most of the interventions addressed in
    the CSHGP, [it is important to note that infectious TB cases, which
    are found in adults, are the primary target population for TB
    prevention and control projects]{.underline}.

-   As identified in the project context, further describe the
    programmatic aspect(s) of the tuberculosis prevention and control
    project that will be implemented or strengthened in this project:

```{=html}
<!-- -->
```
-   Identify the specific USAID TB sub-elements(s) to be implemented or
    strengthened and explain the approaches used to accomplish this.

-   Explain how the proposed activities are consistent with the Stop TB
    Strategy and NTP Strategic Plan.

-   Explain how the proposed activities will strategically link
    with/complement the efforts of other partners based on the mapping
    in the project context section.

-   Explain the applicant's proposed plan for sustainability, making
    linkages to scale-up and sharing lessons learned within the country.
    This could include participation in coordinating bodies including
    the national level Stop TB Partnerships and programming/planning
    meetings at the various levels of the systems.

-   If appropriate, describe proposed strategy(s) and activities to
    strengthen the linkages between or the integration of TB and HIV
    projects.

-   Address issues of quality and access (including gender inequality)
    as well as integration of TB services with other interventions.

-   If the government may become a GFATM recipient describe the
    strategy/plan for dealing with any implication this may have for the
    proposed project.

```{=html}
<!-- -->
```
-   Discuss how the approach used will involve the individual, family,
    health worker, community, district and/or national levels.

-   As an **attachment**, please present a brief, one- to two-page work
    plan in table format which reflects the overall project approach,
    objectives, timeline, and budget. Also present the project's
    training activities/plan in table format for each intervention that
    includes a brief description of the training objective, number of
    participants, and timing of training as an **attachment**.

```{=html}
<!-- -->
```
-   Discuss how progress towards project objectives will be measured.
    Describe how current data on indicators will be collected, analyzed
    and used for project management.

> The USAID TB Element and Stop TB strategy includes a standard set of
> internationally recognized indicators for national level reporting as
> well as routine project monitoring and evaluation. Due to the
> variation in projects, all applicants will be required to report on
> only two standard TB indicators: "Treatment Success Rate" and Case
> Notification Rate as defined:
>
> **Treatment Success Rate**
>
> [Numerator:]{.underline} Number of new smear-positive pulmonary TB
> cases registered in a specified period that were cured plus the number
> that completed treatment
>
> [Denominator:]{.underline} Total number of new smear-positive
> pulmonary TB cases registered in the same period
>
> **Case Notification Rate**
>
> [Numerator]{.underline}: Number of new smear-positive pulmonary TB
> cases reported
>
> X 100,000

[Denominator]{.underline}: Total population in the specified area

> Additionally, applicants **should** include other indicators that
> reflect the various components of the proposed project. The Compendium
> of Indicators for Monitoring and Evaluating NTPs found at
> <http://whqlibdoc.who.int/hq/2004/WHO_HTM_TB_2004.344.pdf> should be
> consulted as part of this process. In addition, the recent evaluation
> of the CSHGP TB grants came up with a suggested list of facility and
> community-based indicators that could be used for certain
> interventions (See Annex C). There are also Advocacy, Communication
> and Social Mobilization (ACSM) indicators available on the Stop TB
> Partnership's ACSM Country Level webpage. The link to this and other
> tools can be found at:
> <http://www.stoptb.org/wg/advocacy_communication/acsmcl/tools.asp>
>
> *[Please note]{.underline}:* The standard child survival indicators
> are not appropriate for a proposed tuberculosis project.

-   Describe the government's existing routine monitoring and evaluation
    system for TB. Describe how (if appropriate) the proposed project
    will strengthen the government's data collection system. The World
    Health Organization (WHO) has established a set of internationally
    recognized and accepted indicators and tools for reporting,
    monitoring and evaluating TB projects. Applicants are expected to
    use the WHO system if established by the government or, if
    appropriate, implement the WHO system (if it does not exist) within
    the structure of the NTP. Do not create a new or parallel system.

```{=html}
<!-- -->
```
-   Describe the types of baseline assessments, studies, or surveys that
    will be carried out. Include baselines of local partner capacity,
    and any qualitative and population-based assessments.

-   In the attachments, provide a matrix or other graphic to present the
    information which summarizes the proposed project's goal,
    results-based objective(s) and major activities. These should be the
    same as already discussed in the narrative of earlier sections. In
    addition, include indicator(s) for measuring the achievement of each
    objective. The sample program matrix in Annex G is a suggested
    template. If the applicant PVO has standardized a particular
    approach, such as a logical framework or a results framework, please
    use the organization's preferred format. The graphic should provide
    the reader with a concise summary of the proposed project, to what
    the project will hold itself accountable to achieve, and how the
    project will measure these outcomes and impact.

**4. Partnerships**

This section of the application provides information about the
partnerships that will be fostered by this proposal. The section should
provide evidence that the PVO has coordinated and is collaborating with
all key players in TB and/or TB/HIV nationally and at the selected site.

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Provide a matrix outlining the partner(s), geographic area the
    partner(s) will be working in, technical area they will be covering,
    and the gap they are filling in the project.

```{=html}
<!-- -->
```
-   The proposed activity(s) need to be appropriate and coordinated
    closely with other actors in the TB and health sectors to ensure a
    comprehensive Stop TB Strategy and to avoid overlap. Include those
    of other PVOs, USAID field missions, networks or associations of
    NGOs, local organizations, private commercial and traditional
    providers, multi-bilateral partners, international TB organizations,
    and the government, if not already addressed in the mapping in the
    project context section.

-   Describe the type and background of the partner organization(s)
    and/or groups with which the applicant will work and why they were
    selected. Describe their experience in TB programming, technical
    capacity, and role in this project and how it complements the U.S.
    PVO's comparative advantage.

-   Discuss the approach the project will take, including tools to be
    used, to build the organizational capacity of the local partner
    (which may be the NTP, the private sector, and/or an NGO), and to
    assist the local partner in its organizational development. Describe
    the objectives of the local partner and how the activities and
    achievements of this project will benefit them in the future.

-   Describe how the project is consistent with the relevant USAID
    Mission and CSHGP priorities for TB and TB/HIV. In addition, provide
    clear linkages to other Mission/PEPFAR-supported TB, TB/HIV, and/or
    other health projects.

-   Describe the process used to involve all relevant stakeholders (e.g.
    MOH, NTP, community and local partners) in the selection of the
    site, interventions, and strategies.

-   In an **attachment**, include a letter showing support or
    endorsement for the proposed project from the NTP and any other
    organizations with which the project will establish a formal
    relationship. Each letter must be dated within three months of the
    application submission and include the partners' role in the
    project.

**5. Organizational Capacity**

This section provides an overview of the demonstrated capacity and
capability of the organization to manage and implement the technical
interventions of the proposed project. Please highlight those areas of
project management that were not discussed in other sections.

-   [Guidance]{.underline}:

```{=html}
<!-- -->
```
-   Briefly describe the U.S. PVO applicant's experience in designing,
    implementing, monitoring, and evaluating TB prevention and control
    projects at the regional, nationa,l and community level.

-   Briefly describe how the capacity of the U.S. PVO headquarters and
    local field staff will be strengthened in the planning,
    implementation, and evaluation of TB control projects.

-   Describe the U.S. PVO applicant's operations, current agreements and
    working relationships with the host country government and other
    organizations within the country proposed in this application.
    Documentation of current legal authorization for the U.S. PVO, or
    international affiliate, to operate in the host country must be
    provided in an **attachment**. Also in the **attachments**, please
    include draft Memoranda of Understanding (MOUs) with partners, if
    applicable.

```{=html}
<!-- -->
```
-   Applications must demonstrate the ability of the U.S. PVO to ensure
    the implementation of a quality TB project in one of the following
    ways:

```{=html}
<!-- -->
```
-   Past performance in the implementation of TB prevention and control
    projects in a developing country. Provide information on where
    projects have been carried out, describe the strategy(s), activities
    implemented, project partners, relationship with the National TB
    Program, and project outcomes;

-   Technical capacity at the PVO Headquarters with demonstrated field
    experience in implementing TB prevention and control projects
    (include the HQ backstopping individual's C.V. in an
    **attachment**). Within the work plan, the applicant needs to
    clearly demonstrate how TB technical capacity development will be
    achieved at the country level, to ensure appropriate implementation;

-   Applicants for which TB is a new activity or have limited experience
    must include in the proposal a formal partnership with an
    organization experienced in TB prevention and control that will
    provide technical assistance to the project and capacity development
    to the U.S. PVO. Describe the partner organization's TB experience
    and include a letter of support from the institution that confirms
    their support for the project and gives a description of the
    technical assistance they will provide to the project. The work plan
    and budget must reflect this involvement.

```{=html}
<!-- -->
```
-   Briefly describe other sector projects the PVO is involved with in
    the same geographic area (such as food security, HIV, or education)
    where innovative opportunities may exist for synergies of projects
    and plans to synergize with other projects where applicable.

```{=html}
<!-- -->
```
-   Describe the proposed management structure for this project and
    provide a project organogram in the attachments. Include in the
    narrative a description of the responsibilities of the PVO,
    partners, and principal organizations and staff involved, reporting
    relationships, authority, and lines of communication within and
    between each of these organizations. Please include job descriptions
    and CVs of key staff (headquarters backstop, project director and
    M&E position) as **attachments**.

-   In the **attachments,** please provide an organizational chart that
    clearly delineates the key personnel responsible for technically
    backstopping this project in the PVO U.S. headquarters office and
    managing this project in the in-country office. Describe how they
    fit into the overall organization and the linkages between the
    headquarters, regional (if applicable), and field project personnel.

```{=html}
<!-- -->
```
-   In the **attachments**, please provide a **[table]{.underline}** of
    ALL persons who will contribute to achieving the results of the
    project. This may include, but is not limited to: PVO headquarters
    and field staff, local partner staff, MOH/NTP staff, community
    health workers and private sector providers. For each type of worker
    provide: 1) the number of workers in that category; 2)
    organizational affiliation; 3) main responsibilities; 4) TB-specific
    expertise; 5) percent of effort devoted to project activities;
    and 6) entity responsible for remunerating the worker (e.g. PVO,
    MOH/NTP, community, volunteer).

```{=html}
<!-- -->
```
-   Discuss the roles and responsibilities of project staff vis-à-vis
    budgeting, financial monitoring, and reporting on the financial
    status of the project, to ensure accountability in the use of U.S.
    Government and matching funds.

```{=html}
<!-- -->
```
-   In table format, please present a brief, one- to two-page work plan,
    which reflects the overall project approach and budget. Be sure to
    include a separate table for the project's training plan as
    described in the Project Strategy section.

**[Technical Evaluation Criteria for TB Category
Applications]{.underline}**

All sub-criteria are weighted equally unless otherwise stipulated.

**[Executive Summary (1 point) -- 1 page maximum]{.underline}**

-   Clear and concise overview of the proposed project that includes all
    elements listed in the Executive Summary guidelines.

**[Project Context (9 points)]{.underline}**

-   Detailed description of the TB burden, particularly in the target
    area.

-   Clear and concise description of health care delivery services,
    including both formal and informal sectors in relation to TB
    services.

-   Clear and comprehensive overview of the TB control program in target
    area according to the components of the Stop TB Strategy including
    strengths and weaknesses, which support the selection of proposed TB
    interventions.

-   Clear description of socioeconomic factors and other parameters
    (constraints and opportunities) that influence the TB burden.

-   Clear and comprehensive mapping of other TB and/or TB/HIV activities
    by other partners (PVOs, other organizations, USAID field mission
    projects, global initiatives, etc.) and opportunities for synergies
    of project interventions and strategies.

**[Project Strategy: (45 points)]{.underline}**

-   Selected strategies and interventions clearly support stated goals
    and objectives.

-   Proposed project includes a strong rationale for selected
    population, selected geographic area, the chosen technical
    intervention package to address gaps (omissions and inclusions),
    chosen levels of implementation (i.e., household, community,
    facility, policy), the role of the implementing partner(s), and
    chosen delivery strategy.

-   Clear description of how the project will relate to the NTP
    Strategic Plan and specific activities and partners working within
    it nationally and in the project area.

-   Clear description and appropriate selection of technically sound
    activities through which the project plans will achieve improved
    quality, access, and equity at the individual/community levels.

-   Clear description and appropriate selection of technically sound
    activities through which the project plans will achieve improved
    quality, access, and equity at the facility level (includes referral
    activities).

-   Issues of sustainability and scale-up fully addressed and realistic
    to the situation.

-   Work plan reflects project goal, objectives, activities, and budget.

**[Partnerships (16 points)]{.underline}**

-   USAID Mission strategies and priorities identified and congruent
    with proposed project as well as clear linkages are described to
    other Mission- and/or PEPFAR-supported TB and TB/HIV projects and
    efforts.

-   NTP and target area stakeholders appropriately involved in the
    selection of site, interventions and/or strategies and methodologies
    that will be scaled up.

-   Rationale for choice of implementing partners/sub-grantees.

-   Clear description of the objectives of the local partner and how the
    project will build the capacity of the local partner.

-   Letters of support provided demonstrating partners' understanding of
    their role in the proposed project (NTP letter is mandatory but
    USAID Mission letter is not required).

**[Organizational Capacity (20 points)]{.underline}**

-   Organization has demonstrated capacity and capability to implement
    the proposed technical and programmatic approaches through
    discussion of results and/or programmatic lessons learned of
    previous TB projects. If the organization does not have this
    experience, a technical partner should be identified for providing
    this expertise with a key role in the planning and implementation of
    the proposed project.

-   Sufficient and appropriate human resources with technical TB
    expertise are devoted to the project.

-   Roles and responsibilities of key staff and project partners are
    clear.

**[Monitoring and Evaluation (9 points)]{.underline}**

-   Proposed project indicators are globally accepted, relevant to
    proposed programming, and consistent with the NTP M&E system. In
    addition, the proposed plan to monitor these indicators is feasible.

```{=html}
<!-- -->
```
-   Process to gather, analyze and use data in management of project is
    clearly articulated and feasible.

-   Planned baseline, midterm, and final assessments are appropriate and
    budgeted for.

## III. Cost Application Guidelines

A. [Budget Preparation and Submission Instructions]{.underline}

**Cost Share -- An Applicant must contribute from its non-U.S.
government resources, at least 25% of the total cost of the proposed
project.**

[Standard Form 424 & 424A]{.underline}

Standard Form 424 is the standard form used by applicants as the
required face sheet for applications submitted for Federal assistance.
Standard Form 424A is the form used by applicants for presenting overall
budget information. **These forms (424 & 424A), along with detailed
instructions for completing them, are included in ANNEX F of this
document.** Please pay careful attention to the budget instructions.
There are specific criteria that must be met for this program, some of
which may have been amended since the previous RFA. Failure to
accurately complete these forms could result in a non-funded
application.

The Standard Form 424A, [Section A]{.underline}, requests costs
organized by [headquarters]{.underline} and [field]{.underline}, and by
Federal and Non-Federal. This information should be the same as that
presented in other sections. Federal refers to the funds requested from
USAID and Non-Federal refers to funding from the applicant and other
sources. The amounts for Federal and Non-Federal presented here should
be the same as the Estimated Funding presented on Standard Form 424,
15.a and b, plus any entry for e. The total project amount on SF 424
should be the same amount presented in Section A and in Section B. For
further information regarding use of Non-Federal funds, refer to the
discussion of budget narrative and "cost-share" in this section of the
RFA.

[Headquarters costs]{.underline} are direct costs incurred by the U.S.
PVO/NGO head office in the United States in support of the child
survival and health projects overseas. This does not duplicate
established indirect cost rates. USAID will support up to 15% of the
direct costs of the USAID funds in the project budget at the PVO/NGO's
U.S. headquarters for support to the field project, and for improving
child survival and health technical and operational capabilities of the
PVO/NGO(s). USAID will support up to 20% of headquarters costs for New
Partner projects to allow for improving the organization's institutional
capacity of child survival and health programming. The headquarters
budget should be directly related to the description of how the PVO/NGO
builds and maintains technical and operational capacity. In addition to
backstopping and site visits to the field project, types of activities
that PVO/NGOs have included in the past are continuing education
opportunities for staff, information exchange and technical networking
among PVO/NGOs, reference materials, and observational visits to the
other field projects of the same organization or others. All
headquarters costs must be appropriately distributed in the correct
amounts and contained within the correct categories of Standard Form
424A, Section B, as per the guidelines in [Section D]{.underline}.

[Field costs]{.underline} should include all funds designated for
expenditure within the host-country for carrying out the planned
project. All field costs must be appropriately distributed in the
correct amounts and contained within the correct categories of Standard
Form 424A, Section B, as per the guidelines in this RFA.

Standard Form 424A, [Section B]{.underline} is divided into eleven
"[Object Class Categories]{.underline}." The Object Class Categories
must be presented in two columns, "[Federal]{.underline}," which are the
costs being funded by the USAID portion of the over-all project budget,
and "[Non-Federal]{.underline}," which are the costs covered by the cost
share portion of the entire project budget. The entire project budget
must be appropriately distributed and contained within these categories
and columns. The categories include Personnel, Fringe Benefits, Travel,
Equipment, Supplies, Contractual, Construction, Other, Total Direct
Charges, Indirect Charges, and Totals. The Construction category does
[not]{.underline} apply to this program. Project costs proposed for
"training" and for "sub-grants" must be included in the "Other" Object
Class Category. For further elaboration on each of the Object Class
Categories, please refer to the instructions in [Section D]{.underline}.
[Section D]{.underline} includes a sample Standard Form 424 and 424A.

[Detailed Budget and Budget Narrative]{.underline}

The detailed budget and narrative should follow the SF 424 and 424A and
should fully define and support the line item costs for both the
Federally-funded (USAID) and Non-Federally funded (PVO/NGO cost-share)
portions of the budget. The budget narrative should clearly describe the
method used to estimate and the rationale for all costs. For example,
when describing international airfare, the budget narrative should
specify the amount estimated for roundtrip airfare by destination,
should provide the source for the estimate (travel agent, airline,
etc.), and should indicate the number of trips expected. Simply stating
a lump sum for international airfare is not adequate. Based on the
calculations shown in the narrative, the Cognizant Technical Officer
(CTO) and the Agreement Officer should be able to easily verify all
costs for the proposed project. The costs proposed for "training" and
"sub-grants" must be itemized in the explanation of the Object Class
Categories within the budget narrative, so that they may be subsequently
negotiated and included in the appropriate category of the Cooperative
Agreement Budget.

All costs contained in the budget should accurately reflect the planned
level of project activities in the project design. For example, the
training budget should reflect the specific training activities to be
undertaken by the project. If the project approach includes training,
then the budget should reflect the detailed training costs for this
level of activity. This same principle should be maintained throughout
the budget when itemizing all field costs.

The detailed budget and budget narrative should contain the following
information for each year of the project as well as for the life of the
project, and presented by Federal and Non-Federal funds:

-   The breakdown of all costs associated with the project according to
    costs of, if applicable, headquarters, regional and/or country
    offices;

-   The breakdown of all costs according to each partner organization
    involved in the project;

-   The costs associated with external, expatriate technical assistance
    and those associated with local in-country technical assistance;

-   The breakdown of the financial and in-kind contributions of all
    organizations involved in implementing this Cooperative Agreement;

-   Potential contributions of non-USAID or private commercial donors to
    this Cooperative Agreement each year (phase-out of USAID funding for
    key personnel is encouraged); and

-   The procurement plan for commodities (note that contraceptives will
    not be provided under this Cooperative Agreement).

[Procurement Plan]{.underline}

Applications for all program categories should include a detailed
procurement plan containing explicit information on how procurements
will be accomplished. Carefully read the guidance in 22 CFR 228.
**GH/HIDN does [NOT]{.underline} customarily seek waivers for the
purchase of non-U.S. motor vehicles, pharmaceuticals, used equipment,
seeds or pesticides. The applicant should consider funding such
commodities with the Non-Federal portion of the program budget.**

The recipient is expected to comply with USAID Eligibility Rules for
Goods and Services in the Standard Provisions and 22 CFR Part 228, and
use its cost-share for any goods and services that do not comply with
these rules.

B. [References]{.underline}

-   Mandatory Standard Provisions for U.S., Nongovernmental Recipients:
    <http://www.usaid.gov/policy/ads/300/303maa.pdf>

-   22 CFR 226 USAID Assistance Regulations:
    <http://www.access.gpo.gov/nara/cfr/waisidx_02/22cfr226_02.html>

-   22 CFR 228 USAID Source, Origin, Nationality Regulations:
    <http://www.access.gpo.gov/nara/cfr/waisidx_01/22cfr228_01.html>

-   ADS Series 300 Acquisition and Assistance:
    <http://www.usaid.gov/pubs/ads/>

-   AAPD 02-10 Cost Sharing in Grants and Cooperative Agreements to
    NGOs:
    <http://www.usaid.gov/business/business_opportunities/cib/pdf/aapd02_10.pdf>

-   SF 424, SF 424A, SF 424B Grants Management:
    <http://www.whitehouse.gov/omb/grants/grants_forms.html>

-   AAPD 05-04 Implementation of the United States Leadership Against
    HIV/AIDS, Tuberculosis and Malaria Act of 2003 -- Eligibility
    Limitation on the Use of Funds and Opposition to Prostitution and
    Sex Trafficking:
    <http://www.usaid.gov/business/business_opportunities/cib/pdf/aapd05_04.pdf>

-   Guidance on the Definition and Use of the Child Survival and Health
    Programs Fund and the Global HIV/AIDS Initiative Account:
    <http://www.usaid.gov/policy/ads/200/200mab.pdf>

## IV. Additional Documentation

Certain documents are required to be submitted by an applicant in order
for a Grant Officer to make a determination of responsibility. However,
it is USAID policy not to burden applicants with undue reporting
requirements if that information is readily available through other
sources.

The following sections describe additional documentation that applicants
for Assistance must submit to USAID prior to award. See Section B.I
regarding page limits. Applicants are encouraged to be as concise as
possible, but still provide the necessary detail to address the
following:

A. A current Negotiated Indirect Cost Rate Agreement

B. Applicants who do not currently have a Negotiated Indirect Cost Rate
Agreement (NICRA) from their cognizant agency shall submit the following
information:

1.  Copies of the applicant's financial reports for the previous 3-year
    period, which have been audited by a certified public accountant or
    other auditor satisfactory to USAID;

2.  Projected budget, cash flow and organizational chart; and

3.  A copy of the organization's accounting manual.

C. Applicants should submit any additional evidence of responsibility
deemed necessary for the Grant Officer to make a determination of
responsibility. The applicant should submit a list of all past and
current U.S. government contracts, cooperative agreements and grants for
the last three (3) years; this will be included in the **attachments**
section. The information submitted should substantiate that the
Applicant:

1.  Has adequate financial resources or the ability to obtain such
    resources as required during the performance of the award.

2.  Has the ability to comply with the award conditions, taking into
    account all existing and currently prospective commitments of the
    applicant, nongovernmental and governmental.

3.  Has a satisfactory record of performance. Past relevant
    unsatisfactory performance is ordinarily sufficient to justify a
    finding of non-responsibility, unless there is clear evidence of
    subsequent satisfactory performance.

4.  Has a satisfactory record of integrity and business ethics; and

5.  Is otherwise qualified and eligible to receive a grant under
    applicable laws and regulations (e.g., EEO).

D. Applicants that have never received a grant, cooperative agreement or
contract from the U.S. Government are required to submit a copy of their
accounting manual. If a copy has already been submitted to the U.S.
Government, the applicant should advise which Federal Office has a copy.

E. Acknowledgement of Amendments to the RFA -- Applicants shall
acknowledge receipt of any amendment to this RFA by signing and
returning the amendment. The Government must receive the acknowledgment
by the time specified for receipt of applications.

F. AAPD 05-04 Certification for HIV/AIDS Program Funds -- Applicants
proposing a 30% or less HIV/AIDS intervention are required to comply
with AAPD 05-04, 'Implementation of the United States Leadership Against
HIV/AIDS, Tuberculosis and Malaria Act of 2003 -- Eligibility Limitation
on the Use of Funds and Opposition to Prostitution and Sex Trafficking'
by signing the certification in Section D, Part IV of this RFA.

G. If recommended forward, the Applicant must submit a Branding Strategy
and Marking Plan according to the guidelines set in the Standard
Provision for U.S. Nongovernmental Recipients, MARKING UNDER
USAID-FUNDED ASSISTANCE INSTRUMENTS (DECEMBER 2005). The Standard
Provisions for U.S., Nongovernmental Recipients have been included in
Section E of the RFA. Additionally, a link to the applicable Standard
Provisions has been included in the section entitled 'References' on the
preceding page.

## V. Additional Considerations

In addition to the aforementioned guidelines, the applicant is requested
to take note of the following:

A. [Unnecessarily Elaborate Applications]{.underline}: Unnecessarily
elaborate brochures or other presentations beyond those sufficient to
present a complete and effective application in response to this RFA are
not desired and may be construed as an indication of the applicant's
lack of cost consciousness. Elaborate art work, expensive paper and
bindings, and expensive visual and other presentation aids are neither
necessary nor wanted.

B. [Preparation of Applications]{.underline}:

1.  Applicants who include data that they do not want disclosed to the
    public for any purpose or used by the U.S. Government except for
    evaluation purposes, should:

```{=html}
<!-- -->
```
(a) Mark the title page with the following legend:

> "This application includes data that shall not be disclosed outside
> the U.S. Government and shall not be duplicated, used, or disclosed --
> in whole or in part -- for any purpose other than to evaluate this
> application. If, however, a grant is awarded to this applicant as a
> result of -- or in connection with -- the submission of this data, the
> U.S. Government shall have the right to duplicate, use, or disclose
> the data to the extent provided in the resulting grant. This
> restriction does not limit the U.S. Government's right to use
> information contained in this data if it is obtained from another
> source without restriction. The data subject to this restriction are
> contained in sheets;" and

(b) Mark each sheet of data it wishes to restrict with the following
    legend:

> "Use or disclosure of data contained on this sheet is subject to the
> restriction on the title page of this application."

C. [Explanation to Prospective Applicants]{.underline}: Any prospective
applicant desiring an explanation or interpretation of this RFA must
request it in writing within three weeks of receipt of the application
to allow a reply to reach all prospective applicants for the submission
of their applications. Oral explanations or instructions given before
award of a Grant will not be binding. Any information given to a
prospective applicant concerning this RFA will be furnished promptly to
all other prospective applicants as an amendment of this RFA, if that
information is necessary in submitting applications or if the lack of it
would be prejudicial to any other prospective applicants.

D. [Award]{.underline}:

1.  The Government may award one or more Agreements resulting from this
    RFA to the responsible applicant(s) whose application(s) conforming
    to this RFA offers the greatest value (see also Section II of this
    RFA). The Government may (a) reject any or all applications, (b)
    accept other than the lowest cost application, (c) accept more than
    one application (see Section III, Selection Criteria), (d) accept
    alternate applications, and (e) waive informalities and minor
    irregularities in applications received.

2.  The Government may award one or more Agreement(s) on the basis of
    initial applications received, without discussions. Therefore, each
    initial application should contain the applicant's best terms from a
    cost and technical standpoint.

3.  A written award mailed or otherwise furnished to the successful
    applicant(s) within the time for acceptance specified either in the
    application(s) or in this RFA (whichever is later) shall result in a
    binding Agreement without further action by either party. Before the
    application's specified expiration time, the Government may accept
    an application, whether or not there are negotiations after its
    receipt, unless a written notice of withdrawal is received before
    award. Negotiations conducted after receipt of an application do not
    constitute a rejection or counteroffer by the Government.

4.  Neither financial data submitted with an application, nor
    representations concerning facilities or financing, will form a part
    of the resulting Agreement(s).

E. [Authority to Obligate the Government]{.underline}: The Grant Officer
is the only individual who may legally commit the Government to the
expenditure of public funds. No costs chargeable to the proposed
Agreement may be incurred before receipt of either a fully executed
Agreement or a specific, written authorization from the Grant Officer.

# SECTION D: REQUIRED FORMS, CERTIFICATIONS, ASSURANCES, AND OTHER STATEMENTS OF RECIPIENT

I.  Certifications

    1.  Assurance of Compliance with Laws and Regulations Governing
        Nondiscrimination in Federally Assisted Programs

    2.  Certification Regarding Lobbying

    3.  Prohibition on Assistance to Drug Traffickers for Covered
        Countries

    4.  Terrorist Financing

    5.  Certification of Recipient

II. Key Individual Certification Narcotics Offenses and Drug Trafficking

III. Participant Certification Narcotics Offenses and Drug Trafficking

IV. Certification of Compliance with the Standard Provisions entitled
    "Condoms" and "Prohibition of the Promotion or Advocacy of the
    Legalization or Practice of Prostitution or Sex Trafficking."

V.  Survey on Ensuring Equal Opportunity for Applicants

VI. Other Statements of Recipient

```{=html}
<!-- -->
```
1.  Authorized Individuals

2.  Taxpayer Identification Number

3.  Contractor Identification Number -- Data Universal Numbering System
    Number

4.  Letter of Credit Number

5.  Procurement Information

6.  Past Performance Reference

7.  Type of Organization

8.  Estimated Cost of Communication Products

# 

**CERTIFICATIONS, ASSURANCES, AND OTHER STATEMENTS OF THE RECIPIENT**

(MAY 2006)

NOTE: When these Certifications, Assurances, and Other Statements of
Recipient are used for cooperative agreements, the term \"Grant\" means
\"Cooperative Agreement\".

## PART I - CERTIFICATIONS AND ASSURANCES

1.  **ASSURANCE OF COMPLIANCE WITH LAWS AND REGULATIONS GOVERNING
    NON-DISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS**

*Note: This certification applies to Non-U.S. organizations if any part
of the program will be undertaken in the United States.*

\(1\) The recipient hereby assures that no person in the United States
shall, on the bases set forth below, be excluded from participation in,
be denied the benefits of, or be otherwise subjected to discrimination
under, any program or activity receiving financial assistance from
USAID, and that with respect to the Cooperative Agreement for which
application is being made, it will comply with the requirements of:

(a) Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352, 42 U.S.C.
    2000-d), which prohibits discrimination on the basis of race, color
    or national origin, in programs and activities receiving Federal
    financial assistance;

(b) Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), which
    prohibits discrimination on the basis of handicap in programs and
    activities receiving Federal financial assistance;

(c) The Age Discrimination Act of 1975, as amended (Pub. L. 95-478),
    which prohibits discrimination based on age in the delivery of
    services and benefits supported with Federal funds;

(d) Title IX of the Education Amendments of 1972 (20 U.S.C. 1681, et
    seq.), which prohibits discrimination on the basis of sex in
    education programs and activities receiving Federal financial
    assistance (whether or not the programs or activities are offered or
    sponsored by an educational institution); and

(e) USAID regulations implementing the above nondiscrimination laws, set
    forth in Chapter II of Title 22 of the Code of Federal Regulations.

\(2\) If the recipient is an institution of higher education, the
Assurances given herein extend to admission practices and to all other
practices relating to the treatment of students or clients of the
institution, or relating to the opportunity to participate in the
provision of services or other benefits to such individuals, and shall
be applicable to the entire institution unless the recipient establishes
to the satisfaction of the USAID Administrator that the institution\'s
practices in designated parts or programs of the institution will in no
way affect its practices in the program of the institution for which
financial assistance is sought, or the beneficiaries of, or participants
in, such programs.

\(3\) This assurance is given in consideration of and for the purpose of
obtaining any and all Federal grants, loans, contracts, property,
discounts, or other Federal financial assistance extended after the date
hereof to the recipient by the Agency, including installment payments
after such date on account of applications for Federal financial
assistance which was approved before such date. The recipient recognizes
and agrees that such Federal financial assistance will be extended in
reliance on the representations and agreements made in this Assurance,
and that the United States shall have the right to seek judicial
enforcement of this Assurance. This Assurance is binding on the
recipient, its successors, transferees, and assignees, and the person or
persons whose signatures appear below are authorized to sign this
Assurance on behalf of the recipient.

2.  **CERTIFICATION REGARDING LOBBYING**

The undersigned certifies, to the best of his or her knowledge and
belief, that:

\(1\) No Federal appropriated funds have been paid or will be paid, by
or on behalf of the undersigned, to any person for influencing or
attempting to influence an officer or employee of any agency, a Member
of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with the awarding of any Federal
contract, the making of any Federal Cooperative Agreement, the making of
any Federal loan, the entering into of any cooperative agreement, and
the extension, continuation, renewal, amendment or modification of any
Federal contract, grant, loan, or cooperative agreement.

\(2\) If any funds other than Federal appropriated funds have been paid
or will be paid to any person for influencing or attempting to influence
an officer or employee of any agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-LLL,
\"Disclosure of Lobbying Activities,\" in accordance with its
instructions.

\(3\) The undersigned shall require that the language of this
certification be included in the award documents for all subawards at
all tiers (including subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that all subrecipients
shall certify and disclose accordingly.

This certification is a material representation of fact upon which
reliance was placed when this transaction was made or entered into.
Submission of this certification is a prerequisite for making or
entering into this transaction imposed by section 1352, title 31, United
States Code. Any person who fails to file the required certification
shall be subject to a civil penalty of not less than \$10,000 and not
more than \$100,000 for each such failure.

Statement for Loan Guarantees and Loan Insurance

The undersigned states, to the best of his or her knowledge and belief,
that: If any funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with this commitment
providing for the United States to insure or guarantee a loan, the
undersigned shall complete and submit Standard Form-LLL, \"Disclosure
Form to Report Lobbying,\" in accordance with its instructions.
Submission of this statement is a prerequisite for making or entering
into this transaction imposed by section 1352, title 31, U.S. Code. Any
person who fails to file the required statement shall be subject to a
civil penalty of not less than \$10,000 and not more than \$100,000 for
each such failure.

3.  **Prohibition on Assistance to Drug Traffickers for Covered
    Countries and Individuals (ADS 206)**

USAID reserves the right to terminate this Agreement, to demand a refund
or take other appropriate measures if the Grantee is found to have been
convicted of a narcotics offense or to have been engaged in drug
trafficking as defined in 22 CFR Part 140. The undersigned shall review
USAID ADS 206 to determine if any certifications are required for Key
Individuals or Covered Participants.

If there are COVERED PARTICIPANTS: USAID reserves the right to terminate
assistance to or take other appropriate measures with respect to, any
participant approved by USAID who is found to have been convicted of a
narcotics offense or to have been engaged in drug trafficking as defined
in 22 CFR Part 140.

4.  **CERTIFICATION REGARDING TERRORIST FINANCING IMPLEMENTING EXECUTIVE
    ORDER 13224**

By signing and submitting this application, the prospective recipient
provides the

certification set out below:

\(1\) The Recipient, to the best of its current knowledge, did not
provide, within the

previous ten years, and will take all reasonable steps to ensure that it
does not and will not knowingly provide, material support or resources
to any individual or entity that commits, attempts to commit, advocates,
facilitates, or participates in terrorist acts, or has committed,
attempted to commit, facilitated, or participated in terrorist acts, as
that term is defined in paragraph 3.

\(2\) The following steps may enable the Recipient to comply with its
obligations under paragraph 1:

(a) Before providing any material support or resources to an individual
    or entity, the Recipient will verify that the individual or entity
    does not (i) appear on the master list of Specially Designated
    Nationals and Blocked Persons, which list is maintained by the U.S.
    Treasury's Office of Foreign Assets Control (OFAC) and is available
    online at OFAC's website :
    http://www.treas.gov/offices/eotffc/ofac/sdn/t11sdn.pdf, or (ii) is
    not included in any supplementary information concerning prohibited
    individuals or entities that may be provided by USAID to the
    Recipient.

(b) Before providing any material support or resources to an individual
    or entity, the Recipient also will verify that the individual or
    entity has not been designated by the United Nations Security (UNSC)
    sanctions committee established under UNSC Resolution 1267 (1999)
    (the "1267 Committee") \[individuals and entities linked to the
    Taliban, Osama bin Laden, or the Al Qaida Organization\]. To
    determine whether there has been a published designation of an
    individual or entity by the 1267 Committee, the Recipient should
    refer to the consolidated list available online at the Committee's
    website:
    <http://www.un.org/Docs/sc/committees/1267/1267ListEng.htm>.

(c) Before providing any material support or resources to an individual
    or entity, the Recipient will consider all information about that
    individual or entity of which it is aware and all public information
    that is reasonably available to it or of which it should be aware.

(d) The Recipient also will implement reasonable monitoring and
    oversight

> procedures to safeguard against assistance being diverted to support
> terrorist activity.

\(3\) For purposes of this Certification-

(a) "Material support and resources" means currency or monetary
    instruments or

> financial securities, financial services, lodging, training, expert
> advice or assistance, safehouses, false documentation or
> identification, communications equipment, facilities, weapons, lethal
> substances, explosives, personnel, transportation, and other physical
> assets, except medicine or religious materials."

(b) "Terrorist act" means-

> \(i\) an act prohibited pursuant to one of the 12 United Nations
> Conventions and Protocols related to terrorism (see UN terrorism
> conventions Internet site:
> http://untreaty.un.org/English/Terrorism.asp); or
>
> \(ii\) an act of premeditated, politically motivated violence
> perpetrated against noncombatant targets by subnational groups or
> clandestine agents; or
>
> \(iii\) any other act intended to cause death or serious bodily injury
> to a civilian, or to any other person not taking an active part in
> hostilities in a situation of armed conflict, when the purpose of such
> act, by its nature or context, is to intimidate a population, or to
> compel a government or an international organization to do or to
> abstain from doing any act.

(c) "Entity" means a partnership, association, corporation, or other
    organization, group or subgroup.

(d) References in this Certification to the provision of material
    support and resources shall not be deemed to include the furnishing
    of USAID funds or USAID-financed commodities to the ultimate
    beneficiaries of USAID assistance, such as recipients of food,
    medical care, micro-enterprise loans, shelter, etc., unless the
    Recipient has reason to believe that one or more of these
    beneficiaries commits, attempts to commit, advocates, facilitates,
    or participates in terrorist acts, or has committed, attempted to
    commit, facilitated or participated in terrorist acts.

(e) The Recipient's obligations under paragraph 1 are not applicable to
    the procurement of goods and/or services by the Recipient that are
    acquired in the ordinary course of business through contract or
    purchase, e.g., utilities, rents, office supplies, gasoline, etc.,
    unless the Recipient has reason to believe that a vendor or supplier
    of such goods and services commits, attempts to commit, advocates,
    facilitates, or participates in terrorist acts, or has committed,
    attempted to commit, facilitated or participated in terrorist acts.

This Certification is an express term and condition of any agreement
issued as a result of this application, and any violation of it shall be
grounds for unilateral termination of the agreement by USAID prior to
the end of its term.

5.  **CERTIFICATION OF RECIPIENT**

> By signing below the recipient provides certifications and assurances
> for (1) the Assurance of Compliance with Laws and Regulations
> Governing Non-Discrimination in Federally Assisted Programs, (2) the
> Certification Regarding Lobbying, (3) the Prohibition on Assistance to
> Drug Traffickers for Covered Countries and Individuals (ADS 206) and
> (4) the Certification Regarding Terrorist Financing Implementing
> Executive Order 13224 above.

RFA/APS No.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Application No.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of Application
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Recipient
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Typed Name and Title
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

## PART II - KEY INDIVIDUAL CERTIFICATION NARCOTICS OFFENSES AND DRUG TRAFFICKING

I hereby certify that within the last ten years:

1\. I have not been convicted of a violation of, or a conspiracy to
violate, any law or regulation of the United States or any other country
concerning narcotic or psychotropic drugs or other controlled
substances.

2\. I am not and have not been an illicit trafficker in any such drug or
controlled substance.

3\. I am not and have not been a knowing assistor, abettor, conspirator,
or colluder with others in the illicit trafficking in any such drug or
substance.

Signature: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title/Position: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Organization: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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

Date of Birth: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

NOTICE:

1\. You are required to sign this Certification under the provisions of
22 CFR Part 140, Prohibition on Assistance to Drug Traffickers. These
regulations were issued by the Department of State and require that
certain key individuals of organizations must sign this Certification.

2\. If you make a false Certification you are subject to U.S. criminal
prosecution under 18 U.S.C. 1001.

## PART III - PARTICIPANT CERTIFICATION NARCOTICS OFFENSES AND DRUG TRAFFICKING

1\. I hereby certify that within the last ten years:

a\. I have not been convicted of a violation of, or a conspiracy to
violate, any law or regulation of the United States or any other country
concerning narcotic or psychotropic drugs or other controlled
substances.

b\. I am not and have not been an illicit trafficker in any such drug or
controlled substance.

c\. I am not or have not been a knowing assistor, abettor, conspirator,
or colluder with others in the illicit trafficking in any such drug or
substance.

2\. I understand that USAID may terminate my training if it is
determined that I engaged in the above conduct during the last ten years
or during my USAID training.

Signature:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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

Date of Birth:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

NOTICE:

1\. You are required to sign this Certification under the provisions of
22 CFR Part 140,Prohibition on Assistance to Drug Traffickers. These
regulations were issued by the Department of State and require that
certain participants must sign this Certification.

2\. If you make a false Certification you are subject to U.S. criminal
prosecution under 18 U.S.C. 1001.

## 

## PART IV - CERTIFICATION OF COMPLIANCE WITH THE STANDARD PROVISIONS ENTITLED "CONDOMS" AND "PROHIBITION ON THE PROMOTION OR ADVOCACY OF THE LEGALIZATION OR PRACTICE OF PROSTITUTION OR SEX TRAFFICKING."

*Applicability: This certification requirement only applies to the prime
recipient. Before a U.S. or non-U.S. non-governmental organization
receives FY04-FY08 HIV/AIDS funds under a grant or cooperative
agreement, such recipient must provide to the Agreement Officer a
certification substantially as follows*:

"\[Recipient\'s name\] certifies compliance as applicable with the
standard

provisions entitled "Condoms" and "Prohibition on the Promotion or
Advocacy

of the Legalization or Practice of Prostitution or Sex Trafficking"
included in

the referenced agreement."

RFA/APS No.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Application No.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of Application
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Applicant/Subgrantee
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Typed Name and Title
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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

Signature \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

## PART V - SURVEY ON ENSURING EQUAL OPPORTUNITY FOR APPLICANTS

*Applicability: All RFA's must include the attached Survey on Ensuring
Equal Opportunity for Applicants as an attachment to the RFA package.
Applicants under unsolicited applications are also to be provided the
survey. (While inclusion of the survey by Agreement Officers in RFA
packages is required, the applicant's completion of the survey is
voluntary, and must not be a requirement of the RFA. The absence of a
completed survey in an application may not be a basis upon which the
application is determined incomplete or non-responsive. Applicants who
volunteer to complete and submit the survey under a competitive or
non-competitive action are instructed within the text of the survey to
submit it as part of the application process.)*

## PART VI - OTHER STATEMENTS OF RECIPIENT

**1. AUTHORIZED INDIVIDUALS**

The recipient represents that the following persons are authorized to
negotiate on its behalf with the Government and to bind the recipient in
connection with this application or grant:

Name Title Telephone No. Facsimile No.

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

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

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

**2. TAXPAYER IDENTIFICATION NUMBER (TIN)**

If the recipient is a U.S. organization, or a foreign organization which
has income effectively connected with the conduct of activities in the
U.S. or has an office or a place of business or a fiscal paying agent in
the U.S., please indicate the recipient\'s TIN:

TIN: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> **3. DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER**

\(a\) In the space provided at the end of this provision, the recipient
should supply the Data Universal Numbering System (DUNS) number
applicable to that name and address. Recipients should take care to
report the number that identifies the recipient\'s name and address
exactly as stated in the proposal.

\(b\) The DUNS is a 9-digit number assigned by Dun and Bradstreet
Information Services. If the recipient does not have a DUNS number, the
recipient should call Dun and Bradstreet directly at 1-800-333-0505. A
DUNS number will be provided immediately by telephone at no charge to
the recipient. The recipient should be prepared to provide the following
information:

(1) Recipient\'s name.

(2) Recipient\'s address.

(3) Recipient\'s telephone number.

(4) Line of business.

(5) Chief executive officer/key manager.

(6) Date the organization was started.

(7) Number of people employed by the recipient.

(8) Company affiliation.

\(c\) Recipients located outside the United States may obtain the
location and phone number of the local Dun and Bradstreet Information
Services office from the Internet Home Page at
http://www.dbisna.com/dbis/customer/custlist.htm. If an offeror is
unable to locate a local service center, it may send an e-mail to Dun
and Bradstreet at globalinfo@dbisma.com.

The DUNS system is distinct from the Federal Taxpayer Identification
Number (TIN) system.

DUNS:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**4. LETTER OF CREDIT (LOC) NUMBER**

If the recipient has an existing Letter of Credit (LOC) with USAID,
please indicate the LOC number:

LOC:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**5. PROCUREMENT INFORMATION**

\(a\) Applicability. This applies to the procurement of goods and
services planned by the recipient (i.e., contracts, purchase orders,
etc.) from a supplier of goods or services for the direct use or benefit
of the recipient in conducting the program supported by the grant, and
not to assistance provided by the recipient (i.e., a subgrant or
subagreement) to a subgrantee or subrecipient in support of the
subgrantee\'s or subrecipient\'s program. Provision by the recipient of
the requested information does not, in and of itself, constitute USAID
approval.

\(b\) Amount of Procurement. Please indicate the total estimated dollar
amount of goods and services which the recipient plans to purchase under
the grant:

\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\(c\) Nonexpendable Property. If the recipient plans to purchase
nonexpendable equipment which would require the approval of the
Agreement Officer, please indicate below (using a continuation page, as
necessary) the types, quantities of each, and estimated unit costs.
Nonexpendable equipment for which the Agreement Officer\'s approval to
purchase is required is any article of nonexpendable tangible personal
property charged directly to the grant, having a useful life of more
than one year and an acquisition cost of \$5,000 or more per unit.

TYPE/DESCRIPTION(Generic) QUANTITY ESTIMATED UNIT COST

\(d\) Source, Origin, and Componentry of Goods. If the recipient plans
to purchase any goods/commodities which are not of U.S. source and/or
U.S. origin, and/or does not contain at least 50% componentry, which are
not at least 50% U.S. source and origin, please indicate below (using a
continuation page, as necessary) the types and quantities of each,
estimated unit costs of each, and probable source and/or origin, to
include the probable source and/or origin of the components if less than
50% U.S. components will be contained in the commodity. \"Source\" means
the country from which a commodity is shipped to the cooperating country
or the cooperating country itself if the commodity is located therein at
the time of purchase. However, where a commodity is shipped from a free
port or bonded warehouse in the form in which received therein,
\"source\" means the country from which the commodity was shipped to the
free port or bonded warehouse. Any commodity whose source is a non-Free
World country is ineligible for USAID financing. The \"origin\" of a
commodity is the country or area in which a commodity is mined, grown,
or produced. A commodity is produced when, through manufacturing,
processing, or substantial and major assembling of components, a
commercially recognized new commodity results, which is substantially
different in basic characteristics or in purpose or utility from its
components. Merely packaging various items together for a particular
procurement or relabeling items do not constitute production of a
commodity. Any commodity whose origin is a non-Free World country is
ineligible for USAID financing. \"Components\" are the goods, which go
directly into the production of a produced commodity. Any component from
a non-Free World country makes the commodity ineligible for USAID
financing.

TYPE/DESCRIPTION QUANTITY ESTIMATED GOODS PROBABLE GOODS PROBABLE

(Generic) UNIT COST COMPONENTS SOURCE COMPONENTS ORIGIN

\(e\) Restricted Goods. If the recipient plans to purchase any
restricted goods, please indicate below (using a continuation page, as
necessary) the types and quantities of each, estimated unit costs of
each, intended use, and probable source and/or origin. Restricted goods
are Agricultural Commodities, Motor Vehicles, Pharmaceuticals,
Pesticides, Rubber Compounding Chemicals and Plasticizers, Used
Equipment, U.S. Government-Owned Excess Property, and Fertilizer.

TYPE/DESCRIPTION QUANTITY ESTIMATED PROBABLE INTENDED USE

(Generic) UNIT COST SOURCE ORIGIN

\(f\) Supplier Nationality. If the recipient plans to purchase any goods
or services from suppliers of goods and services whose nationality is
not in the U.S., please indicate below (using a continuation page, as
necessary) the types and quantities of each good or service, estimated
costs of each, probable nationality of each non-U.S. supplier of each
good or service, and the rationale for purchasing from a non-U.S.
supplier. Any supplier whose nationality is a non-Free World country is
ineligible for USAID financing.

TYPE/DESCRIPTION QUANTITY ESTIMATED PROBABLE SLUPPIER NATIONALITY
RATIONALE

(Generic) UNIT COST (Non-US Only) for NON-US

\(g\) Proposed Disposition. If the recipient plans to purchase any
nonexpendable equipment with a unit acquisition cost of \$5,000 or more,
please indicate below (using a continuation page, as necessary) the
proposed disposition of each such item. Generally, the recipient may
either retain the property for other uses and make compensation to USAID
(computed by applying the percentage of federal participation in the
cost of the original program to the current fair market value of the
property), or sell the property and reimburse USAID an amount computed
by applying to the sales proceeds the percentage of federal
participation in the cost of the original program (except that the
recipient may deduct from the federal share \$500 or 10% of the
proceeds, whichever is greater, for selling and handling expenses), or
donate the property to a host country institution, or otherwise dispose
of the property as instructed by USAID.

TYPE/DESCRIPTION(Generic) QUANTITY ESTIMATED UNIT COST PROPOSED
DISPOSITION

**6. PAST PERFORMANCE REFERENCES**

On a continuation page, please provide past performance information
requested in the RFA.

**7. TYPE OF ORGANIZATION**

The recipient, by checking the applicable box, represents that -

\(a\) If the recipient is a U.S. entity, it operates as \[ \] a
corporation incorporated under the laws of the State of, \[ \] an
individual, \[ \] a partnership, \[ \] a nongovernmental nonprofit
organization, \[ \] a state or loc al governmental organization, \[ \] a
private college or university, \[ \] a public college or university, \[
\] an international organization, or \[ \] a joint venture; or

\(b\) If the recipient is a non-U.S. entity, it operates as \[ \] a
corporation organized under the laws of
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (country), \[
\] an individual, \[ \] a partnership, \[ \] a nongovernmental nonprofit
organization, \[ \] a nongovernmental educational institution, \[ \] a
governmental organization, \[ \] an international organization, or \[ \]
a joint venture.

**8. ESTIMATED COSTS OF COMMUNICATIONS PRODUCTS**

The following are the estimate(s) of the cost of each separate
communications product (i.e., any printed material \[other than non-
color photocopy material\], photographic services, or video production
services) which is anticipated under the grant. Each estimate must
include all the costs associated with preparation and execution of the
product. Use a continuation page as necessary.

# SECTION E: STANDARD PROVISIONS FOR U.S. Nongovernmental Recipients

**U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT**

**I. MANDATORY STANDARD PROVISIONS FOR U.S. NONGOVERNMENTAL RECIPIENTS**

1\. APPLICABILITY OF 22 CFR PART 226 (MAY 2005)

2\. INELIGIBLE COUNTRIES (MAY 1986)

3\. NONDISCRIMINATION (MAY 1986)

4\. NONLIABILITY (NOVEMBER 1985)

5\. AMENDMENT (NOVEMBER 1985)

6\. NOTICES (NOVEMBER 1985)

7\. SUBAGREEMENTS (JUNE 1999)

8\. OMB APPROVAL UNDER THE PAPERWORK REDUCTION ACT (DECEMBER 2003)

9\. USAID ELIGIBILITY RULES FOR GOODS AND SERVICES (APRIL 1998)

\*10. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS (JANUARY
2004)

\*11. DRUG-FREE WORKPLACE (JANUARY 2004)

\*12. EQUAL PROTECTION OF THE LAWS FOR FAITH-BASED AND COMMUNITY
ORGANIZATIONS (FEBRUARY 2004)

\*13. IMPLEMENTATION OF E.O. 13224 \-- EXECUTIVE ORDER ON TERRORIST
FINANCING (MARCH 2002)

\*14. MARKING UNDER USAID-FUNDED ASSISTANCE INSTRUMENTS (DECEMBER 2005)

15\. REGULATIONS GOVERNING EMPLOYEES (AUGUST 1992)

16\. CONVERSION OF UNITED STATES DOLLARS TO LOCAL CURRENCY (NOVEMBER
1985)

17\. USE OF POUCH FACILITIES (AUGUST 1992)

18\. INTERNATIONAL AIR TRAVEL AND TRANSPORTATION (JUNE 1999)

19\. OCEAN SHIPMENT OF GOODS (JUNE 1999)

20\. LOCAL PROCUREMENT (APRIL 1998)

21\. VOLUNTARY POPULATION PLANNING ACTIVITIES -- MANDATORY REQUIREMENTS
(MAY 2006)

**II. REQUIRED AS APPLICABLE STANDARD PROVISIONS FOR U.S.,
NONGOVERNMENTAL RECIPIENTS**

1\. NEGOTIATED INDIRECT COST RATES - PREDETERMINED (APRIL 1998)

2\. NEGOTIATED INDIRECT COST RATES - PROVISIONAL (Nonprofit)

(APRIL 1998)

3\. NEGOTIATED INDIRECT COST RATE - PROVISIONAL (Profit)

(APRIL 1998)

4\. PUBLICATIONS AND MEDIA RELEASES (MARCH 2006)

5\. PARTICIPANT TRAINING (APRIL 1998)

6\. VOLUNTARY POPULATION PLANNING ACTIVITIES -- SUPPLEMENTAL
REQUIREMENTS (MAY 2006)

7\. PROTECTION OF THE INDIVIDUAL AS A RESEARCH SUBJECT

(APRIL 1998)

8\. CARE OF LABORATORY ANIMALS (MARCH 2004)

9\. TITLE TO AND CARE OF PROPERTY (COOPERATING COUNTRY TITLE) (NOVEMBER
1985)

10\. PUBLIC NOTICES (MARCH 2004)

11\. (RESERVED)

\*12. COST SHARING (MATCHING) (JULY 2002)

13\. PROHIBITION OF ASSISTANCE TO DRUG TRAFFICKERS (JUNE 1999)

\*14. INVESTMENT PROMOTION (NOVEMBER 2003)

\*15. REPORTING OF FOREIGN TAXES (MARCH 2006)

\*16. FOREIGN GOVERNMENT DELEGATIONS TO INTERNATIONAL CONFERENCES
(JANUARY 2002)

17\. ORGANIZATIONS ELIGIBLE FOR ASSISTANCE (JULY 2004)

18\. PROHIBITION ON THE USE OF FEDERAL FUNDS TO PROMOTE, SUPPORT, OR
ADVOCATE FOR THE LEGALIZATION OR PRACTICE OF PROSTITUTION - ASSISTANCE
(JULY 2004)

\*19. ORGANIZATIONS ELIGIBLE FOR ASSISTANCE (JUNE 2005)

\*20. CONDOMS (JUNE 2005)

\*21. PROHIBITION ON THE PROMOTION OR ADVOCACY OF THE LEGALIZATION OR
PRACTICE OF PROSTITUTION OR SEX TRAFFICKING (JUNE 2005)

22\. USAID DISABILITY POLICY - ASSISTANCE (DECEMBER 2004)

23\. STANDARDS FOR ACCESSIBILITY FOR THE DISABLED IN USAID ASSISTANCE
AWARDS INVOLVING CONSTRUCTION (SEPTEMBER 2004)

\*An asterisk indicates that the adjacent information is new or
substantively revised.

## I. MANDATORY STANDARD PROVISIONS FOR US NONGOVERNMENTAL RECIPIENTS

**1. APPLICABILITY OF 22 CFR PART 226 (MAY 2005)**

\(a\) All provisions of 22 CFR Part 226 and all Standard Provisions
attached to this agreement are applicable to the recipient and to sub
recipients which meet the definition of \"Recipient\" in Part 226,
unless a section specifically excludes a sub recipient from coverage.
The recipient shall assure that sub recipients have copies of all the
attached standard provisions.

\(b\) For any sub awards made with Non-US sub recipients the Recipient
shall include the applicable \"Standard Provisions for Non-US
Nongovernmental Grantees.\" Recipients are required to ensure compliance
with sub recipient monitoring procedures in accordance with OMB Circular
A-133.

**(END OF MANDATORY STANDARD PROVISION)**

**2. INELIGIBLE COUNTRIES (MAY 1986*)***

Unless otherwise approved by the USAID Agreement Officer, funds will
only be expended for assistance to countries eligible for assistance
under the Foreign Assistance Act of 1961, as amended, or under acts
appropriating funds for foreign assistance.

**(END OF MANDATORY STANDARD PROVISION)**

**3. NONDISCRIMINATION (MAY 1986)**

No U.S. citizen or legal resident shall be excluded from participation
in, be denied the benefits of, or be otherwise subjected to
discrimination under any program or activity funded by this award on the
basis of race, color, national origin, age, handicap, or sex.

**(END OF MANDATORY STANDARD PROVISION)**

**4. NONLIABILITY (NOVEMBER 1985)**

USAID does not assume liability for any third party claims for damages
arising out of this award.

**(END OF MANDATORY STANDARD PROVISION)**

**5. AMENDMENT (NOVEMBER 1985)**

The award may be amended by formal modifications to the basic award
document or by means of an exchange of letters between the Agreement
Officer and an appropriate official of the recipient.

**(END OF MANDATORY STANDARD PROVISION)**

**6. NOTICES (NOVEMBER 1985)**

Any notice given by USAID or the recipient shall be sufficient only if
in writing and delivered in person, mailed, or cabled as follows:

To the USAID Agreement Officer, at the address specified in the award.

To recipient, at recipient\'s address shown in the award or to such
other address

designated within the award.

Notices shall be effective when delivered in accordance with this
provision, or on the effective date of the notice, whichever is later.

**(END OF MANDATORY STANDARD PROVISION)**

7\. SUBAGREEMENTS (JUNE 1999)

Subrecipients, subawardees, and contractors have no relationship with
USAID under the terms of this agreement. All required USAID approvals
must be directed through the recipient to USAID.

**(END OF MANDATORY STANDARD PROVISION)**

**8. OMB APPROVAL UNDER THE PAPERWORK REDUCTION ACT**

**(DECEMBER 2003)**

\*Information collection requirements imposed by this grant are covered
by OMB approval number 0412-0510; the current expiration date is
04/30/2005. The Standard Provisions containing the requirement and an
estimate of the public reporting burden (including time for reviewing
instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of
information) are:

[Standard Provision]{.underline} [Burden Estimate]{.underline}

Air Travel and Transportation 1.0 (hour)

Ocean Shipment of Goods .5

Patent Rights .5

Publications .5

Negotiated Indirect Cost Rates -

(Predetermined and Provisional) 1.0

Voluntary Population Planning .5

Protection of the Individual as a 1.0

Research Subject

[22 CFR 226]{.underline} [Burden Estimate]{.underline}

22 CFR 226.40-.49 Procurement

of Goods and Services 1.0

22 CFR 226.30 - .36

Property Standards 1.5

Comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this
burden, may be sent to the Office of Procurement, Policy Division
(M/OP/P) U.S. Agency for International Development, Washington, DC
20523-7801 and to the Office of Management and Budget, Paperwork
Reduction Project (0412-0510), Washington, D.C 20503.

**(END OF MANDATORY STANDARD PROVISION)**

**9. USAID ELIGIBILITY RULES FOR GOODS AND SERVICES (APRIL 1998)**

(This provision is not applicable to goods or services which the
recipient provides with private funds as part of a cost-sharing
requirement, or with Program Income generated under the award.)

a\. Ineligible and Restricted Goods and Services: USAID\'s policy on
ineligible and restricted goods and services is contained in ADS Chapter
312.

> \(1\) Ineligible Goods and Services. Under no circumstances shall the
> recipient procure any of the following under this award:
>
> \(i\) Military equipment,
>
> \(ii\) Surveillance equipment,
>
> \(iii\) Commodities and services for support of police or other law
> enforcement activities,
>
> \(iv\) Abortion equipment and services,
>
> \(v\) Luxury goods and gambling equipment, or
>
> \(vi\) Weather modification equipment.
>
> \(2\) Ineligible Suppliers. Funds provided under this award shall not
> be used to procure any goods or services furnished by any firms or
> individuals whose name appears on the \"Lists of Parties Excluded from
> Federal Procurement and Nonprocurement Programs.\" USAID will provide
> the recipient with a copy of these lists upon request.
>
> \(3\) Restricted Goods. The recipient shall not procure any of the
> following goods and services without the prior approval of the
> Agreement Officer:
>
> \(i\) Agricultural commodities,
>
> \(ii\) Motor vehicles,
>
> \(iii\) Pharmaceuticals,
>
> \(iv\) Pesticides,
>
> \(v\) Used equipment,
>
> \(vi\) U.S. Government-owned excess property, or
>
> \(vii\) Fertilizer.
>
> Prior approval will be deemed to have been met when:
>
> \(i\) the item is of U.S. source/origin;
>
> \(ii\) the item has been identified and incorporated in the program
> description or schedule of the award (initial or revisions), or
> amendments to the award; and
>
> \(iii\) the costs related to the item are incorporated in the approved
> budget of the award.
>
> Where the item has not been incorporated into the award as described
> above, a separate written authorization from the Agreement Officer
> must be provided before the item is procured.

b\. Source and Nationality: The eligibility rules for goods and services
based on source and nationality are divided into two categories. One
applies when the total procurement element during the life of the award
is over \$250,000, and the other applies when the total procurement
element during the life of the award is not over \$250,000, or the award
is funded under the Development Fund for Africa (DFA) regardless of the
amount. The total procurement element includes procurement of all goods
(e.g., equipment, materials, supplies) and services. Guidance on the
eligibility of specific goods or services may be obtained from the
Agreement Officer. USAID policies and definitions on source, origin and
nationality are contained in 22 CFR Part 228, Rules on Source, Origin
and Nationality for Commodities and Services Financed by the Agency for
International Development, which is incorporated into this Award in its
entirety.

\(1\) For DFA funded awards or when the total procurement element during
the

> life of this award is valued at \$250,000 or less, the following rules
> apply:
>
> \(i\) The authorized source for procurement of all goods and services
> to be reimbursed under the award is USAID Geographic Code 935,
> \"Special Free World,\" and such goods and services must meet the
> source, origin and nationality requirements set forth in 22 CFR Part
> 228 in accordance with the following order of preference:
>
> \(A\) The United States (USAID Geographic Code 000),
>
> \(B\) The Cooperating Country,
>
> \(C\) USAID Geographic Code 941, and
>
> \(D\) USAID Geographic Code 935.
>
> \(ii\) Application of order of preference: When the recipient procures
> goods and services from other than U.S. sources, under the order of
> preference in paragraph (b)(1)(i) above, the recipient shall document
> its files to justify each such instance. The documentation shall set
> forth the circumstances surrounding the procurement and shall be based
> on one or more of the following reasons, which will be set forth in
> the grantee\'s
>
> documentation:
>
> \(A\) The procurement was of an emergency nature, which would not
> allow for the delay attendant to soliciting U.S. sources,
>
> \(B\) The price differential for procurement from U.S. sources
> exceeded by 50% or more the delivered price from the non-U.S. source,
>
> \(C\) Compelling local political considerations precluded
> consideration of U.S. sources,
>
> \(D\) The goods or services were not available from U.S. sources, or
>
> \(E\) Procurement of locally available goods and services, as opposed
> to procurement of U.S. goods and services, would best promote the
> objectives of the Foreign Assistance program under the award.
>
> \(2\) When the total procurement element exceeds \$250,000 (unless
> funded by DFA), the following applies: Except as may be specifically
> approved or directed in advance by the Agreement Officer, all goods
> and services financed with U.S. dollars, which will be reimbursed
> under this award must meet the source, origin and nationality
> requirements set forth in 22 CFR Part 228 for the authorized
> geographic code specified in the schedule of this award. If none is
> specified, the authorized source is Code 000, the
>
> United States.

c\. Printed or Audio-Visual Teaching Materials: If the effective use of
printed or audio-visual teaching materials depends upon their being in
the local language and if such materials are intended for technical
assistance projects or activities financed by USAID in whole or in part
and if other funds including U.S.-owned or U.S.-controlled local
currencies are not readily available to finance the procurement of such
materials, local language versions may be procured from the following
sources, in order of preference:

> \(1\) The United States (USAID Geographic Code 000),
>
> \(2\) The Cooperating Country,
>
> \(3\) \"Selected Free World\" countries (USAID Geographic Code 941),
> and
>
> \(4\) \"Special Free World\" countries (USAID Geographic Code 899).

d\. If USAID determines that the recipient has procured any of these
goods or services under this award contrary to the requirements of this
provision, and has received payment for such purposes, the Agreement
Officer may require the recipient to refund the entire amount of the
purchase. This provision must be included in all subagreements which
include procurement of goods or services which total over \$5,000.

**(END OF MANDATORY STANDARD PROVISION)**

**\*10. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY**

**MATTERS (JANUARY 2004)**

a\. The recipient agrees to notify the Agreement Officer immediately
upon learning that it or any of its principals:

> \(1\) Are presently excluded or disqualified from covered transactions
> by any Federal department or agency;
>
> \(2\) Have been convicted within the preceding three-year period
> preceding this proposal been convicted of or had a civil judgment
> rendered against them for commission of fraud or a criminal offense in
> connection with obtaining, attempting to obtain, or performing a
> public (Federal, State, or local) transaction or contract under a
> public transaction; violation of Federal or State antitrust statutes
> or commission of embezzlement, theft, forgery, bribery, falsification
> or destruction of records, making false statements, tax evasion,
> receiving stolen property, making false claims, or obstruction of
> justice; commission of any other offense indicating a lack of business
> integrity or business honesty that seriously and directly affects your
> present responsibility;
>
> \(3\) Are presently indicted for or otherwise criminally or civilly
> charged by a governmental entity (Federal, State, or local) with
> commission of any of the offenses enumerated in paragraph (1)(b); and
>
> \(4\) Have had one or more public transactions (Federal, State, or
> local) terminated for cause or default within the preceding three
> years. b. The recipient agrees that, unless authorized by the
> Agreement Officer, it will not knowingly enter into any subagreements
> or contracts under this grant with a person or entity that is included
> on the Excluded Parties List System (http://epls.arnet.gov). The
> recipient further agrees to include the following provision in any
> subagreements or contracts entered into under this award:

DEBARMENT, SUSPENSION, INELIGIBILITY, AND VOLUNTARY EXCLUSION

(DECEMBER 2003)

The recipient/contractor certifies that neither it nor its principals is
presently excluded or

disqualified from participation in this transaction by any Federal
department or agency.

b\. The policies and procedures applicable to debarment, suspension, and

ineligibility under USAID-financed transactions are set forth in 22 CFR
Part 208.

**(END OF MANDATORY STANDARD PROVISION)**

**\*11. DRUG-FREE WORKPLACE (JANUARY 2004)**

a\. The recipient agrees that it will publish a drug-free workplace
statement and provide a copy to each employee who will be engaged in the
performance of any Federal award.

The statement must:

> \(1\) Tell the employees that the unlawful manufacture, distribution,
> dispensing, possession, or use of a controlled substance is prohibited
> in its workplace;
>
> \(2\) Specify the actions the recipient will take against employees
> for violating that prohibition; and

\(3\) Let each employee know that, as a condition of employment under
any award, he or she

> \(i\) Must abide by the terms of the statement, and
>
> \(ii\) Must notify you in writing if he or she is convicted for a
> violation of a criminal drug statute occurring in the workplace, and
> must do so no more than five calendar days after the conviction.

b\. The recipient agrees that it will establish an ongoing drug-free
awareness program to inform employees about:

\(i\) The dangers of drug abuse in the workplace;

\(ii\) Your policy of maintaining a drug-free workplace;

\(iii\) Any available drug counseling, rehabilitation and employee
assistance programs; and

> \(iv\) The penalties that you may impose upon them for drug abuse
> violations occurring in the workplace.

c\. Without the Agreement Officer's expressed written approval, the
policy statement and program must be in place as soon as possible, no
later than the 30 days after the effective date of this award or the
completion date of this award, whichever occurs first.

d\. The recipient agrees to immediately notify the Agreement Officer if
an employee is convicted of a drug violation in the workplace. The
notification must be in writing, identify the employee's position title,
the number of each award on which the employee worked. The notification
must be sent to the Agreement Officer within ten calendar days after the
recipient learns of the conviction.

e\. Within 30 calendar days of learning about an employee's conviction,
the recipient must either

> \(1\) Take appropriate personnel action against the employee, up to
> and including termination, consistent with the requirements of the
> Rehabilitation Act of 1973 (29 USC 794), as amended, or
>
> \(2\) Require the employee to participate satisfactorily in a drug
> abuse assistance or rehabilitation program approved for these purposes
> by a Federal, State or local health, law enforcement, or other
> appropriate agency.

f\. The policies and procedures applicable to violations of these
requirements are set forth in 22 CFR Part 210.

**(END OF MANDATORY STANDARD PROVISION)**

**\*12. EQUAL PROTECTION OF THE LAWS FOR FAITH-BASED AND**

**COMMUNITY ORGANIZATIONS (FEBRUARY 2004)**

a\. The recipient may not discriminate against any beneficiary or
potential beneficiary under this award on the basis of religion or
religious belief. Accordingly, in providing services supported in whole
or in part by this agreement or in its outreach activities related to
such services, the recipient may not discriminate against current or
prospective program beneficiaries on the basis of religion, a religious
belief, a refusal to hold a religious belief, or a refusal to actively
participate in a religious practice;

b\. The Federal Government must implement Federal programs in accordance
with the Establishment Clause and the Free Exercise Clause of the First
Amendment to the Constitution. Therefore, if the recipient engages in
inherently religious activities, such as worship, religious instruction,
and proselytization, it must offer those services at a different time or
location from any programs or services directly funded by this award,
and participation by beneficiaries in any such inherently religious
activities must be voluntary.

c.  If the recipient makes subawards under this agreement, faith-based
    organizations should be

eligible to participate on the same basis as other organizations, and
should not be discriminated against on the basis of their religious
character or affiliation.

**(END OF MANDATORY STANDARD PROVISION)**

**\*13. IMPLEMENTATION OF E.O. 13224 \-- EXECUTIVE ORDER ON**

**TERRORIST FINANCING (MARCH 2002)**

The Recipient is reminded that U.S. Executive Orders and U.S. law
prohibits transactions with, and the provision of resources and support
to, individuals and organizations associated with terrorism. It is the
legal responsibility of the recipient to ensure compliance with these
Executive Orders and laws. This provision must be included in all
contracts/subawards issued under this agreement.

**(END OF MANDATORY STANDARD PROVISION)**

**\*14. MARKING UNDER ASSISTANCE INSTRUMENTS (DEC 2005)**

**(a) Definitions**

***Commodities*** mean any material, article, supply, goods or
equipment, excluding recipient offices, vehicles, and non-deliverable
items for recipient's internal use, in administration of the USAID
funded grant, cooperative agreement, or other agreement or subagreement.

***Principal Officer*** means the most senior officer in a USAID
Operating Unit in the field, e.g., USAID Mission Director or USAID
Representative. For global programs managed from Washington but executed
across many countries, such as disaster relief and assistance to
internally displaced persons, humanitarian emergencies or immediate post
conflict and political crisis response, the cognizant Principal Officer
may be an Office Director, for example, the Directors of USAID/W/Office
of Foreign Disaster Assistance and Office of Transition Initiatives. For
non-presence countries, the cognizant Principal Officer is the Senior
USAID officer in a regional USAID Operating Unit responsible for the
non-presence country, or in the absence of such a responsible operating
unit, the Principal U.S Diplomatic Officer in the non-presence country
exercising delegated authority from USAID.

***Programs*** mean an organized set of activities and allocation of
resources directed toward a common purpose, objective, or goal
undertaken or proposed by an organization to carry out the
responsibilities assigned to it.

***Projects*** include all the marginal costs of inputs (including the
proposed investment) technically required to produce a discrete
marketable output or a desired result (for example, services from a
fully functional water/sewage treatment facility).

***Public communications*** are documents and messages intended for
distribution to audiences external to the recipient's organization. They
include, but are not limited to, correspondence, publications, studies,
reports, audio visual productions, and other informational products;
applications, forms, press and promotional materials used in connection
with USAID funded programs, projects or activities, including signage
and plaques; Web sites/Internet activities; and events such as training
courses, conferences, seminars, press conferences and so forth.

***Subrecipient*** means any person or government (including cooperating
country government) department, agency, establishment, or for profit or
nonprofit organization that receives a USAID subaward, as defined in 22
C.F.R. 226.2.

***Technical Assistance*** means the provision of funds, goods,
services, or other foreign assistance, such as loan guarantees or food
for work, to developing countries and other USAID recipients, and
through such recipients to subrecipients, in direct support of a
development objective -- as opposed to the internal management of the
foreign assistance program.

***USAID Identity (Identity)*** means the official marking for the
United States Agency for International Development (USAID), comprised of
the USAID logo or seal and new brandmark, with the tagline that clearly
communicates that our assistance is "from the American people." The
USAID Identity is available on the USAID website at
**www.usaid.gov/branding** and USAID provides it without royalty,
license, or other fee to recipients of USAID-funded grants, or
cooperative agreements, or other assistance awards

**(b) Marking of Program Deliverables**

\(1\) All recipients must mark appropriately all overseas programs,
projects, activities, public communications, and commodities partially
or fully funded by a USAID grant or cooperative agreement or other
assistance award or subaward with the USAID Identity, of a size and
prominence equivalent to or greater than the recipient's, other donor's,
or any other third party's identity or logo.

\(2\) The Recipient will mark all program, project, or activity sites
funded by USAID, including visible infrastructure projects (for example,
roads, bridges, buildings) or other programs, projects, or activities
that are physical in nature (for example, agriculture, forestry, water
management) with the USAID Identity. The Recipient should erect
temporary signs or plaques early in the construction or implementation
phase. When construction or implementation is complete, the Recipient
must install a permanent, durable sign, plaque or other marking.

\(3\) The Recipient will mark technical assistance, studies, reports,
papers, publications, audio-visual productions, public service
announcements, Web sites/Internet activities and other promotional,
informational, media, or communications products funded by USAID with
the USAID Identity.

\(4\) The Recipient will appropriately mark events financed by USAID,
such as training courses, conferences, seminars, exhibitions, fairs,
workshops, press conferences and other public activities, with the USAID
Identity. Unless directly prohibited and as appropriate to the
surroundings, recipients should display additional materials, such as
signs and banners, with the USAID Identity. In circumstances in which
the USAID Identity cannot be displayed visually, the recipient is
encouraged otherwise to acknowledge USAID and the American people's
support.

\(5\) The Recipient will mark all commodities financed by USAID,
including commodities or equipment provided under humanitarian
assistance or disaster relief programs, and all other equipment,
supplies, and other materials funded by USAID, and their export
packaging with the USAID Identity.

\(6\) The Agreement Officer may require the USAID Identity to be larger
and more prominent if it is the majority donor, or to require that a
cooperating country government's identity be larger and more prominent
if circumstances warrant, and as appropriate depending on the audience,
program goals, and materials produced.

\(7\) The Agreement Officer may require marking with the USAID Identity
in the event that the recipient does not choose to mark with its own
identity or logo.

\(8\) The Agreement Officer may require a pre-production review of USAID
funded

public communications and program materials for compliance with the
approved Marking Plan.

\(9\) Subrecipients. To ensure that the marking requirements "flow
down\'\' to subrecipients of subawards, recipients of USAID funded
grants and cooperative agreements or other assistance awards will
include the USAID-approved marking provision in any USAID funded
subaward, as follows:

*"As a condition of receipt of this subaward, marking with the USAID
Identity of a*

*size and prominence equivalent to or greater than the recipient's,
subrecipient's,*

*other donor's or third party's is required. In the event the recipient
chooses not to*

*require marking with its own identity or logo by the subrecipient,
USAID may, at*

*its discretion, require marking by the subrecipient with the USAID
Identity."*

\(10\) Any 'public communications', as defined in 22 C.F.R. 226.2,
funded by USAID, in which the content has not been approved by USAID,
must contain the following disclaimer:

*"This study/report/audio/visual/other information/media product
(specify) is made possible by the generous support of the American
people through the United States Agency for International Development
(USAID). The contents are the responsibility of \[insert recipient
name\] and do not necessarily reflect the views of USAID or the United
States Government."*

\(11\) The recipient will provide the Cognizant Technical Officer (CTO)
or other USAID personnel designated in the grant or cooperative
agreement with two copies of all program and communications materials
produced under the award. In addition, the recipient will submit one
electronic or one hard copy of all final documents to USAID's
Development Experience Clearinghouse.

**(c) Implementation of marking requirements.**

\(1\) When the grant or cooperative agreement contains an approved
Marking Plan, the recipient will implement the requirements of this
provision following the approved Marking Plan.

\(2\) When the grant or cooperative agreement does not contain an
approved Marking Plan, the recipient will propose and submit a plan for
implementing the requirements of this provision within \[***Agreement
Officer fill-in***\] days after the effective date of this provision.
The plan will include:

> \(i\) A description of the program deliverables specified in paragraph
> (b) of this provision that the recipient will produce as a part of the
> grant or cooperative agreement and which will visibly bear the USAID
> Identity.
>
> \(ii\) the type of marking and what materials the applicant uses to
> mark the program deliverables with the USAID Identity,
>
> \(iii\) when in the performance period the applicant will mark the
> program deliverables, and where the applicant will place the marking,

\(3\) The recipient may request program deliverables not be marked with
the USAID Identity by identifying the program deliverables and providing
a rationale for not marking these program deliverables. Program
deliverables may be exempted from USAID marking requirements when:

> \(i\) USAID marking requirements would compromise the intrinsic
> independence or neutrality of a program or materials where
> independence or neutrality is an inherent aspect of the program and
> materials;
>
> \(ii\) USAID marking requirements would diminish the credibility of
> audits, reports, analyses, studies, or policy recommendations whose
> data or findings must be seen as independent;
>
> \(iii\) USAID marking requirements would undercut host-country
> government "ownership" of constitutions, laws, regulations, policies,
> studies, assessments, reports, publications, surveys or audits, public
> service announcements, or other communications better positioned as
> "by" or "from" a cooperating country ministry or government official;

\(iv\) USAID marking requirements would impair the functionality of an
item;

\(v\) USAID marking requirements would incur substantial costs or be
impractical;

> \(vi\) USAID marking requirements would offend local cultural or
> social norms, or be considered inappropriate;

\(vii\) USAID marking requirements would conflict with international
law.

\(4\) The proposed plan for implementing the requirements of this
provision, including any proposed exemptions, will be negotiated within
the time specified by the Agreement Officer after receipt of the
proposed plan. Failure to negotiate an approved plan with the time
specified by the Agreement Officer may be considered as noncompliance
with the requirements is provision.

**(d) Waivers.**

\(1\) The recipient may request a waiver of the Marking Plan or of the
marking requirements of this provision, in whole or in part, for each
program, project, activity, public communication or commodity, or, in
exceptional circumstances, for a region or country, when USAID required
marking would pose compelling political, safety, or security concerns,
or when marking would have an adverse impact in the cooperating country.
The recipient will submit the request through the Cognizant Technical
Officer. The Principal Officer is responsible for approvals or
disapprovals of waiver requests.

\(2\) The request will describe the compelling political, safety,
security concerns, or adverse impact that require a waiver, detail the
circumstances and rationale for the waiver, detail the specific
requirements to be waived, the specific portion of the Marking Plan to
be waived, or specific marking to be waived, and include a description
of how program materials will be marked (if at all) if the USAID
Identity is removed. The request should also provide a rationale for any
use of recipient's own identity/logo or that of a third party on
materials that will be subject to the waiver.

\(3\) Approved waivers are not limited in duration but are subject to
Principal Officer review at any time, due to changed circumstances.

\(4\) Approved waivers "flow down" to recipients of subawards unless
specified otherwise. The waiver may also include the removal of USAID
markings already affixed, if circumstances warrant.

\(5\) Determinations regarding waiver requests are subject to appeal to
the Principal Officer's cognizant Assistant Administrator. The recipient
may appeal by submitting a written request to reconsider the Principal
Officer's waiver determination to the cognizant Assistant Administrator.

**(e) Non-retroactivity.** The requirements of this provision do not
apply to any materials, events, or commodities produced prior to January
2, 2006. The requirements of this provision do not apply to program,
project, or activity sites funded by USAID, including visible
infrastructure projects (for example, roads, bridges, buildings) or
other programs, projects, or activities that are physical in nature (for
example, agriculture, forestry, water management) where the construction
and implementation of these are complete prior to January 2, 2006 and
the period of the grant does not extend past January 2, 2006.

**(END OF MANDATORY STANDARD PROVISION)**

**15. REGULATIONS GOVERNING EMPLOYEES (AUGUST 1992)**

> (The following applies to the recipient\'s employees working in the
> cooperating country under the agreement who are not citizens of the
> cooperating country.)

a\. The recipient\'s employees shall maintain private status and may not
rely on local

U.S. Government offices or facilities for support while under this
grant.

b\. The sale of personal property or automobiles by recipient employees
and their dependents in the foreign country to which they are assigned
shall be subject to the same limitations and prohibitions which apply to
direct-hire USAID personnel employed by the Mission, including the rules
contained in 22 CFR Part 136, except as this may conflict with host
government regulations.

c\. Other than work to be performed under this award for which an
employee is assigned by the recipient, no employee of the recipient
shall engage directly or indirectly, either in the individual\'s own
name or in the name or through an agency of another person, in any
business, profession, or occupation in the foreign countries to which
the individual is assigned, nor shall the individual make loans or
investments to or in any business, profession or occupation in the

foreign countries to which the individual is assigned.

d\. The recipient\'s employees, while in a foreign country, are expected
to show respect for its conventions, customs, and institutions, to abide
by its applicable laws and regulations, and not to interfere in its
internal political affairs.

e\. In the event the conduct of any recipient employee is not in
accordance with the preceding paragraphs, the recipient\'s chief of
party shall consult with the USAID Mission Director and the employee
involved and shall recommend to the recipient a course of action with
regard to such employee.

f\. The parties recognize the rights of the U.S. Ambassador to direct
the removal from a country of any U.S. citizen or the discharge from
this grant award of any third country national when, in the discretion
of the Ambassador, the interests of the United States so require.

g\. If it is determined, either under (e) or (f) above, that the
services of such employee should be terminated, the recipient shall use
its best efforts to cause the return of such employee to the United
States, or point of origin, as appropriate.

**(END OF MANDATORY STANDARD PROVISION)**

**16. CONVERSION OF UNITED STATES DOLLARS TO LOCAL**

**CURRENCY (NOVEMBER 1985)**

(This provision applies when activities are undertaken outside the
United States.)

> Upon arrival in the Cooperating Country, and from time to time as
> appropriate, the recipient\'s chief of party shall consult with the
> Mission Director who shall provide, in writing, the procedure the
> recipient and its employees shall follow in the conversion of United
> States dollars to local currency. This may include, but is not limited
> to, the conversion of currency through the cognizant United States
> Disbursing Officer or Mission Controller, as appropriate.

**(END OF MANDATORY STANDARD PROVISION)**

**17. USE OF POUCH FACILITIES (AUGUST 1992)**

(This provision applies when activities are undertaken outside the
United States.)

a\. Use of diplomatic pouch is controlled by the Department of State.
The Department of State has authorized the use of pouch facilities for
USAID recipients and their employees as a general policy, as detailed in
items (1) through (6) below. However, the final decision regarding use
of pouch facilities rest with the Embassy or USAID Mission. In
consideration of the use of pouch

facilities, the recipient and its employees agree to indemnify and hold
harmless, the Department of State and USAID for loss or damage occurring
in pouch transmission:

> \(1\) Recipients and their employees are authorized use of the pouch
> for transmission and receipt of up to a maximum of .9 kgs per shipment
> of correspondence and documents needed in the administration of
> assistance programs.
>
> \(2\) U.S. citizen employees are authorized use of the pouch for
> personal mail up to a maximum of .45 kgs per shipment (but see (a)(3)
> below).
>
> \(3\) Merchandise, parcels, magazines, or newspapers are not
> considered to be personal mail for purposes of this standard provision
> and are not authorized to be sent or received by pouch.
>
> \(4\) Official and personal mail pursuant to a.1. and 2. above sent by
> pouch should be addressed as follows:

Name of individual or organization (followed by letter symbol \"G\")

City Name of post (USAID/\_\_\_\_\_\_)

Agency for International Development

Washington, D.C. 20523-0001

> \(5\) Mail sent via the diplomatic pouch may not be in violation of
> U.S. Postal laws and may not contain material ineligible for pouch
> transmission.
>
> \(6\) Recipient personnel are NOT authorized use of military postal
> facilities ( (APO/FPO). This is an Adjutant General\'s decision based
> on existing laws and regulations governing military postal facilities
> and is being enforced worldwide.

b\. The recipient shall be responsible for advising its employees of
this authorization,

these guidelines, and limitations on use of pouch facilities.

c\. Specific additional guidance on grantee use of pouch facilities in
accordance with this standard provision is available from the Post
Communication Center at the Embassy or USAID Mission.

**(END OF MANDATORY STANDARD PROVISION)**

**18. INTERNATIONAL AIR TRAVEL AND TRANSPORTATION (JUNE 1999)**

> (This provision is applicable when costs for international travel or
> transportation will be paid for with USAID funds. This provision is
> not applicable if the recipient is providing for travel with private
> funds as part of a cost-sharing requirement, or with Program Income
> generated under the award.)

a\. PRIOR BUDGET APPROVAL

> In accordance with OMB Cost Principles, direct charges for foreign
> travel costs are allowable only when each foreign trip has received
> prior budget approval. Such approval will be deemed to have been met
> when:
>
> \(1\) the trip is identified. Identification is accomplished by
> providing the following information: the number of trips, the number
> of individuals per trip, and the destination country(s).
>
> \(2\) the information noted at (a)(1) above is incorporated in: the
> proposal, the program description or schedule of the award, the
> implementation plan (initial or revisions), or amendments to the
> award; and

\(3\) the costs related to the travel are incorporated in the approved
budget of the award.

The Agreement Officer may approve travel which has not been incorporated
in writing as required by paragraph (a)(2). In such case, a copy of the
Agreement Officer\'s approval must be included in the agreement file.

b\. NOTIFICATION

\(1\) As long as prior budget approval has been met in accordance with
paragraph (a) above, a separate Notification will not be necessary
unless:

> \(i\) the primary purpose of the trip is to work with USAID Mission
> personnel, or
>
> \(ii\) the recipient expects significant administrative or substantive
> programmatic support from the Mission. Neither the USAID Mission nor
> the Embassy will require Country Clearance of employees or contractors
> of USAID Recipients.

\(2\) Recipient will observe the following standards:

> \(i\) Send a written notice to the cognizant USAID Technical Office in
>
> the Mission. If the recipient\'s primary point of contact is a
> Technical
>
> Officer in USAID/W, the recipient may send the notice to that person.
> It
>
> will be the responsibility of the USAID/W Technical Officer to forward
> the notice to the field.
>
> \(ii\) The notice should be sent as far in advance as possible, but at
> least 14 calendar days in advance of the proposed travel. This notice
> may be sent by fax or e-mail. The recipient should retain proof that
> notification
>
> was made.
>
> \(iii\) The notification shall contain the following information: the
> award
>
> number, the cognizant Technical Officer, the traveler\'s name (if
> known),
>
> date of arrival, and the purpose of the trip.
>
> \(iv\) The USAID Mission will respond only if travel has been denied.
> It
>
> will be the responsibility of the Technical Officer in the Mission to
> contact
>
> the recipient within 5 working days of having received the notice if
> the
>
> travel is denied. If the recipient has not received a response within
> the
>
> time frame, the recipient will be considered to have met these
> standards
>
> for notification, and may travel.
>
> \(v\) If a subrecipient is required to issue a Notification, as per
> this section, the subrecipient may contact the USAID Technical Officer
> directly, or the prime may contact USAID on the subrecipient\'s
> behalf.

c.  SECURITY ISSUES

Recipients are encouraged to obtain the latest Department of State
Travel Advisory Notices before travelling. These Notices are available
to the general public and may be obtained directly from the State
Department, or via Internet.

Where security is a concern in a specific region, recipients may choose
to notify the US Embassy of their presence when they have entered the
country. This may be especially important for long-term posting.

d.  USE OF U.S.-OWNED LOCAL CURRENCY

Travel to certain countries shall, at USAID\'s option, be funded from
U.S.-owned local currency. When USAID intends to exercise this option,
USAID will either issue a U.S. Government S.F. 1169, Transportation
Request (GTR) which the grantee may exchange for tickets, or issue the
tickets directly. Use of such U.S.-owned currencies will constitute a
dollar charge to this grant.

e.  THE FLY AMERICA ACT

The Fly America Act (49 U.S.C. 40118) requires that all air travel and
shipments under this award must be made on U.S. flag air carriers to the
extent service by such carriers is available. The Administrator of
General Services Administration (GSA) is authorized to issue regulations
for purposes of implementation. Those regulations may be found at 41 CFR
part 301, and are hereby incorporated by reference into this award.

f\. COST PRINCIPLES

The recipient will be reimbursed for travel and the reasonable cost of
subsistence, post differentials and other allowances paid to employees
in international travel status in accordance with the recipient\'s
applicable cost principles and established policies and practices which
are uniformly applied to federally financed and other activities of the
grantee.

If the recipient does not have written established policies regarding
travel costs, the standard for determining the reasonableness of
reimbursement for overseas allowance will be the Standardized
Regulations (Government Civilians, Foreign Areas), published by the U.S.
Department of State, as from time to time amended. The most current
subsistence, post differentials, and other allowances may be obtained
from the Agreement Officer.

g\. SUBAWARDS.

This provision will be included in all subawards and contracts which
require international air travel and transportation under this award.

**(END OF MANDATORY STANDARD PROVISION)**

**19. OCEAN SHIPMENT OF GOODS (JUNE 1999)**

**(**This provision is applicable for awards and subawards for \$100,000
or more and when goods purchased with funds provided under this award
are transported to cooperating countries on ocean vessels whether or not
award funds are used for the transportation.)

a\. At least 50% of the gross tonnage of all goods purchased under this
agreement and transported to the cooperating countries shall be made on
privately owned U.S. flag commercial ocean vessels, to the extent such
vessels are available at fair and reasonable rates for such vessels.

b\. At least 50% of the gross freight revenue generated by shipments of
goods purchased under this agreement and transported to the cooperating
countries on dry cargo liners shall be paid to or for the benefit of
privately owned U.S. flag commercial ocean vessels to the extent such
vessels are available at fair and reasonable rates for such vessels.

c\. When U.S. flag vessels are not available, or their use would result
in a significant delay, the grantee may request a determination of
non-availability from the USAID Transportation Division, Office of
Procurement, Washington, D.C. 20523, giving the basis for the request
which will relieve the grantee of the requirement to use U.S. flag
vessels for the amount of tonnage included in the determination.
Shipments made on non-free world ocean vessels are not reimbursable
under this grant.

d\. The recipient shall send a copy of each ocean bill of lading,
stating all of the carrier\'s charges including the basis for
calculation such as weight or cubic measurement, covering a shipment
under this agreement to:

U.S. Department of Transportation,

Maritime Administration, Division of National Cargo,

400 7th Street, S.W.,

Washington, DC 20590, and

U.S. Agency for International Development,

Office of Procurement, Transportation Division

1300 Pennsylvania Avenue, N.W.

Washington, DC 20523-7900

e\. Shipments by voluntary nonprofit relief agencies (i.e., PVOs/NGOs)
shall be governed by this standard provision and by USAID Regulation 2,
\"Overseas Shipments of Supplies by Voluntary Nonprofit Relief
Agencies\" (22 CFR Part 202).

f\. Shipments financed under this grant must meet applicable eligibility
requirements set out in 22 CFR 228.21.

**(END OF STANDARD PROVISION)**

**20. LOCAL PROCUREMENT (APRIL 1998)**

(This provision applies when activities are undertaken outside the
United States.)

a\. Financing local procurement involves the use of appropriated funds
to finance the procurement of goods and services supplied by local
businesses, dealers or producers, with payment normally being in the
currency of the cooperating country.

b\. Locally financed procurements must be covered by source and
nationality waivers as set forth in 22 CFR 228, Subpart F, except as
provided for in mandatory standard provision, \"USAID Eligibility Rules
for Goods and Services,\" or when one of the following exceptions
applies:

\(1\) Locally available commodities of U.S. origin, which are otherwise
eligible

> for financing, if the value of the transaction is estimated not to
> exceed
>
> \$100,000 exclusive of transportation costs.

\(2\) Commodities of geographic code 935 origin if the value of the
transaction

> does not exceed the local currency equivalent of \$5,000.

\(3\) Professional Services Contracts estimated not to exceed \$250,000.

\(4\) Construction Services Contracts estimated not to exceed
\$5,000,000.

\(5\) Commodities and services available only in the local economy (no
specific

> per transaction value applies to this category). This category
> includes the
>
> following items:

(i) Utilities including fuel for heating and cooking, waste disposal and

> trash collection;

(ii) Communications - telephone, telex, fax, postal and courier
     services;

> \(iii\) Rental costs for housing and office space;
>
> \(iv\) Petroleum, oils and lubricants for operating vehicles and
> equipment;
>
> \(v\) Newspapers, periodicals and books published in the cooperating
>
> country;
>
> \(vi\) Other commodities and services and related expenses that, by
> their nature or as a practical matter, can only be acquired,
> performed, or incurred in the cooperating country, e.g., vehicle
> maintenance, hotel accommodations, etc.

c\. The coverage on ineligible and restricted goods and services in the
mandatory

standard provision entitled, \"USAID Eligibility Rules for Goods and
Services,\"

also apply to local procurement.

d\. This provision will be included in all subagreements where local
procurement of

goods or services is a supported element.

**(END OF MANDATORY STANDARD PROVISION)**

**21. VOLUNTARY POPULATION PLANNING ACTIVITIES --**

**MANDATORY REQUIREMENTS (MAY 2006)**

Requirements for Voluntary Sterilization Programs

\(1\) None of the funds made available under this award shall be used to
pay for the

performance of involuntary sterilization as a method of family planning
or to

> coerce or provide any financial incentive to any individual to
> practice sterilization.

Prohibition on Abortion-Related Activities:

\(1\) No funds made available under this award will be used to finance,
support, or be

attributed to the following activities: (i) procurement or distribution
of equipment

intended to be used for the purpose of inducing abortions as a method of
family

planning; (ii) special fees or incentives to any person to coerce or
motivate them

to have abortions; (iii) payments to persons to perform abortions or to
solicit

persons to undergo abortions; (iv) information, education, training, or

communication programs that seek to promote abortion as a method of
family

planning; and (v) lobbying for or against abortion. The term "motivate",
as it

relates to family planning assistance, shall not be construed to
prohibit the

provision, consistent with local law, of information or counseling about
all

pregnancy options.

\(2\) No funds made available under this award will be used to pay for
any biomedical

research which relates, in whole or in part, to methods of, or the
performance of,

abortions or involuntary sterilizations as a means of family planning.

Epidemiologic or descriptive research to assess the incidence, extent or

consequences of abortions is not precluded.

**\[END OF MANDATORY STANDARD PROVISIONS\]**

## II. REQUIRED AS APPLICABLE STANDARD PROVISIONS FOR U.S., NONGOVERNMENTAL RECIPIENTS

**1. NEGOTIATED INDIRECT COST RATES - PREDETERMINED**

**(APRIL 1998)**

***APPLICABILITY:*** This provision is applicable to educational or
nonprofit institutions whose indirect cost rates under this award are on
a predetermined basis.

> **NEGOTIATED INDIRECT COST RATES -- PREDETERMINED**
>
> **(APRIL 1998)**

a\. The allowable indirect costs shall be determined by applying the
predetermined

indirect cost rates to the bases specified in the schedule of this
award.

b\. Within the earlier of 30 days after receipt of the A-133 audit
report or nine months after the end of the audit period, the recipient
shall submit to the cognizant agency for audit the required OMB Circular
A-133 audit report, proposed predetermined indirect cost rates, and
supporting cost data. If USAID is the cognizant agency or no cognizant
agency has been designated, the recipient

shall submit four copies of the audit report, the proposed predetermined
indirect

cost rates, and supporting cost data to the Overhead, Special Costs, and
Closeout Branch, Office of Procurement, USAID, Washington DC 20523-7802.
The proposed rates shall be based on the recipient\'s actual cost
experience during that fiscal year. Negotiations of predetermined
indirect cost rates shall begin soon after receipt of the recipient\'s
proposal.

c\. Allowability of costs and acceptability of cost allocation methods
shall be determined in accordance with the applicable cost principles.

d\. The results of each negotiation shall be set forth in an indirect
cost rate agreement signed by both parties. Such agreement is
automatically incorporated into this award and shall specify (1) the
agreed upon predetermined rates, (2) the bases to which the rates apply,
(3) the fiscal year for which the rates apply, and (4) the specific
items treated as direct costs. The indirect cost rate agreement shall
not change any monetary ceiling, award obligation, or specific cost

allowance or disallowance provided for in this award.

e\. Pending establishment of predetermined indirect costs rates for any
fiscal year, the recipient shall be reimbursed either at the rates fixed
for the previous fiscal year or at billing rates acceptable to the USAID
Agreement Officer, subject to appropriate adjustment when the final
rates for the fiscal year or other period are established.

**(END OF PROVISION)**

2\. NEGOTIATED INDIRECT COST RATES - PROVISIONAL (NONPROFIT)

(APRIL 1998)

***APPLICABILITY:*** This provision is applicable to any nonprofit
organizations whose indirect cost rates under this award are on a
provisional basis.

> **NEGOTIATED INDIRECT COST RATES - PROVISIONAL (NONPROFIT)**
>
> **(APRIL 1998)**
>
> a\. Provisional indirect cost rates shall be established for each of
> the recipient\'s accounting periods during the term of this award.
> Pending establishment of revised provisional or final rates, allowable
> indirect costs shall be reimbursed at the rates, on the bases, and for
> the periods shown in the schedule of the award.

b\. Within the earlier of 30 days after receipt of the A-133 audit
report or nine months after the end of the audit period, the recipient
shall submit to the cognizant agency for audit the required OMB Circular
A-133 audit report, proposed final indirect cost rates, and supporting
cost data. If USAID is the cognizant agency or no cognizant agency has
been designated, the recipient shall submit four copies of the audit
report, along with the proposed final indirect cost rates and supporting
cost data, to the Overhead, Special Costs, and Closeout Branch, Office
or Procurement, USAID, Washington, DC 20523-7802. The proposed rates
shall be based on the recipient\'s actual cost experience during that
fiscal year. Negotiations of final indirect cost rates shall begin soon
after receipt of the recipient\'s proposal.

c\. Allowability of costs and acceptability of cost allocation methods
shall be determined in accordance with the applicable cost principles.

d\. The results of each negotiation shall be set forth in a written
indirect cost rate agreement signed by both parties. Such agreement is
automatically incorporated into this award and shall specify (1) the
agreed upon final rates, (2) the bases to which the rates apply, (3) the
fiscal year for which the rates apply, and (4) the items treated as
direct costs. The agreement shall not change any monetary ceiling, award
obligation, or specific cost allowance or disallowance provided for in
this award.

e\. Pending establishment of final indirect cost rate(s) for any fiscal
year, the recipient shall be reimbursed either at negotiated provisional
rates or at billing rates acceptable to the Agreement Officer, subject
to appropriate adjustment when the final rates for the fiscal year are
established. To prevent substantial overpayment or underpayment, the
provisional or billing rates may be prospectively or retroactively
revised by mutual agreement.

f\. Failure by the parties to agree on final rates is a 22 CFR 226.90
dispute.

**(END OF PROVISION)**

**3. NEGOTIATED INDIRECT COST RATE - PROVISIONAL (Profit) (APRIL 1998)**

***APPLICABILITY:*** This provision applies to for-profit organizations
whose indirect cost rates under this award are on a provisional basis.

> **NEGOTIATED INDIRECT COST RATE - PROVISIONAL (Profit) (APRIL 1998)**

a\. Provisional indirect cost rates shall be established for the
recipient\'s accounting periods during the term of this award. Pending
establishment of revised provisional or final rates, allowable indirect
costs shall be reimbursed at the rates, on the bases, and for the
periods shown in the schedule of this award. Indirect cost rates and the
appropriate bases shall be established in accordance with FAR Subpart
42.7.

b\. Within six months after the close of the recipient\'s fiscal year,
the recipient shall submit to the cognizant agency for audit the
proposed final indirect cost rates and supporting cost data. If USAID is
the cognizant agency or no cognizant agency has been designated, the
recipient shall submit three copies of the proposed final indirect cost
rates and supporting cost data, to the Overhead, Special Costs, and
Closeout Branch, Office or Procurement, USAID, Washington, DC
20523-7802. The proposed rates shall be based on the recipient\'s actual
cost experience during that fiscal year. Negotiations of final indirect
cost rates shall begin soon after receipt of the recipient\'s proposal.

c\. Allowability of costs and acceptability of cost allocation methods
shall be determined in accordance with the applicable cost principles.

d\. The results of each negotiation shall be set forth in an indirect
cost rate agreement signed by both parties. Such agreement is
automatically incorporated into this award and shall specify (1) the
agreed upon final rates, (2) the bases to which the rates apply, (3) the
fiscal year for which the rates apply, and (4) the items treated as
direct costs. The agreement shall not change any monetary ceiling, award
obligation, or specific cost allowance or disallowance provided for in
this award.

e\. Pending establishment of final indirect cost rates for any fiscal
year, the recipient shall be reimbursed either at negotiated provisional
rates or at billing rates acceptable to the Agreement Officer, subject
to appropriate adjustment when the final rates for the fiscal year are
established. To prevent substantial overpayment or underpayment, the
provisional or billing rates may be prospectively or retroactively
revised by mutual agreement.

f\. Failure by the parties to agree on final rates is a 22 CFR 226.90
dispute.

**(END OF PROVISION)**

**4. PUBLICATIONS AND MEDIA RELEASES (MARCH 2006)**

***APPLICABILITY:*** This provision is applicable when publications are
financed under the award.

**PUBLICATIONS AND MEDIA RELEASES (MARCH 2006)**

a\. The recipient shall provide the USAID Cognizant Technical Officer
one copy of all published works developed under the award with lists of
other written work produced under the award. In addition, the recipient
shall submit final documents in electronic format unless no electronic
version exists at the following address: Online (preferred)
http://www.dec.org/submit.cfm.

> Mailing address:
>
> Document Acquisitions
>
> USAID Development Experience Clearinghouse (DEC)
>
> 8403 Colesville Road Suite 210
>
> Silver Spring, MD 20910-6368
>
> Contract Information
>
> Telephone (301) 562-0641
>
> Fax (301) 588-7787
>
> E-mail: docsubmit@dec.cdie.org
>
> Electronic documents must consist of only one electronic file that
> comprises the complete and final equivalent of a hard copy. They may
> be submitted online (preferred); on 3.5" diskettes, a Zip disk, CD-R,
> or by e-mail. Electronic documents should be in PDF (Portable Document
> Format). Submission in other formats is acceptable but discouraged.
>
> Each document submitted should contain essential bibliographic
> elements, such as 1) descriptive title; 2) author(s) name; 3) award
> number; 4) sponsoring USAID office; 5) strategic objective; and 6)
> date of publication;:

b\. In the event award funds are used to underwrite the cost of
publishing, in lieu of the publisher assuming this cost as is the normal
practice, any profits or royalties up to the amount of such cost shall
be credited to the award unless the schedule of the award has identified
the profits or royalties as program income.

c\. Except as otherwise provided in the terms and conditions of the
award, the author or the recipient is free to copyright any books,
publications, or other copyrightable materials developed in the course
of or under this award, but USAID reserves a royalty-free nonexclusive
and irrevocable right to reproduce, publish, or otherwise use, and to
authorize others to use the work for Government purposes.

**(END OF PROVISION)**

**5. PARTICIPANT TRAINING (APRIL 1998)**

***APPLICABILITY:*** This provision is applicable when any participant
training is financed under the award.

**PARTICIPANT TRAINING (APRIL 1998)**

a\. Definition: A participant is any non-U.S. individual being trained
under this award outside of that individual\'s home country.

b\. Application of ADS Chapter 253: Participant training under this
award shall comply with the policies established in ADS Chapter 253,
Participant Training, except to the extent that specific exceptions to
ADS 253 have been provided in this award with the concurrence of the
Office of International Training.

c\. Orientation: In addition to the mandatory requirements in ADS 253,
recipients are strongly encouraged to provide, in collaboration with the
Mission training officer, predeparture orientation and orientation in
Washington at the Washington International Center. The latter
orientation program also provides the opportunity to arrange for home
hospitality in Washington and elsewhere in the United States through
liaison with the National Council for International Visitors (NCIV). If
the Washington orientation is determined not to be feasible, home
hospitality can be arranged in most U.S. cities if a request for such is
directed to the Agreement Officer, who will transmit the request to NCIV
through EGAT/ED/PT.

**(END OF PROVISION)**

**6. VOLUNTARY POPULATION PLANNING ACTIVITIES --**

**SUPPLEMENTAL REQUIREMENTS (MAY 2006)**

***APPLICABLITY:*** This provision is applicable to all awards involving
any aspect of voluntary population planning activities.

> **VOLUNTARY POPULATION PLANNING ACTIVITIES -- SUPPLEMENTAL
> REQUIREMENTS (MAY 2006)**

a\. Voluntary Participation and Family Planning Methods:

> \(1\) The recipient agrees to take any steps necessary to ensure that
> funds made available under this award will not be used to coerce any
> individual to practice methods of family planning inconsistent with
> such individual\'s moral, philosophical, or religious beliefs.
> Further, the recipient agrees to conduct its activities in a manner
> which safeguards the rights, health and welfare of all individuals who
> take part in the program.

\(2\) Activities which provide family planning services or information
to individuals, financed in whole or in part under this agreement, shall
provide a broad range of family planning methods and services available
in the country in which the activity is conducted or shall provide
information to such individuals regarding where such methods and
services may be obtained.

b\. Requirements for Voluntary Family Planning Projects

> \(1\) A Family planning project must comply with the requirements of
> this paragraph.
>
> \(2\) A project is a discrete activity through which a governmental or
> nongovernmental organization or public international organization
> provides family planning services to people and for which funds
> obligated under this award, or goods or services financed with such
> funds, are provided under this award, except funds solely for the
> participation of personnel in short-term, widely attended training
> conferences or programs.
>
> \(3\) Service providers and referral agents in the project shall not
> implement or be subject to quotas or other numerical targets of total
> number of births, number of family planning acceptors, or acceptors of
> a particular method of family planning. Quantitative estimates or
> indicators of the number of births, acceptors, and acceptors of a
> particular method that are used for the purpose of budgeting,
> planning, or reporting with respect to the project are not quotas or
> targets under this paragraph, unless service providers or referral
> agents in the project are required to achieve the estimates or
> indicators.
>
> \(4\) The project shall not include the payment of incentives, bribes,
> gratuities or financial rewards to (i) any individual in exchange for
> becoming a family planning acceptor or (ii) any personnel performing
> functions under the project for achieving a numerical quota or target
> of total number of births, number of family planning acceptors, or
> acceptors of a particular method of contraception. This restriction
> applies to salaries or payments paid or made to personnel performing
> functions under the project if the amount of the salary or payment
> increases or decreases based on a predetermined number of births,
> number of family planning acceptors, or number of acceptors of a
> particular method of contraception that the personnel affect or
> achieve.
>
> \(5\) No person shall be denied any right or benefit, including the
> right of access to participate in any program of general welfare or
> health care, based on the person's decision not to accept family
> planning services offered by the project.
>
> \(6\) The project shall provide family planning acceptors
> comprehensible information about the health benefits and risks of the
> method chosen, including those conditions that might render the use of
> the method inadvisable and those adverse side effects known to be
> consequent to the use of the method. This requirement may be satisfied
> by providing information in accordance with the medical practices and
> standards and health conditions in the country where the project is
> conducted through counseling, brochures, posters, or package inserts.
>
> \(7\) The project shall ensure that experimental contraceptive drugs
> and devices and medical procedures are provided only in the context of
> a scientific study in which participants are advised of potential
> risks and benefits.
>
> \(8\) With respect to projects for which USAID provides, or finances
> the contribution of, contraceptive commodities or technical services
> and for which there is no subaward or contract under this award, the
> organization implementing a project for which such assistance is
> provided shall agree that the project will comply with the
> requirements of this paragraph while using such commodities or
> receiving such services.

\(9\)

> i\) The recipient shall notify USAID when it learns about an alleged
> violation in a project of the requirements of subparagraphs (3), (4),
> (5) or (7) of this paragraph;
>
> ii\) The recipient shall investigate and take appropriate corrective
> action, if necessary, when it learns about an alleged violation in a
> project of subparagraph (6) of this paragraph and shall notify USAID
> about violations in a project affecting a number of people over a
> period of time that indicate there is a systemic problem in the
> project.
>
> iii\) The recipient shall provide USAID such additional information
> about violations as USAID may request.

c\. Additional Requirements for Voluntary Sterilization Programs

> \(1\) None of the funds made available under this award shall be used
> to pay for the performance of involuntary sterilization as a method of
> family planning or to coerce or provide any financial incentive to any
> individual to practice sterilization.
>
> \(2\) The recipient shall ensure that any surgical sterilization
> procedures supported in whole or in part by funds from this award are
> performed only after the individual has voluntarily appeared at the
> treatment facility and has given informed consent to the sterilization
> procedure. Informed consent means the voluntary, knowing assent from
> the individual after being advised of the surgical procedures to be
> followed, the attendant
>
> discomforts and risks, the benefits to be expected, the availability
> of alternative methods of family planning, the purpose of the
> operation and its irreversibility, and the option to withdraw consent
> anytime prior to the operation. An individual\'s consent is considered
> voluntary if it is based upon the exercise of free choice and is not
> obtained by any special
>
> inducement or any element of force, fraud, deceit, duress, or other
> forms
>
> of coercion or misrepresentation.
>
> \(3\) Further, the recipient shall document the patient\'s informed
> consent by (i) a written consent document in a language the patient
> understands and speaks, which explains the basic elements of informed
> consent, as set out above, and which is signed by the individual and
> by the attending physician or by the authorized assistant of the
> attending physician; or (ii) when a patient is unable to read
> adequately a written certification by the
>
> attending physician or by the authorized assistant of the attending
> physician that the basic elements of informed consent above were
> orally presented to the patient, and that the patient thereafter
> consented to the performance of the operation. The receipt of this
> oral explanation shall be acknowledged by the patient\'s mark on the
> certification and by the
>
> signature or mark of a witness who shall speak the same language as
> the patient.
>
> \(4\) The recipient must retain copies of informed consent forms and
> certification documents for each voluntary sterilization procedure for
> a period of three years after performance of the sterilization
> procedure.

d\. Prohibition on Abortion-Related Activities:

> \(1\) No funds made available under this award will be used to
> finance, support, or be attributed to the following activities: (i)
> procurement or distribution of equipment intended to be used for the
> purpose of inducing abortions as a method of family planning; (ii)
> special fees or incentives to any person to coerce or motivate them to
> have abortions; (iii) payments to persons to perform abortions or to
> solicit persons to undergo abortions; (iv) information, education,
> training, or communication programs that seek to
>
> promote abortion as a method of family planning; and (v) lobbying for
> or
>
> against abortion. The term "motivate", as it relates to family
> planning assistance, shall not be construed to prohibit the provision,
> consistent with local law, of information or counseling about all
> pregnancy options.
>
> \(2\) No funds made available under this award will be used to pay for
> any biomedical research which relates, in whole or in part, to methods
> of, or the performance of, abortions or involuntary sterilizations as
> a means of family planning. Epidemiologic or descriptive research to
> assess the incidence, extent or consequences of abortions is not
> precluded.

\*e. Ineligibility of Foreign Nongovernmental Organizations that Perform
or Actively

Promote Abortion as a Method of Family Planning.

I. Grants and Cooperative Agreements with U.S. Nongovernmental
Organizations

> \(1\) The recipient agrees that it will not furnish assistance for
> family planning under this award to any foreign nongovernmental
> organization that performs or actively promotes abortion as a method
> of family planning in USAID-recipient countries or that provides
> financial support to any other foreign nongovernmental organization
> that conducts such activities. For purposes of this paragraph (e), a
> foreign nongovernmental organization is
>
> a nongovernmental organization that is not organized under the laws of
> any State of the United States, the District of Columbia or the
> Commonwealth of Puerto Rico.
>
> \(2\) Prior to furnishing funds provided under this award to another
> nongovernmental organization organized under the laws of any State of
> the United States, the District of Columbia, or the Commonwealth of
> Puerto Rico, the recipient shall obtain the written agreement of such
> organization that the organization shall not furnish assistance for
> family planning under this award to any foreign nongovernmental
> organization except under the conditions and requirements that are
> applicable to the recipient as set forth in this paragraph (e).
>
> \(3\) The recipient may not furnish assistance for family planning
> under this award to a foreign nongovernmental organization (the
> subrecipient) unless:
>
> \(i\) The subrecipient certifies in writing that it does not perform
> or actively promote abortion as a method of family planning in USAID
> recipient countries and does not provide financial support to any
> other foreign nongovernmental organization that conducts such
> activities; and
>
> \(ii\) The recipient obtains the written agreement of the subrecipient
> containing the undertakings described in subparagraph (4) below.
>
> \(4\) Prior to furnishing assistance for family planning under this
> award to a subrecipient, the subrecipient must agree in writing that:
>
> \(i\) The subrecipient will not, while receiving assistance under this
> award, perform or actively promote abortion as a method of family
> planning in USAID-recipient countries or provide financial support to
> other foreign nongovernmental organizations that conduct such
> activities;
>
> \(ii\) The recipient and authorized representatives of USAID may, at
> any reasonable time: (A) inspect the documents and materials
> maintained or prepared by the subrecipient in the usual course of its
> operations that describe the family planning activities of the
>
> subrecipient, including reports, brochures and service statistics; (B)
> observe the family planning activity conducted by the subrecipient;
> (C) consult with family planning personnel of the subrecipient; and
> (D) obtain a copy of the audited financial statement or report of the
> subrecipient, if there is one;
>
> \(iii\) In the event that the recipient or USAID has reasonable cause
> to believe that a subrecipient may have violated its undertaking not
> to perform or actively promote abortion as a method of family
> planning, the recipient shall review the family planning program of
> the subrecipient to determine whether a violation of the undertaking
> has occurred. The subrecipient shall make available to the recipient
> such books and records and other information as may be reasonably
> requested in order to conduct the review. USAID may also review the
> family planning program of the subrecipient under these circumstances,
> and USAID shall have access to such books and records and information
> for inspection upon request;
>
> \(iv\) The subrecipient shall refund to the recipient the entire
> amount of assistance for family planning furnished to the subrecipient
> under this award in the event it is determined that the certification
> provided by the subrecipient under subparagraph (3), above, is false;
>
> \(v\) Assistance for family planning provided to the subrecipient
> under this award shall be terminated if the subrecipient violates any
> undertaking in the agreement required by subparagraphs (3) and (4),
> and the subrecipient shall refund to the recipient the value of any
> assistance furnished under this award that is used to perform or
> actively promote abortion as a method of family planning; and
>
> \(vi\) The subrecipient may furnish assistance for family planning
> under this award to another foreign nongovernmental organization (the
> subsubrecipient) only if: (A) the sub-subrecipient certifies in
> writing that it does not perform or actively promote abortion as a
> method of family planning in USAID-recipient countries and does not
> provide financial support to any other foreign nongovernmental
> organization that conducts such activities; and (B) the subrecipient
> obtains the written agreement of the sub-subrecipient that contains
> the same undertakings and obligations to the subrecipient as those
> provided by the subrecipient to the recipient as described in
> subparagraphs (4)(i)-(v) above.
>
> \(5\) Agreements with subrecipients and sub-subrecipients required
> under subparagraphs (3) and (4) shall contain the definitions set
> forth in subparagraph (10) of this paragraph (e).
>
> \(6\) The recipient shall be liable to USAID for a refund for a
> violation of any requirement of this paragraph (e) only if: (i) the
> recipient knowingly furnishes assistance for family planning to a
> subrecipient who performs or actively promotes abortion as a method of
> family planning; or (ii) the certification provided by a subrecipient
> is false and the recipient failed to make reasonable efforts to verify
> the validity of the certification prior to furnishing assistance to
> the subrecipient; or (iii) the recipient knows or has reason to know,
> by virtue of the monitoring which the recipient is required to perform
> under the terms of this award, that a subrecipient has violated any of
> the undertakings required under subparagraph (4) and the recipient
> fails to terminate assistance for family planning to the subrecipient,
> or fails to require the subrecipient to terminate assistance to a
> sub-subrecipient that violates any undertaking of the agreement
> required under subparagraph 4(vi), above. If the recipient finds, in
> exercising its monitoring responsibility under this award, that a
> subrecipient or subsubrecipient receives frequent requests for the
> information described in subparagraph (10)(iii)(A)(II), below, the
> recipient shall verify that this information is being provided
> properly in accordance with subparagraph (10)(iii)(A)(II) and shall
> describe to USAID the reasons for reaching its conclusion.
>
> \(7\) In submitting a request to USAID for approval of a recipient\'s
> decision to furnish assistance for family planning to a subrecipient,
> the recipient shall include a description of the efforts made by the
> recipient to verify the validity of the certification provided by the
> subrecipient. USAID may request the recipient to make additional
> efforts to verify the validity of the certification. USAID will inform
> the recipient in writing when USAID is satisfied that reasonable
> efforts have been made. If USAID concludes that these efforts are
> reasonable within the meaning of subparagraph (6) above, the recipient
> shall not be liable to USAID for a refund in the event the
> subrecipient\'s certification is false unless the recipient knew the
> certification to be false or misrepresented to USAID the efforts made
> by the recipient to verify the validity of the certification.
>
> \(8\) It is understood that USAID may make independent inquiries, in
> the community served by a subrecipient or sub-subrecipient, regarding
> whether it performs or actively promotes abortion as a method of
> family planning.
>
> \(9\) A subrecipient must provide the certification required under
> subparagraph (3) and a sub-subrecipient must provide the certification
> required under subparagraph (4)(vi) each time a new agreement is
> executed with the subrecipient or sub-subrecipient in furnishing
> assistance for family planning under the award.

\(10\) The following definitions apply for purposes of this paragraph
(e):

> \(i\) Abortion is a method of family planning when it is for the
> purpose of spacing births. This includes, but is not limited to,
> abortions performed for the physical or mental health of the mother,
> but does not include abortions performed if the life of the mother
> would be endangered if the fetus were carried to term or abortions
> performed following rape or incest (since abortion under these
> circumstances is not a family planning act).
>
> \(ii\) To perform abortions means to operate a facility where
> abortions are performed as a method of family planning. Excluded from
> this definition are clinics or hospitals that do not include abortion
> in their family planning programs. Also excluded from this definition
> is the treatment of injuries or illnesses caused by legal or illegal
> abortions, for example, postabortion care.
>
> \(iii\) To actively promote abortion means for an organization to
> commit resources, financial or other, in a substantial or continuing
> effort to increase the availability or use of abortion as a method of
> family planning.
>
> \(A\) This includes, but is not limited to, the following:
>
> \(I\) Operating a family planning counseling service that includes, as
> part of the regular program, providing advice and information
> regarding the benefits and availability of abortion as a method of
> family planning;
>
> \(II\) Providing advice that abortion is an available option in the
> event other methods of family planning are not used or are not
> successful or encouraging women to consider abortion (passively
> responding to a question regarding where a safe, legal abortion may be
> obtained is not considered active promotion if the question is
> specifically asked by a woman who is already pregnant, the woman
> clearly states that she has already decided to have a legal abortion,
> and the family planning counselor reasonably believes that the ethics
> of the medical profession in the country requires a response regarding
> where it may be obtained safely);
>
> \(III\) Lobbying a foreign government to legalize or make available
> abortion as a method of family planning or lobbying such a government
> to continue the legality of abortion as a method of family planning;
> and
>
> \(IV\) Conducting a public information campaign in USAID recipient
> countries regarding the benefits and/or availability of abortion as a
> method of family planning.
>
> \(B\) Excluded from the definition of active promotion of abortion as
> a method of family planning are referrals for abortion as a result of
> rape or incest, or if the life of the mother would be endangered if
> the fetus were carried to term. Also excluded from this definition is
> the treatment of injuries or illnesses caused by legal or illegal
> abortions, for example, post-abortion care.
>
> \(C\) Action by an individual acting in the individual\'s capacity
> shall not be attributed to an organization with which the individual
> is associated, provided that the organization neither endorses nor
> provides financial support for the action and takes reasonable steps
>
> to ensure that the individual does not improperly represent that the
> individual is acting on behalf of the organization.
>
> \(iv\) To furnish assistance for family planning to a foreign
> nongovernmental organization means to provide financial support under
> this award to the family planning program of the organization, and
> includes the transfer of funds made available under this award or
> goods or services financed with such funds, but does not include the
> purchase of goods or
>
> services from an organization or the participation of an individual in
> the general training programs of the recipient, subrecipient or
> subsubrecipient.
>
> \(v\) To control an organization means the possession of the power to
> direct or cause the direction of the management and policies of an
> organization.
>
> \(11\) In determining whether a foreign nongovernmental organization
> is eligible
>
> to be a subrecipient or sub-subrecipient of assistance for family
> planning under this award, the action of separate nongovernmental
> organizations shall not be imputed to the subrecipient or
> sub-subrecipient, unless, in the judgment of USAID, a separate
> nongovernmental organization is being used as a sham to avoid the
> restrictions of this paragraph (e). Separate nongovernmental
> organizations are those that have distinct legal existence in
> accordance with the laws of the countries in which they are organized.
> Foreign organizations that are separately organized shall not be
> considered separate, however, if one is controlled by the other. The
> recipient may request USAID\'s approval to treat as separate the
> family planning activities of two or more organizations, that would
> not be considered separate under the preceding sentence, if the
> recipient believes, and provides a written justification to USAID
> therefore, that the family planning activities of the organizations
> are sufficiently distinct so as to warrant not imputing the activity
> of one to the other.

\(12\) Assistance for family planning may be furnished under this award
by a recipient or sub-subrecipient to a foreign government event though
the government includes abortion in its family planning program,
provided that no assistance may be furnished in support of the abortion
activity of the government and any funds transferred to the government
shall be placed in a segregated account to ensure that such funds may
not be used to support the abortion activity of the government.

\(13\) The requirements of this paragraph are not applicable to child
spacing assistance furnished to a foreign nongovernmental organization
that is engaged primarily in providing health services if the objective
of the assistance is to finance integrated health care services to
mothers and children and child spacing is one of several health care
services being provided by the organization as part of a larger child
survival effort with the objective of reducing infant and child
mortality.

II\. Grants and Cooperative Agreements with Non-U.S., Nongovernmental
Organizations

> \(1\) The recipient certifies that it does not now and will not during
> the term of this award perform or actively promote abortion as a
> method of family planning in USAID-recipient countries or provide
> financial support to any other foreign nongovernmental organization
> that conducts such activities. For purposes of this paragraph (e), a
> foreign nongovernmental organization is a nongovernmental organization
> that is not organized under the laws of any State of the United
> States, the District of Columbia or the Commonwealth of Puerto Rico.
>
> \(2\) The recipient agrees that the authorized representative of USAID
> may, at any reasonable time: (i) inspect the documents and materials
> maintained or prepared by the recipient in the usual course of its
> operations that describe the family planning activities of the
> recipient, including reports, brochures and service statistics; (ii)
> observe the family planning activity conducted by the recipient, (iii)
> consult with the family planning personnel of the recipient; and (iv)
> obtain a copy of the audited financial statement or report of the
> recipient, if there is one.
>
> \(3\) In the event USAID has reasonable cause to believe that the
> recipient may have violated its undertaking not to perform or actively
> promote abortion as a method of family planning, the recipient shall
> make available to USAID such books and records and other information
> as USAID may reasonably request in order to determine whether a
> violation of the undertaking has occurred.
>
> \(4\) The recipient shall refund to USAID the entire amount of
> assistance for family planning furnished under this award in the event
> it is determined that the certification provided by the recipient
> under subparagraph (1), above, is false.
>
> \(5\) Assistance for family planning to the recipient under this award
> shall be terminated if the recipient violates any undertaking required
> by this paragraph (e), and the recipient shall refund to USAID the
> value of any assistance furnished under this award that is used to
> perform or actively promote abortion as a method of family planning.
>
> \(6\) The recipient may not furnish assistance for family planning
> under this award to a foreign nongovernmental organization (the
> subrecipient) unless: (i) the subrecipient certifies in writing that
> it does not perform or actively promote abortion as a method of family
> planning in USAID-recipient countries and does not provide financial
> support to any other foreign nongovernmental organization that
> conducts such activities; and (ii) the recipient obtains the written
> agreement of the subrecipient containing the undertakings described in
> subparagraph (7), below.
>
> \(7\) Prior to furnishing assistance for family planning under this
> award to a subrecipient, the subrecipient must agree in writing that:
>
> \(i\) The subrecipient will not, while receiving assistance under this
> award, perform or actively promote abortion as a method of family
> planning in USAID-recipient countries or provide financial support to
> other nongovernmental organizations that conduct such activities.
>
> \(ii\) The recipient and authorized representatives of USAID may, at
> any reasonable time: (A) inspect the documents and materials
> maintained or prepared by the subrecipient in the usual course of its
> operations that describe the family planning activities of the
> subrecipient, including reports, brochures and service statistics; (B)
> observe the family planning activity conducted by the subrecipient;
> (C) consult with family planning
>
> personnel of the subrecipient; and (D) obtain a copy of the audited
> financial statement or report of the subrecipient, if there is one.
>
> \(iii\) In the event the recipient or USAID has reasonable cause to
> believe that a subrecipient may have violated its undertaking not to
> perform or actively promote abortion as a method of family planning,
> the recipient shall review the family planning program of the
> subrecipient to determine whether a violation of the undertaking has
> occurred. The subrecipient shall make available to the recipient such
> books and records
>
> and other information as may be reasonably requested in order to
> conduct the review. USAID may also review the family planning program
> of the subrecipient under these circumstances, and USAID shall have
> access to such books and records and information for inspection upon
> request.
>
> \(iv\) The subrecipient shall refund to the recipient the entire
> amount of assistance for family planning furnished to the subrecipient
> under this award in the event it is determined that the certification
> provided by the subrecipient under subparagraph (6), above, is false.
>
> \(v\) Assistance for family planning to the subrecipient under this
> award shall be terminated if the subrecipient violates any undertaking
> required by this paragraph (e), and the subrecipient shall refund to
> the recipient the value of any assistance furnished under this award
> that is used to perform or actively promote abortion as a method of
> family planning.
>
> \(vi\) The subrecipient may furnish assistance for family planning
> under this award to another foreign nongovernmental organization (the
> subsubrecipient) only if: (A) the sub-subrecipient certifies in
> writing that it does not perform or actively promote abortion as a
> method of family planning in USAID-recipient countries and does not
> provide financial
>
> support to any other foreign nongovernmental organization that
> conducts such activities; and (B) the subrecipient obtains the written
> agreement of the sub-subrecipient that contains the same undertakings
> and obligations to the subrecipient as those provided by the
> subrecipient to the recipient as described in subparagraphs
> (7)(i)-(v), above.
>
> \(8\) Agreements with subrecipients and sub-subrecipients required
> under subparagraphs (6) and (7) shall contain the definitions set
> forth in subparagraph (13) of this paragraph (e).
>
> \(9\) The recipient shall be liable to USAID for a refund for a
> violation by a subrecipient relating to its certification required
> under subparagraph (6) or by a subrecipient or a sub-subrecipient
> relating to its undertakings in the agreement required under
> subparagraphs (6) and (7) only if: (i) the recipient knowingly
> furnishes assistance for family planning to a subrecipient that
> performs or actively promotes abortion as a method of family planning;
> or (ii) the certification provided by a subrecipient is false and the
> recipient failed to make reasonable efforts to verify the validity of
> the certification prior to furnishing assistance to the subrecipient;
> or (iii) the recipient knows or has reason to know, by virtue of the
> monitoring that the recipient is required to perform under the terms
> of this award, that a subrecipient has violated any of the
> undertakings required under subparagraph (7) and the recipient fails
> to terminate assistance for family planning to the subrecipient, or
> fails to require the subrecipient to terminate assistance to a
> sub-subrecipient that violates any undertaking of the agreement
> required under subparagraph 7(vi), above. If the recipient finds, in
> exercising its monitoring responsibility under this award, that a
> subrecipient or sub-subrecipient receives frequent requests for the
> information described in subparagraph (13)(iii)(A)(II), below, the
> recipient shall verify that this information is being provided
> properly in accordance with subparagraph 13(iii)(A)(II) and shall
> describe to USAID the reasons for reaching its conclusion.
>
> \(10\) In submitting a request to USAID for approval of a recipient\'s
> decision to furnish assistance for family planning to a subrecipient,
> the recipient shall include a description of the efforts made by the
> recipient to verify the validity of the certification provided by the
> subrecipient. USAID may request the recipient to make additional
> efforts to verify the validity of the certification. USAID will inform
> the recipient in writing when USAID is satisfied that reasonable
> efforts have been made. If USAID concludes that these efforts are
> reasonable within the meaning of subparagraph (9) above, the recipient
> shall not be liable to USAID for a refund in the event the
> subrecipient\'s certification is false unless the recipient knew the
> certification to be false or misrepresented to USAID the efforts made
> by the recipient to verify the validity of the certification.
>
> \(11\) It is understood that USAID may make independent inquiries, in
> the community served by a subrecipient or sub-subrecipient, regarding
> whether it performs or actively promotes abortion as a method of
> family planning.
>
> \(12\) A subrecipient must provide the certification required under
> subparagraph (6) and a sub-subrecipient must provide the certification
> required under subparagraph (7)(vi) each time a new agreement is
> executed with the subrecipient or sub-subrecipient in furnishing
> assistance for family planning under this award.

\(13\) The following definitions apply for purposes of paragraph (e):

> \(i\) Abortion is a method of family planning when it is for the
> purpose of spacing births. This includes, but is not limited to,
> abortions performed for the physical or mental health of the mother
> but does not include abortions performed if the life of the mother
> would be endangered if the fetus were carried to term or abortions
> performed following rape or incest (since abortion under these
> circumstances is not a family planning act).
>
> \(ii\) To perform abortions means to operate a facility where
> abortions are performed as a method of family planning. Excluded from
> this definition are clinics or hospitals that do not include abortion
> in their family planning programs. Also excluded from this definition
> is the treatment of injuries or illnesses caused by legal or illegal
> abortions, for example, postabortion care.
>
> \(iii\) To actively promote abortion means for an organization to
> commit resources, financial or other, in a substantial or continuing
> effort to increase the availability or use of abortion as a method of
> family planning.
>
> \(A\) This includes, but is not limited to, the following:
>
> \(I\) Operating a family planning counseling service that includes, as
> part of the regular program, providing advice and information
> regarding the benefits and availability of abortion as a method of
> family planning;
>
> \(II\) Providing advice that abortion is an available option in the
> event other methods of family planning are not used or are not
> successful or encouraging women to consider abortion (passively
> responding to a question regarding where a safe, legal abortion may be
> obtained is not considered active promotion if the question is
> specifically asked by a woman who is already pregnant, the woman
> clearly states that she has already decided to have a legal abortion,
> and the family planning counselor reasonably believes that the ethics
> of the medical profession in the country requires a response regarding
> where it may be obtained safely);
>
> \(III\) Lobbying a foreign government to legalize or make available
> abortion as a method of family planning or lobbying such a government
> to continue the legality of abortion as a method of family planning;
> and
>
> \(IV\) Conducting a public information campaign in USAID recipient
> countries regarding the benefits and/or availability of abortion as a
> method of family planning.
>
> \(B\) Excluded from the definition of active promotion of abortion as
> a method of family planning are referrals for abortion as a result of
> rape or incest or if the life of the mother would be endangered if the
> fetus were carried to term. Also excluded from this definition is the
> treatment of injuries or illnesses caused by legal or illegal
> abortions, for example, post-abortion care.
>
> \(C\) Action by an individual acting in the individual\'s own capacity
> shall not be attributed to an organization with which the individual
> is associated, provided that the organization neither endorses nor
> provides financial support for the action and takes reasonable steps
> to ensure that the individual does not improperly represent the
> individual is acting on behalf of the organization.
>
> \(iv\) To furnish assistance for family planning to a foreign
> nongovernmental organization means to provide financial support under
> this award to the family planning program of the organization, and
> includes the transfer of funds made available under this award or
> goods or services financed with such funds, but does not include the
> purchase of goods or services from an organization or the
> participation of an individual in the general training programs of the
> recipient, subrecipient or subsubrecipient.
>
> \(v\) To control an organization means the possession of the power to
> direct or cause the direction of the management and policies of an
> organization.
>
> \(14\) In determining whether a foreign nongovernmental organization
> is eligible to be a recipient, subrecipient or sub-subrecipient of
> assistance for family planning under this award, the action of
> separate nongovernmental organizations shall not be imputed to the
> recipient, subrecipient or subsubrecipient, unless, in the judgment of
> USAID, a separate nongovernmental organization is being used as a sham
> to avoid the restrictions of this paragraph (e). Separate
> nongovernmental organizations are those that have distinct legal
> existence in accordance with the laws of the countries in which they
> are organized. Foreign organizations that are separately organized
> shall not be considered separate, however, if one is controlled by the
> other. The recipient may request USAID\'s approval to treat as
> separate the family planning activities of two or more organizations,
> which would not be considered separate under the preceding sentence,
> if the recipient believes, and provides a written justification to
> USAID therefore, that the family planning activities of the
> organizations are sufficiently distinct so as to warrant not imputing
> the activity of one of the other.
>
> \(15\) Assistance for family planning may be furnished under this
> award by a recipient, subrecipient or sub-subrecipient to a foreign
> government even though the government includes abortion in its family
> planning program, provided that no assistance may be furnished in
> support of the abortion activity of the government and any funds
> transferred to the government shall be placed in a segregated account
> to ensure that such funds may not be used to support the abortion
> activity of the government.
>
> \(16\) The requirements of this paragraph are not applicable to child
> spacing assistance furnished to a foreign nongovernmental organization
> that is engaged primarily in providing health services if the
> objective of the assistance is to finance integrated health care
> services to mothers and children and child spacing is one of several
> health care services being provided by the organization as part of a
> larger child survival effort with the objective of reducing infant and
> child mortality.

III\. Exceptions

The paragraphs set forth in sections (I) and (II) above are not
applicable in the situations described below:

> \(1\) While the paragraphs are to be used in grants and cooperative
> agreements (and assistance subagreements) that provide financing for
> family planning activity or activities, if family planning is a
> component of an activity involving assistance or other purposes, such
> as food and nutrition, health for education, paragraph (e),
> \`\`Ineligibility of Foreign Nongovernmental Organizations that
> Perform or Actively Promote Abortion as a Method of Family
> Planning,\'\' applies only to the family planning component.
>
> \(2\) When health or child survival funds are used to provide
> assistance for child spacing as well as health purposes, these
> paragraphs are applicable to such assistance unless: (a) the foreign
> nongovernmental organization is one that primarily provides health
> services; (b) the objective of the assistance is to finance integrated
> health care services to mothers and children; and (c) child spacing is
> one of several health care services being provided as part of a larger
> child survival effort with the objective of reducing infant and child
> mortality. These paragraphs need not be included in the assistance
> agreement if it indicates that assistance for child spacing will be
> provided only in this way. USAID support under these circumstances is
> considered a contribution to a health service delivery program and not
> to a family planning program. In such a case, these paragraphs need
> not be included in an assistance agreement.
>
> \(3\) These paragraphs need not be included in assistance agreements
> with United States nongovernmental organizations for family planning
> purposes if implementation of the activity does not involve assistance
> to foreign nongovernmental organizations.
>
> \*f. The recipient shall insert paragraphs (a), (b), (c), (d), and (f)
> of this provision in all subsequent subagreements and contracts
> involving family planning or population activities that will be
> supported in whole or in part from funds under this award. Paragraph
> (e) shall be inserted in subagreements and sub-subagreements in
> accordance with the terms of paragraph (e). The term subagreement
> means subgrants and subcooperative agreements.

**(END OF PROVISION)**

**7. PROTECTION OF THE INDIVIDUAL AS A RESEARCH SUBJECT**

**(APRIL 1998)**

***APPLICABILITY:*** This provision is applicable when human subjects
are involved in research financed by the award.

> **PROTECTION OF THE INDIVIDUAL AS A RESEARCH SUBJECT (APRIL 1998)**

a\. Safeguarding the rights and welfare of human subjects involved in
research supported by USAID is the responsibility of the organization to
which support is awarded. USAID has adopted the Common Federal Policy
for the Protection of Human Subjects, Part 225 of Title 22 of the Code
of Federal Regulations (the \"Policy\"). Additional interpretation,
procedures, and implementation guidance of the Policy are found in USAID
General Notice entitled \"Procedures for the Protection of Human
Subjects in Research Supported by USAID,\" issued April 19, 1995, as
from time to time amended. USAID\'s Cognizant Human Subjects Officer
(CHSO) in USAID/W has oversight, guidance, and interpretation
responsibility for the Policy.

b\. Recipient organizations must comply with USAID policy when humans
are the subject of research, as defined in 22 CFR 225.102(d), funded by
the grant and recipients must provide \"assurance\", as required by 22
CFR 225.103, that they follow and abide by the procedures in the Policy.
See also Section 5 of the April 19, 1995, USAID General Notice which
sets forth activities to which the Policy is applicable. The existence
of a bona fide, applicable assurance approved by the Department of
Health and Human Services (HHS) such as the \"multiple project
assurance\" (MPA) will satisfy this requirement. Alternatively,
organizations can provide an acceptable written assurance to USAID as
described in 22 CFR 225.103. Such assurances must be determined by the
CHSO to be acceptable prior to any applicable research being initiated
or conducted under the award. In some limited instances outside the
U.S., alternative systems for the protection of human subjects may be
used provided they are deemed \"at least equivalent\" to those outlined
in Part 225 (See 22 CFR 225.101\[h\]). Criteria and procedures for
making this determination are described in the General Notice cited in
the preceding paragraph.

c\. Since the welfare of the research subject is a matter of concern to
USAID as well as to the organization, USAID staff consultants and
advisory groups may independently review and inspect research and
research processes and procedures involving human subjects, and based on
such findings, the CHSO may prohibit research which presents
unacceptable hazards or otherwise fails to comply with USAID procedures.
Informed consent documents must include the stipulation that the
subject\'s records may be subject to such review.

**(END OF PROVISION)**

8.  **CARE OF LABORATORY ANIMALS (MARCH 2004)**

***APPLICABILITY:*** This provision is applicable when laboratory
animals are involved in research performed in the U.S. and financed by
the award.

**CARE OF LABORATORY ANIMALS (MARCH 2004)**

a\. Before undertaking performance of any grant involving the use of
laboratory animals, the recipient shall register with the Secretary of
Agriculture of the United States in accordance with Section 6, Public
Law 89-544, Laboratory Animal Welfare Act, August 24, 1966, as amended
by Public Law 91-579, Animal Welfare Act of 1970, December 24, 1970. The
recipient shall furnish evidence of such registration to the Agreement
Officer.

b\. The recipient shall acquire animals used in research under this
award only from dealers licensed by the Secretary of Agriculture, or
from exempted sources in accordance with the Public Laws enumerated in
(a) above.

c\. In the care of any live animals used or intended for use in the
performance of this grant, the recipient shall adhere to the principles
enunciated in the Guide for Care and Use of Laboratory Animals prepared
by the Institute of Laboratory Animals Resources, National Academy of
Sciences - National Research Council, and in the United States
Department of Agriculture\'s (USDA) regulations and standards issued
under the Public Laws enumerated in a. above. In case of conflict
between standards, the higher standard shall be used. The recipient\'s
reports on portions of the award in which animals were used shall
contain a certificate stating that the animals were cared for in
accordance with the principles enunciated in the Guide for Care and Use
of Laboratory Animals prepared by the Institute of Laboratory Animal
Resources, NAS-NRC, and/or in the regulations and standards as
promulgated by the Agricultural Research Service, USDA, pursuant to the
Laboratory Animal Welfare Act of 24 August 1966, as amended (P.L. 89-544
and P.L. 91-579). NOTE: The recipient may request registration of the
recipient\'s facility and a current listing of licensed dealers from the
Regional Office of the Animal and Plant Health Inspection Service
(APHIS), USDA, for the region in which the recipient\'s research
facility is located. The location of the appropriate APHIS Regional
Office as well as information concerning this program may be obtained by
contacting the Senior Staff Office, Animal Care Staff, USDA/APHIS, 4700
River Road Unit 84, Riverdale, MD 20737-1234 and at
<http://www.aphis.usda.gov/ac/>.

**(END OF PROVISION)**

**9. TITLE TO AND CARE OF PROPERTY (COOPERATING COUNTRY TITLE) (NOVEMBER
1985)**

***APPLICABILITY:*** This provision is applicable to property titled in
the name of the cooperating country or such public or private agency as
the cooperating country government may designate.

> **TITLE TO AND CARE OF PROPERTY (COOPERATING COUNTRY TITLE) (NOVEMBER
> 1985)**

a\. Except as modified by the schedule of this grant, title to all
equipment, materials and supplies, the cost of which is reimbursable to
the recipient by USAID or by the cooperating country, shall at all times
be in the name of the cooperating country or such public or private
agency as the cooperating country may designate, unless title to
specified types or classes of equipment is reserved to USAID under
provisions set forth in the schedule of this award. All such property
shall be under the custody and control of recipient until the owner of
title directs otherwise or completion of work under this award or its
termination, at which time custody and control shall be turned over to
the owner of title or disposed of in accordance with its instructions.
All performance guarantees and warranties obtained from suppliers shall
be taken in the name of the title owner.

b\. The recipient shall maintain and administer in accordance with sound
business practice a program for the maintenance, repair, protection, and
preservation of Government property so as to assure its full
availability and usefulness for the performance of this grant. The
recipient shall take all reasonable steps to comply with all appropriate
directions or instructions which the Agreement Officer may prescribe as
reasonably necessary for the protection of the Government property.

c\. The recipient shall prepare and establish a program, to be approved
by the appropriate USAID Mission, for the receipt, use, maintenance,
protection, custody and care of equipment, materials and supplies for
which it has custodial responsibility, including the establishment of
reasonable controls to enforce such program. The recipient shall be
guided by the following requirements:

\(1\) Property Control: The property control system shall include but
not be limited to the following:

> \(i\) Identification of each item of cooperating country property
> acquired or furnished under the award by a serially controlled
> identification number and by description of item. Each item must be
> clearly marked \"Property of (insert name of cooperating country).\"
>
> \(ii\) The price of each item of property acquired or furnished under
> this award.
>
> \(iii\) The location of each item of property acquired or furnished
> under this award.
>
> \(iv\) A record of any usable components which are permanently removed
> from items of cooperating country property as a result of modification
> or otherwise.
>
> \(v\) A record of disposition of each item acquired or furnished under
> the award.
>
> \(vi\) Date of order and receipt of any item acquired or furnished
> under the award.
>
> \(vii\) The official property control records shall be kept in such
> condition that at any stage of completion of the work under this
> award, the status of property acquired or furnished under this award
> may be readily ascertained. A report of current status of all items of
> property acquired or furnished under the award shall be submitted
> yearly concurrently with the annual report.
>
> \(2\) Maintenance Program: The recipient\'s maintenance program shall
> be consistent with sound business practice, the terms of the award,
> and provide for:
>
> \(i\) disclosure of need for and the performance of preventive
> maintenance,
>
> \(ii\) disclosure and reporting of need for capital type
> rehabilitation, and
>
> \(iii\) recording of work accomplished under the program:
>
> \(A\) Preventive maintenance - Preventive maintenance is maintenance
> generally performed on a regularly scheduled basis to prevent the
> occurrence of defects and to detect and correct minor defects before
> they result in serious consequences.
>
> \(B\) Records of maintenance - The recipient\'s maintenance program
> shall provide for records sufficient to disclose the maintenance
> actions performed and deficiencies discovered as a result of
> inspections.
>
> \(C\) A report of status of maintenance of cooperating country
> property shall be submitted annually concurrently with the annual
> report.

d\. Risk of Loss:

> \(1\) The recipient shall not be liable for any loss of or damage to
> the cooperating country property, or for expenses incidental to such
> loss or damage except that the recipient shall be responsible for any
> such loss or damage (including expenses incidental thereto):
>
> \(i\) Which results from willful misconduct or lack of good faith on
> the part of any of the recipient\'s directors or officers, or on the
> part of any of its managers, superintendents, or other equivalent
> representatives, who have supervision or direction of all or
> substantially all of the recipient\'s business, or all or
> substantially all of the recipient\'s operation at any one plant,
> laboratory, or separate location in which this award is being
> performed;
>
> \(ii\) Which results from a failure on the part of the recipient, due
> to the willful misconduct or lack of good faith on the part of any of
> its directors, officers, or other representatives mentioned in (i)
> above:
>
> \(A\) to maintain and administer, in accordance with sound business
> practice, the program for maintenance, repair, protection, and
> preservation of cooperating country property as required by (i) above,
> or
>
> \(B\) to take all reasonable steps to comply with any appropriate
> written directions of the Agreement Officer under (b) above;
>
> \(iii\) For which the recipient is otherwise responsible under the
> express terms designated in the schedule of this award;
>
> \(iv\) Which results from a risk expressly required to be insured
> under some other provision of this award, but only to the extent of
> the insurance so required to be procured and maintained, or to the
> extent of insurance actually procured and maintained, whichever is
> greater; or
>
> \(v\) Which results from a risk which is in fact covered by insurance
> or for which the grantee is otherwise reimbursed, but only to the
> extent of such insurance or reimbursement;
>
> \(vi\) Provided, that, if more than one of the above exceptions shall
> be applicable in any case, the recipient\'s liability under any one
> exception shall not be limited by any other exception.
>
> \(2\) The recipient shall not be reimbursed for, and shall not include
> as an item of overhead, the cost of insurance, or any provision for a
> reserve, covering the risk of loss of or damage to the cooperating
> country property, except to the extent that USAID may have required
> the recipient to carry such insurance under any other provision of
> this award.
>
> \(3\) Upon the happening of loss or destruction of or damage to the
> cooperating country property, the recipient shall notify the Agreement
> Officer thereof, shall take all reasonable steps to protect the
> cooperating country property from further damage, separate the damaged
> and undamaged cooperating country property, put all the cooperating
> country property in the best possible order, and furnish to the
> Agreement Officer a statement of:

(i) The lost, destroyed, or damaged cooperating country property;

> \(ii\) The time and origin of the loss, destruction, or damage;
>
> \(iii\) All known interests in commingled property of which the
> cooperating country property is a part; and
>
> \(iv\) The insurance, if any, covering any part of or interest in such
>
> commingled property.
>
> \(4\) The recipient shall make repairs and renovations of the damaged
> cooperating country property or take such other action as the
> Agreement Officer directs.
>
> \(5\) In the event the recipient is indemnified, reimbursed, or
> otherwise compensated for any loss or destruction of or damage to the
> cooperating country property, it shall use the proceeds to repair,
> renovate or replace the cooperating country property involved, or
> shall credit such proceeds against the cost of the work covered by the
> award, or shall otherwise reimburse USAID, as directed by the
> Agreement Officer. The recipient shall do nothing to prejudice
> USAID\'s right to recover against third parties
>
> for any such loss, destruction, or damage, and upon the request of the
> Agreement Officer, shall, at the Governments expense, furnish to USAID
> all reasonable assistance and cooperation (including assistance in the
> prosecution of suits and the execution of instruments or assignments
> in favor of the Government) in obtaining recovery.

e\. Access: USAID, and any persons designated by it, shall at all
reasonable times have access to the premises wherein any cooperating
country property is located, for the purpose of inspecting the
cooperating country property

f\. Final Accounting and Disposition of Cooperating Country Property:
Within 90 days after completion of this award, or at such other date as
may be fixed by the Agreement Officer, the recipient shall submit to the
Agreement Officer an inventory schedule covering all items of equipment,
materials and supplies under the recipient\'s custody, title to which is
in the cooperating country or public or private agency designated by the
cooperating country, which have not been consumed in the performance of
this award. The recipient shall also indicate what disposition has been
made of such property.

g\. Communications: All communications issued pursuant to this provision
shall be in writing.

**(END OF PROVISION)**

**10. PUBLIC NOTICES (MARCH 2004)**

***APPLICABILITY:*** This provision is applicable when the cognizant
Activity Manager or SO Team determines that the award is of public
interest and requests that the provision be included in the award.

It is USAID\'s policy to inform the public as fully as possible of its
programs and activities. The recipient is encouraged to give public
notice of the receipt of this award and, from time to time, to announce
progress and accomplishments. Press releases or other public notices
should include a statement substantially as follows:

> \"The U.S. Agency for International Development administers the U.S.
> foreign assistance program providing economic and humanitarian
> assistance in more than 120 countries worldwide.\"

The recipient may call on USAID\'s Bureau for Legislative and Public
Affairs for advice regarding public notices. The recipient is requested
to provide copies of notices or announcements to the cognizant technical
officer and to USAID\'s Bureau for Legislative and Public Affairs as far
in advance of release as possible.

**(END OF PROVISION)**

**11. (RESERVED)**

**\*12. COST SHARING (MATCHING) (JULY 2002)**

***APPLICABILITY***: This provision, along with 22 CFR 226, is
applicable when the recipient has agreed or is required to cost share or
provide a matching share.

**COST SHARING (MATCHING) (July 2002)**

a\. If at the end of any funding period, the recipient has expended an
amount of non-Federal funds less than the agreed upon amount or
percentage of total expenditures, the Agreement Officer may apply the
difference to reduce the amount of USAID incremental funding in the
following funding period. If the award has expired or has been
terminated, the Agreement Officer may require the recipient to refund
the difference to USAID.

b\. The source, origin and nationality requirements and the restricted
goods provision established in the Standard Provision entitled \"USAID
Eligibility Rules for Goods and Services\" do not apply to cost sharing
(matching) expenditures.

**(END OF PROVISION)**

**13. PROHIBITION OF ASSISTANCE TO DRUG TRAFFICKERS**

> **(JUNE 1999)**

***APPLICABILITY:*** This provision is applicable where performance of
the award will take place in "Covered" Countries, as described in ADS
206 (see 206.5.3)

**PROHIBITION OF ASSISTANCE TO DRUG TRAFFICKERS**

**(JUNE 1999)**

a\. USAID reserves the right to terminate assistance to, or take other
appropriate measures with respect to, any participant approved by USAID
who is found to have been convicted of a narcotics offense or to have
been engaged in drug trafficking as defined in 22 CFR Part 140.

b\. (1) For any loan over \$1000 made under this agreement, the
recipient shall insert a clause in the loan agreement stating that the
loan is subject to immediate cancellation, acceleration, recall or
refund by the recipient if the borrower or a key individual of a
borrower is found to have been convicted of a narcotics offense or to
have been engaged in drug trafficking as defined in 22 CFR Part140.

> \(2\) Upon notice by USAID of a determination under section (1) and at
> USAID\'s option, the recipient agrees to immediately cancel,
> accelerate or recall the loan, including refund in full of the
> outstanding balance. USAID reserves the right to have the loan refund
> returned to USAID.

c\. (1) The recipient agrees not to disburse, or sign documents
committing the recipient to disburse, funds to a subrecipient designated
by USAID (\"Designated Subrecipient\") until advised by USAID that: (i)
any United States Government review of the Designated Subrecipient and
its key individuals has been completed; (ii) any related certifications
have been obtained; and (iii) the assistance to the Designated
Subrecipient has been approved. Designation means that the subrecipient
has been unilaterally selected by USAID as the subrecipient. USAID
approval of a subrecipient, selected by another party, or joint
selection by USAID and another party is not designation.

\(2\) The recipient shall insert the following clause, or its substance,
in its agreement with the Designated Subrecipient:

"The recipient reserves the right to terminate this
\[Agreement/Contract\] or take

other appropriate measures if the \[Subrecipient\] or a key individual
of the

\[Subrecipient\] is found to have been convicted of a narcotic offense
or to have

been engaged in drug trafficking as defined in 22 CFR Part 140."

**(END OF PROVISION)**

**\*14. INVESTMENT PROMOTION (NOVEMBER 2003)**

***APPLICABILITY:*** The following clause is required for grants and
cooperative agreements when the program includes gray-area activities or
investment-related activities where specific activities are not
identified at the time of obligation but could be for investment-related
activities, as described in ADS 225 (see 225.3.1.8)

**INVESTMENT PROMOTION (NOVEMBER 2003)**

a\. Except as specifically set forth in this award or otherwise
authorized by USAID in writing, no funds or other support provided
hereunder may be used for any activity that involves investment
promotion in a foreign country.

b\. In the event the recipient is requested or wishes to provide
assistance in the above area or requires clarification from USAID as to
whether the activity would be consistent with the limitation set forth
above, the recipient must notify the Agreement Officer and provide a
detailed description of the proposed activity. The recipient must not
proceed with the activity until advised by USAID that it may do so.

c\. The recipient must ensure that its employees and sub-recipients and
contractors providing investment promotion services hereunder are made
aware of the restrictions set forth in this clause and must include this
clause in all contracts and other sub-agreements entered into hereunder.

**(END OF PROVISION)**

**\*15. REPORTING OF FOREIGN TAXES (MARCH 2006)**

a\. The recipient must annually submit a report by April 16 of the next
year.

b\. Contents of Report. The report must contain:

\(i\) Contractor/recipient name.

\(ii\) Contact name with phone, fax and email.

\(iii\) Agreement number(s).

\(iv\) Amount of foreign taxes assessed by a foreign government \[each
foreign

government must be listed separately\] on commodity purchase
transactions

valued at \$500 or more financed with U.S. foreign assistance funds
under this

agreement during the prior U.S. fiscal year.

\(v\) Only foreign taxes assessed by the foreign government in the
country

receiving U.S. assistance is to be reported. Foreign taxes by a third
party foreign

government are not to be reported. For example, if an assistance program
for

Lesotho involves the purchase of commodities in South Africa using
foreign

assistance funds, any taxes imposed by South Africa would not be
reported in

the report for Lesotho (or South Africa).

\(vi\) Any reimbursements received by the Recipient during the period in
(iv)

regardless of when the foreign tax was assessed and any reimbursements
on the

taxes reported in (iv) received through March 31.

\(vii\) Report is required even if the recipient did not pay any taxes
during the

\(viii\) Cumulative reports may be provided if the recipient is
implementing more

than one program in a foreign country.

c\. Definitions. For purposes of this clause:

\(i\) "Agreement" includes USAID direct and country contracts, grants,

cooperative agreements and interagency agreements.

\(ii\) "Commodity" means any material, article, supply, goods, or
equipment.

\(iii\) "Foreign government" includes any foreign governmental entity.

\(iv\) "Foreign taxes" means value-added taxes and custom duties
assessed by

a foreign government on a commodity. It does not include foreign sales
taxes.

d\. Where. Submit the reports to: \[insert address and point of contact
at the

Embassy, Mission or FM/CMP as appropriate. see b. below\] \[optional
with a copy

to \]

e\. Subagreements. The recipient must include this reporting requirement
in all

applicable subcontracts, subgrants and other subagreements.

f\. For further information see
**http://www.state.gov/m/rm/c10443.htm**.

**(END OF PROVISION)**

**\*16. FOREIGN GOVERNMENT DELEGATIONS TO INTERNATIONAL CONFERENCES
(JANUARY 2002)**

***APPLICABILITY:*** Include this provision in agreements funded from
the following accounts:

• Development Assistance, including assistance for sub-Saharan Africa,

• Child Survival and Disease Programs Fund, and

• Micro and Small Enterprise Development Program Account.

> **FOREIGN GOVERNMENT DELEGATIONS TO INTERNATIONAL CONFERENCES (JANUARY
> 2002)**

Funds in this agreement may not be used to finance the travel, per diem,
hotel expenses, meals, conference fees or other conference costs for any
member of a foreign government's delegation to an international
conference sponsored by a public international organization, except as
provided in ADS Mandatory Reference "Guidance on Funding Foreign
Government Delegations to International Conferences or as approved by
the Agreement Officer.

> These provisions also must be included in the Standard Provisions of
> any new grant or cooperative agreement to a public international
> organization or a U.S. or non-U.S. nongovernmental organization
> financed with FY04 HIV/AIDS funds or modification to an existing grant
> or cooperative agreement that adds FY04 HIV/AIDS.

**(END OF PROVISION)**

**17. ORGANIZATIONS ELIGIBLE FOR ASSISTANCE (JULY 2004)**

***APPLICABILITY:*** This provision must be included in any Request for
Application (RFA) or Annual Program Statement (APS) that could lead to a
grant or cooperative agreement for activities related to human
trafficking funded from any year program resources.

**ORGANIZATIONS ELIGIBLE FOR ASSISTANCE (JULY 2004)**

The U.S. Government is opposed to prostitution and related activities,
which are

> inherently harmful and dehumanizing, and contribute to the phenomenon
> of trafficking in persons. None of the funds made available under this
> agreement may be used to promote, support or advocate the legalization
> or practice of prostitution. Nothing in the preceding sentence shall
> be construed to preclude assistance designed to ameliorate the
> suffering of, or health risks to, victims while they are being
> trafficked or after they are out of the situation that resulted from
> such victims being trafficked. Foreign organizations, whether prime or
> subrecipients, that receive U.S. Government funds to fight trafficking
> in persons cannot promote, support or advocate the legalization or
> practice of prostitution when they are engaged in overseas activities.
> The preceding sentence shall not apply to organizations that provide
> services to individuals solely after they are no longer engaged in
> activities that resulted from such victims being trafficked.

**(END OF PROVISION)**

**18. PROHIBITION ON THE USE OF FEDERAL FUNDS TO PROMOTE, SUPPORT, OR
ADVOCATE FOR THE LEGALIZATION OR PRACTICE OF PROSTITUTION - ASSISTANCE
(JULY 2004)**

***APPLICABILITY***: This provision must be included in any grant or
cooperative agreement that uses funds made available for activities
related to human trafficking funded from any year program resources.

> **PROHIBITION ON THE USE OF FEDERAL FUNDS TO PROMOTE, SUPPORT, OR
> ADVOCATE FOR THE LEGALIZATION OR PRACTICE OF PROSTITUTION - ASSISTANCE
> (JULY 2004)**

a\. The U.S. Government is opposed to prostitution and related
activities, which are inherently harmful and dehumanizing, and
contribute to the phenomenon of trafficking in persons. None of the
funds made available under this agreement may be used to promote,
support, or advocate the legalization or practice of prostitution.
Nothing in the preceding sentence shall be construed to preclude
assistance designed to ameliorate the suffering of, or health risks to,
victims while they are being trafficked or after they are out of the
situation that resulted from such victims being trafficked.

b\. \[This subsection (b) only applies to foreign non-governmental
organizations and PIOs receiving U.S. Government funds to carry out
programs that target victims of severe forms of trafficking as either
prime awardees or subawardees.\]

> \(1\) For programs that target victims of severe forms of trafficking,
> as a condition of entering into this agreement or subagreement, the
> recipient/subrecipient agrees that in its activities outside of the
> United States and its possessions it does not promote, support, or
> advocate the legalization or practice of prostitution. The preceding
> sentence shall not apply to organizations that provide services to
> individuals solely after they are no longer engaged in activities that
> resulted from such victims being trafficked.

(2) The following definitions apply for purposes of this clause:

> FOREIGN NON-GOVERNMENTAL ORGANIZATION -- The term "foreign
> nongovernmental organization" means an entity that is not organized
> under the laws of any State of the United States, the District of
> Columbia or the Commonwealth of Puerto Rico.
>
> SEVERE FORMS OF TRAFFICKING IN PERSONS. \-- The term ''severe forms of
> trafficking in persons'' means---
>
> \(A\) sex trafficking in which a commercial sex act is induced by
> force, fraud, or
>
> coercion, or in which the person induced to perform such act has not
> attained 18
>
> years of age; or
>
> \(B\) the recruitment, harboring, transportation, provision, or
> obtaining of a
>
> person for labor or services, through the use of force, fraud, or
> coercion for the
>
> purpose of subjection to involuntary servitude, peonage, debt bondage,
> or
>
> slavery.
>
> \(C\) The recipient shall insert this provision in all sub-agreements
> under this
>
> award.
>
> \(D\) This provision includes express terms and conditions of the
> agreement
>
> and any violation of it shall be grounds for unilateral termination,
> in whole or in
>
> part, of the agreement by USAID prior to the end of its term.

**(END OF PROVISION)**

**\*19. ORGANIZATIONS ELIGIBLE FOR ASSISTANCE (JUNE 2005)**

***APPLICABILITY:*** This provision must be included in any agreement
financing HIV/AIDS activities.

**ORGANIZATIONS ELIGIBLE FOR ASSISTANCE (JUNE 2005)**

An organization that is otherwise eligible to receive funds under this
agreement to

> prevent, treat, or monitor HIV/AIDS shall not be required to endorse
> or utilize a multisectoral approach to combating HIV/AIDS, or to
> endorse, utilize, or participate in a prevention method or treatment
> program to which the organization has a religious or moral objection.

**(END OF PROVISION)**

**\*20. CONDOMS (JUNE 2005)**

***APPLICABILITY:*** This provision must be included in any agreement
financing HIV/AIDS activities.

**CONDOMS (JUNE 2005)**

> Information provided about the use of condoms as part of projects or
> activities that are funded under this agreement shall be medically
> accurate and shall include the public health benefits and failure
> rates of such use and shall be consistent with USAID's fact sheet
> entitled, "USAID: HIV/STI Prevention and Condoms. This fact sheet may
> be accessed at:
>
> [**http://www.usaid.gov/our_work/global_health/aids/TechAreas/prevention/**](http://www.usaid.gov/our_work/global_health/aids/TechAreas/prevention/)
>
> **condomfactsheet.html**

**(END OF PROVISION)**

**\*21. PROHIBITION ON THE PROMOTION OR ADVOCACY OF THE**

**LEGALIZATION OR PRACTICE OF PROSTITUTION OR SEX**

**TRAFFICKING (JUNE 2005)**

***APPLICABILITY:*** This provision must be included in any agreement
financing HIV/AIDS activities.

> **PROHIBITION ON THE PROMOTION OR ADVOCACY OF THE LEGALIZATION OR
> PRACTICE OF PROSTITUTION OR SEX TRAFFICKING (JUNE 2005)**

a\. The U.S. Government is opposed to prostitution and related
activities, which are inherently harmful and dehumanizing, and
contribute to the phenomenon of trafficking in persons. None of the
funds made available under this agreement may be used to promote or
advocate the legalization or practice of prostitution or sex
trafficking. Nothing in the preceding sentence shall be construed to
preclude the provision to individuals of palliative care, treatment, or
post-exposure pharmaceutical prophylaxis, and necessary pharmaceuticals
and commodities, including test kits, condoms, and, when proven
effective, microbicides.

b\. Except as noted in the second sentence of this paragraph, as a
condition of entering into this agreement or any subagreement, a
non-governmental organization or public international organization
recipient/subrecipient must have a policy explicitly opposing
prostitution and sex trafficking. The following organizations are exempt
from this paragraph: the Global Fund to Fight AIDS, Tuberculosis and
Malaria; the World Health Organization; the International AIDS Vaccine
Initiative; and any United Nations agency.

c\. The following definition applies for purposes of this provision:

> Sex trafficking means the recruitment, harboring, transportation,
> provision, or obtaining of a person for the purpose of a commercial
> sex act. 22 U.S.C. 7102(9).

d\. The recipient shall insert this provision, which is a standard
provision, in all subagreements.

e\. This provision includes express terms and conditions of the
agreement and any violation of it shall be grounds for unilateral
termination of the agreement by USAID prior to the end of its term.

**(END OF PROVISION)**

**22. USAID DISABILITY POLICY - ASSISTANCE (DECEMBER 2004)**

***APPLICABILITY:*** This provision must be included in Request for
Applications (RFAs), and in awards.

**USAID DISABILITY POLICY - ASSISTANCE (DECEMBER 2004)**

a\. The objectives of the USAID Disability Policy are (1) to enhance the
attainment of United States foreign assistance program goals by
promoting the participation and equalization of opportunities of
individuals with disabilities in USAID policy, country and sector
strategies, activity designs and implementation; (2) to increase
awareness of issues of people with disabilities both within USAID
programs and in host countries; (3) to engage other U.S. government
agencies, host country counterparts, governments, implementing
organizations and other donors in fostering a climate of
nondiscrimination against people with disabilities; and (4) to support
international advocacy for people with disabilities. The full text of
the policy paper can be found at the following website:
<http://pdf.dec.org/pdf_docs/PDABQ631.pdf>

b\. USAID therefore requires that the recipient not discriminate against
people with disabilities in the implementation of USAID funded programs
and that it make every effort to comply with the objectives of the USAID
Disability Policy in performing the program under this grant or
cooperative agreement. To that end and to the extent it can accomplish
this goal within the scope of the program objectives, the recipient
should demonstrate a comprehensive and consistent approach for including
men, women and children with disabilities.

**(END OF PROVISION)**

**23. STANDARDS FOR ACCESSIBILITY FOR THE DISABLED IN**

**USAID ASSISTANCE AWARDS INVOLVING CONSTRUCTION**

**(SEPTEMBER 2004)**

***APPLICABILITY:*** This provision must be included in Request for
Applications (RFAs) and in awards involving construction.

> **STANDARDS FOR ACCESSIBILITY FOR THE DISABLED IN USAID ASSISTANCE
> AWARDS INVOLVING CONSTRUCTION (SEPTEMBER 2004)**

a\. One of the objectives of the USAID Disability Policy is to engage
other U.S. government agencies, host country counterparts, governments,
implementing organizations and other donors in fostering a climate of
nondiscrimination against people with disabilities. As part of this
policy USAID has established standards for any new or renovation
construction project funded by USAID to allow access by people with
disabilities (PWDs). The full text of the policy paper can be found at
the following website: <http://pdf.dec.org/pdf_docs/PDABQ631.pdf>.

b\. USAID requires the recipient to comply with standards of
accessibility for people with disabilities in all structures, buildings
or facilities resulting from new or renovation construction or
alterations of an existing structure.

c\. The recipient will comply with the host country or regional
standards for accessibility in construction when such standards result
in at least substantially equivalent accessibility and usability as the
standard provided in the Americans with Disabilities Act (ADA) of 1990
and the Architectural Barriers Act (ABA) Accessibility Guidelines of
July 2004. Where there are no host country or regional standards for
universal access or where the host country or regional standards fail to
meet the ADA/ABA threshold, the standard prescribed in the ADA and the
ABA will be used.

d\. New Construction. All new construction will comply with the above
standards for accessibility.

e\. Alterations. Changes to an existing structure that affect, the
usability of the structure will comply with the above standards for
accessibility unless the recipient obtains the Agreement Officer's
advance approval that compliance is technically infeasible or
constitutes an undue burden or both. Compliance is technically
infeasible where structural conditions would require removing or
altering a load-bearing member that is an essential part of the
structural frame or because other existing physical or site constraints
prohibit modification or addition of elements, spaces, or features that
are in full and strict compliance with the minimum requirements of the
standard. Compliance is an undue burden where it entails either a
significant difficulty or expense or both.

f\. Exceptions. The following construction related activities are
excepted from the requirements of paragraphs (a) through (d) above:

> \(1\) Normal maintenance, re-roofing, painting or wall papering, or
> changes to mechanical or electrical systems are not alterations and
> the above standards do not apply unless they affect the accessibility
> of the building or facility; and
>
> \(2\) Emergency construction (which may entail the provision of
> plastic sheeting or tents, minor repair and upgrading of existing
> structures, rebuilding of part of existing structures, or provision of
> temporary structures) intended to be temporary in nature. A portion of
> emergency construction assistance may be provided to people with
> disabilities as part
>
> of the process of identifying disaster- and crisis-affected people as
> "most vulnerable."

**(END OF PROVISION)**

# ANNEXES

Annex A: Conditions of Registration for U.S. Organizations

Annex B: TB Elements and Sub-Elements

Annex C: TB Indicators

Annex D: USAID Mission Contact List & Addresses

Annex E: Application Screening Form

Annex F: Beneficiary Calculation Guidelines

Annex G: Program Matrix

Annex H: SF 424 Forms

[]{.mark}

## Annex A: Conditions of Registration for U.S. Organizations

**Conditions of Registration for U.S. Organizations**

There are eight Conditions of Registration for U.S. organizations. The
first four Conditions relate to whether an organization meets the
definition of a U.S. PVO as set forth in 22 CFR Part 203, while the last
four Conditions establish standards by which the U.S. PVO is evaluated.
An applicant must be registered with USAID as a U.S. PVO if USAID finds
that the applicant has satisfied all of the following Conditions:

**Condition No. 1 (U.S. based).**

Is U.S. based in that it:

\(1\) Is organized under the laws of the United States; and

\(2\) Has its headquarters in the United States.

**Condition No. 2 (Private).**

Is a nongovernmental organization (NGO) and solicits and receives cash
contributions from the U.S. general public

**Condition No. 3 (Voluntary).**

Is a charitable organization in that it:

\(1\) Is nonprofit and exempt from Federal income taxes under Section
501(C)(3) of the Internal Revenue Code; and

\(2\) Is not a university, college, accredited degree-granting
institution of education, private foundation, hospital, organization
established by a major political party in the United States,
organization established, funded and audited by the U.S. Congress,
organization engaged exclusively in research or scientific activities,
church, synagogue, mosque or other similar entity organized primarily
for religious purposes.

**Condition No. 4 (Overseas Program Activities).**

Conducts, or anticipates conducting, overseas program activities that
are consistent with the general purposes of the Foreign Assistance Act
and/or Public Law 480.

**Condition No. 5 (Board of Directors).**

Has a governing body:

\(1\) That meets at least annually;

\(2\) Whose members do not receive any form of income for serving on the
board; and

\(3\) Whose majority is not composed of the PVO\'s officers or staff
members.

**Condition No. 6 (Financial Viability).**

That it:

\(1\) Accounts for its funds in accordance with generally accepted
accounting principles (GAAP);

\(2\) Has a sound financial position;

\(3\) Provides its financial statements to the public upon request; and

\(4\) Has been incorporated for not less than 18 months.

**Condition No. 7 (Program Activities vs. Supporting Services).**

That it:

\(1\) Expends and distributes its funds in accordance with the annual
report of program activities;

\(2\) Does not expend more than 40 percent of total expenses on
supporting services.

\(3\) In order to maintain its registration, conducts international
program activities within the last three years. For example, if a U.S.
PVO did not have any international activities for 2004, the current
year, or 2003, but did have activities in 2002, then it would remain
registered. However, if it did not have any international activities in
2005, USAID would remove it from the Registry in 2006 because for the
previous three years (2003, 2004, 2005), it did not conduct any
international activities.

**Condition No. 8 (General Eligibility).**

It is not:

\(1\) Suspended or debarred by an agency of the U.S. Government;

\(2\) Designated as a foreign terrorist organization by the Secretary of
State, pursuant to Section 219 of the Immigration and Nationality Act,
as amended; or

\(3\) The subject of a decision by the Department of State to the effect
that registration or a financial relationship between USAID and the
organization is contrary to the national defense, national security, or
foreign policy interests of the United States.

**Where to Register**

The Office of Private Voluntary Cooperation-American Schools and
Hospitals Abroad (PVCASHA) in the Bureau for Democracy, Conflict and
Humanitarian Assistance (DCHA) registers U.S. PVOs and IPVOs. PVC-ASHA
serves as the focal point for maintaining a productive partnership
between USAID and the PVO community. Organizations interested in
applying for registration are encouraged to visit our Web site at
www.usaid.gov Keyword: PVC-ASHA. Applications are submitted to the
following address:

*Registrar*

*U.S. Agency for International Development*

*DCHA/PVC-ASHA/PPO, Room 7.06-091*

*1300 Pennsylvania Avenue, NW*

*Washington, DC 20523-7600*

[]{.mark}

[]{.mark}

[]{.mark}

[]{.mark}

[]{.mark}

[]{.mark}

[]{.mark}

[]{.mark}

[]{.mark}

[]{.mark}

[]{.mark}

[]{.mark}

[]{.mark}

[]{.mark}

[]{.mark}

[]{.mark}

[]{.mark}

[]{.mark}

## Annex B: Tuberculosis Element and Sub-Elements

**Program Element 3.1.2:** Tuberculosis

> **Sub-Element 3.1.2.1:** DOTS Expansion and Enhancement
>
> **Sub-Element 3.1.2.2:** Drugs for the Treatment of TB
>
> **Sub-Element 3.1.2.3:** Improve Management of TB/HIV
>
> **Sub-Element 3.1.2.4:** Multi Drug Resistant TB (MDR TB)
>
> **Sub-Element 3.1.2.5:** Care and Support
>
> **Sub-Element 3.1.2.6:** Development of New Tools and Improved
> Approaches
>
> **Sub-Element 3.1.2.7:** Health Governance and Finance (TB)
>
> **Sub-Element 3.1.2.8:** Host Country Strategic Information Capacity
>
> **Sub-Element 3.1.2.9:** Program Design and Learning

**[Tuberculosis Element and Sub-Element Definitions]{.underline}**

**Program Element 3.1.2:** Tuberculosis

> **Definition:** Reduce the number of deaths caused by TB by increasing
> detection of cases of TB and by successfully treating detected cases,
> as well as addressing issues of multi-drug resistant TB, TB and HIV,
> and investing in new tools for TB.

**Sub-Element 3.1.2.1:** DOTS Expansion and Enhancement

> **Definition:** Support political commitment and sustained financing
> for TB treatment with supervision and patient support; ensuring
> capacity of TB programs to manage drugs and other commodities;
> monitoring and evaluation; ; interventions to improve DOTS quality;
> and engagement of all public and private providers in DOTS.

**Sub-Element 3.1.2.2:** Drugs for the Treatment of TB

> **Definition:** Procurement of first or second-line drugs to treat TB.
> Includes the costs of goods; freight; insurance to port; clearance
> costs (temporary storage, required quality assurance testing) and
> transport to district/regional warehouses.

**Sub-Element 3.1.2.3:** Improve Management of TB/HIV

> **Definition:** Build capacity for joint TB/HIV planning, monitoring,
> and evaluation; surveillance of HIV prevalence in TB patients; active
> TB case finding in people living with HIV/AIDS (PLWHA); HIV counseling
> and testing in TB patients; cotrimoxazole preventive therapy; referral
> of HIV+ TB patients to ARV treatment services; isoniazid preventive
> therapy; and TB infection control in health facilities and congregate
> settings.

**Sub-Element 3.1.2.4:** Multi Drug Resistant TB (MDR TB)

> **Definition:** Introduce and expand DOTS Plus for MDR TB including
> detection, diagnosis, and treatment of drug resistant TB; measures to
> detect, diagnose and treat extensively drug resistant TB (XDR TB), and
> containment of XDR TB outbreaks; drug resistance surveillance; TB
> infection control in health facilities and congregate settings

**Sub-Element 3.1.2.5:** TB Care and Support

> **Definition:** Support for men and women affected by TB to improve
> early access to treatment and care, especially among the poor; empower
> TB patients and communities; and encourage community civil society
> participation in TB care, with special attention to decreasing stigma
> and discrimination, using communication and social mobilization, and
> the introduction of international standards of care and TB patient
> charters.

**Sub-Element 3.1.2.6:** Development of New Tools and Improved
Approaches

> **Definition:** Support Phase IIB clinical trials and beyond in the
> areas of new drugs, diagnostics, vaccines; development of clinical
> trial capacity; operations research to improve approaches to treatment
> and care.

**Sub-Element 3.1.2.7:** Health Governance and Finance (TB)

> **Definition:** Promote sustainable improvements in health outcomes
> for men/boys and women/girls by reducing key governance and financing
> constraints to the achievement of multiple health element objectives
> and the health area goal overall. These include activities that reduce
> corruption; increase equity; improve efficiency and increase financial
> protection (especially for underserved populations), including in the
> context of financing, organization of services, facility
> construction/renovation, pharmaceutical management, human capacity
> development and management, and strategic information. Note: Operating
> Units should make efforts to report activities that address specific
> earmarks under other sub-elements, reserving the use of the health
> governance and finance sub-element for overarching activities that
> support multiple health elements.

**Sub-Element 3.1.2.8:** Host Country Strategic Information Capacity

> **Definition**: Establish and/or strengthen host country TB management
> information systems (MIS) and their development and use of tools and
> models to collect, analyze and disseminate a variety of information
> related to the program element. These may include, but are not limited
> to MIS for government ministries or other host country institutions,
> needs assessments, baseline studies, censuses and surveys, targeted
> evaluations, special studies, routine surveillance, data quality
> assessments, and operational research. This sub-element may also
> include developing and disseminating best practices and lessons
> learned and testing demonstration and/or pilot models. Related
> training, supplies, equipment, and non-USG personnel are included.

**Sub-Element 3.1.2.9:** Program Design and Learning

> **Definition**: Develop and conduct needs assessments, baseline
> studies, targeted evaluations, special studies or other
> information-gathering efforts specifically for the design, monitoring
> and evaluation of USG-funded programs. This sub-element may also
> include developing and disseminating best practices and lessons
> learned and testing demonstration and/or pilot models or the
> preparation of strategic plans and other short-term programming tasks.
> Note: All such activities that are carried out by partners as an
> integral part of their monitoring and evaluation efforts for programs
> funded under other sub-elements should be included within those
> sub-elements (e.g. ICASS costs).

<http://www.state.gov/documents/organization/101764.pdf>

## Annex C: TB Indicators

Operational indicators for NGO/PVO projects to strengthen TB service
delivery and community-based TB activities

+--------------------+------------------------+-----------------------+
| **Indicators**     | **Comments**           |                       |
+--------------------+------------------------+-----------------------+
| **[Political       |                        | Includes the          |
| commitm            |                        | expansion of project  |
| ent]{.underline}** |                        | activities by         |
|                    |                        | government;           |
| -   Proportion of  |                        | absorption of project |
|     government     |                        | staff and/or staff    |
|     budget for TB  |                        | functions by the      |
|     services.      |                        | public system; and    |
|                    |                        | increased public      |
| -   Number of      |                        | funding or staffing   |
|     government     |                        | resulting from        |
|     staff for      |                        | PVO/NGO efforts.      |
|     essential TB   |                        |                       |
|     services       |                        |                       |
|     (microscopy,   |                        |                       |
|     DOT,           |                        |                       |
|     supervision,   |                        |                       |
|     monitoring)    |                        |                       |
|     (trend)        |                        |                       |
|                    |                        |                       |
| -   Number of      |                        |                       |
|     local PVO and  |                        |                       |
|     community      |                        |                       |
|     groups         |                        |                       |
|     supporting TB  |                        |                       |
|     (trend)        |                        |                       |
+--------------------+------------------------+-----------------------+
| [**Coverage** **at | At least for public    | Indicators of patient |
| district           | health facilities, but | access. TB treatment  |
| lev                | may include NGO and    | should be provided at |
| el:**]{.underline} | private sector         | least by all public   |
|                    | facilities.            | primary health care   |
| -   Number of      |                        | facilities, and DOT   |
|     health         | There should be        | expanded to the       |
|     facilities     | adequate access to     | community through     |
|     with DOTS      | diagnosis and          | community health      |
|     services [^10] | treatment facilities   | workers or            |
|     / total number | for the community.     | volunteers.           |
|     of health      |                        | Microscopy access may |
|     facilities     | One microscopy         | be expanded through   |
|                    | laboratory (one        | organizing collection |
| -   Average number | microscopist) per      | of and regularly      |
|     of square      | 100,000--200,000       | sending sputum        |
|     kilometers for | inhabitants (light     | samples (or prepared  |
|     a health       | microscopy), depending | slides) to the        |
|     facility       | of the workload and    | laboratory, and the   |
|     catchment area | population density.    | use of suspect        |
|     providing TB   |                        | registers.            |
|     treatment,     |                        |                       |
|     diagnosis, or  |                        |                       |
|     both services. |                        |                       |
|                    |                        |                       |
| -   Population by  |                        |                       |
|     TB microscopy  |                        |                       |
|     unit and per   |                        |                       |
|     microscopy     |                        |                       |
|     reader         |                        |                       |
+--------------------+------------------------+-----------------------+
| **[Diagnosis and   | Trend of total and     | There is no target.   |
| case               | pulmonary              | In a good program the |
| detect             | smear-positive TB      | smear-positive cases  |
| ion]{.underline}** | cases reported.        | reported should       |
|                    | Quarterly and annual.  | initially increase    |
| -   Notification   |                        | and then decrease,    |
|                    |                        | due to decrease of TB |
|                    |                        | prevalence in the     |
|                    |                        | community.            |
+--------------------+------------------------+-----------------------+

+---------------------+------------------------+-----------------------+
| -   Number of TB    | This is a **rapid      | The trend is very     |
|     suspects        | indicator** of case    | useful for measuring  |
|     examined by     | detection. It is the   | impact in small areas |
|     sputum          | number of persons      | and short-term        |
|     microscopy      | examined for diagnosis | projects. The number  |
|                     | by microscopy obtained | should increase as a  |
|                     | from the laboratory    | result of community   |
|                     | register or, in        | participation, ACSM,  |
|                     | facilities without a   | and involvement of    |
|                     | laboratory, from a     | private               |
|                     | suspect register.      | practitioners.        |
|                     | About 5% of the adults |                       |
|                     | attending outpatient   | A more complete       |
|                     | facilities for any     | indicator at health   |
|                     | reason have cough of   | facility level is the |
|                     | over 2 weeks.          | % of adult            |
|                     |                        | outpatients with      |
|                     | It is complemented by  | cough \>2 weeks and % |
|                     | the positivity rate (% | examined by sputum    |
|                     | of persons examined    | microscopy.           |
|                     | that have positive     | Operational research  |
|                     | sputum smears). The    | (rapid and not        |
|                     | positivity is usually  | costly) can give the  |
|                     | 5--15% in general      | real prevalence in    |
|                     | facilities and \~20%   | adult outpatients.    |
|                     | in specialized TB or   |                       |
|                     | respiratory clinics,   |                       |
|                     | it should decrease     |                       |
|                     | with improved patient  |                       |
|                     | access and outpatient  |                       |
|                     | care, and with         |                       |
|                     | community              |                       |
|                     | mobilization.          |                       |
+---------------------+------------------------+-----------------------+
| **[Diagnostic       | Number of              | Indicator of medical  |
| qua                 | smear-positive         | criteria. Over 50% of |
| lity]{.underline}** | cases/Total pulmonary  | all cases and over    |
|                     | TB                     | two-thirds of         |
| -   Proportion of   |                        | pulmonary TB should   |
|     TB cases with   | Number of              | be sputum             |
|     bacteriological | smear-positive cases   | smear-positive        |
|     confirmation    | /Total TB cases.       |                       |
+---------------------+------------------------+-----------------------+
| -   Number of       | For staff and          | It can be obtained    |
|     smears done and | laboratory planning    | monthly or annually,  |
|     average per     | and to ensure quality. | directly from the     |
|     microscopist /  | The optimum is more    | laboratory register.  |
|     day             | than 2 and less than   |                       |
|                     | 20 smears read per day |                       |
|                     | per microscopist       |                       |
|                     | (light microscopy).    |                       |
+---------------------+------------------------+-----------------------+
| -   Proportion of   | Based on re-reading of | The existence of any  |
|     major errors    | a sample of slides by  | system of quality     |
|     [^11] in TB     | a reference            | assurance (QA) is     |
|     microscopy      | laboratory. There are  | essential to ensure   |
|                     | various valid systems  | microscopy quality.   |
|                     | to select the sample.  |                       |
|                     | Less than 1% error is  |                       |
|                     | desirable.             |                       |
+---------------------+------------------------+-----------------------+

+---------------------+-----------------------+------------------------+---+
| **[Treatment        | \% of cases cured and | Treatment success      |   |
| qua                 | % of treatment        | (global target \>85%)  |   |
| lity]{.underline}** | completed (added is   | and default (target    |   |
|                     | the % of treatment    | \<5%) are the most     |   |
| -   Cohort analysis | success)              | useful. In areas with  |   |
|     of treatment    |                       | high HIV infection,    |   |
|     outcomes,       | \% failure, %         | deaths during          |   |
|     mainly for new  | default, % death, %   | treatment is an        |   |
|     smear positive  | transfers.            | indicator of           |   |
|     pulmonary cases |                       | appropriate TB/HIV     |   |
|                     | Quarterly or annual.  | case management.       |   |
|                     | The same analysis can |                        |   |
|                     | be done for           | The results are too    |   |
|                     | re-treatments         | late to monitor impact |   |
|                     | (defaults, relapses   | of most PVO/NGO        |   |
|                     | and failures in       | project grants.        |   |
|                     | separate); and for    |                        |   |
|                     | chronic and MDR.      |                        |   |
+---------------------+-----------------------+------------------------+---+
| -   Sputum          | It is a **rapid       | It measures the        |   |
|     conversion rate | indicator**---a       | capacity to keep       |   |
|                     | surrogate for the     | patients on treatment  |   |
|                     | success rate.         | during the initial     |   |
|                     | Proportion of new     | phase, control their   |   |
|                     | smear-positive        | evolution, and reduce  |   |
|                     | patients that were    | the number of bacilli. |   |
|                     | examined by sputum    |                        |   |
|                     | microscopy **and**    |                        |   |
|                     | showed smear          |                        |   |
|                     | negativity 2 or 3     |                        |   |
|                     | months after starting |                        |   |
|                     | treatment.            |                        |   |
+---------------------+-----------------------+------------------------+---+
| **[Knowledge,       | Repeated KAP or focus | The main objective is  |   |
| attitudes, and      | group studies:        | to change behavior     |   |
| pract               |                       | (practices) to         |   |
| ices]{.underline}** | \- Population         | accelerate diagnosis   |   |
|                     | knowledge that long   | and facilitate         |   |
| -   \% change in    | duration cough may be | compliance with        |   |
|     KAP             | TB, that TB is        | treatment.             |   |
|                     | curable, and that     |                        |   |
| -   \% of patients  | treatment is free of  | A major objective is   |   |
|     that            | charge in public      | to test methods to     |   |
|     participated in | facilities or         | facilitate DOT for the |   |
|     the selection   | interventions.        | patient, and observe   |   |
|     of their DOT    |                       | their efficacy through |   |
|     provider and    | \- TB patient         | treatment outcome.     |   |
|     place of        | knowledge about       | Partial DOT or         |   |
|     treatment       | treatment duration.   | self-administered      |   |
|     (staff          |                       | doses with community   |   |
|     practices)      | DOT is defined as     | support should be      |   |
|                     | direct observation of | documented and         |   |
| -   Number of       | drug intake by        | evaluated.             |   |
|     patients        | another person (in a  |                        |   |
|     referred for    | health facility, by   |                        |   |
|     treatment by    | health staff, by      |                        |   |
|     private         | community health      |                        |   |
|     providers to    | workers or            |                        |   |
|     the public      | volunteers, or by     |                        |   |
|     health          | family members).      |                        |   |
|     facilities      |                       |                        |   |
|     (trend)         |                       |                        |   |
|                     |                       |                        |   |
| -   \% of patients  |                       |                        |   |
|     on DOT          |                       |                        |   |
+---------------------+-----------------------+------------------------+---+
| **[TB               | For areas where the   | They measure the       |   |
| /HIV]{.underline}** | prevalence of HIV in  | capacity to treat HIV  |   |
|                     | the community and in  | infection in TB        |   |
| -   \% of TB        | TB patients is high,  | patients, and to       |   |
|     patients tested | the recommended       | reduce deaths during   |   |
|     for HIV         | policy is to offer    | TB treatment.          |   |
|                     | HIV testing to all TB |                        |   |
| -   \% of new TB    | patients, to treat    |                        |   |
|     patients        | all HIV-infected TB   |                        |   |
|     positive for    | patients with CPT,    |                        |   |
|     HIV             | and to provide ART as |                        |   |
|                     | per national          |                        |   |
| -   \% of TB/HIV    | guidelines.           |                        |   |
|     patients on CPT |                       |                        |   |
|                     |                       |                        |   |
| -   Number of       |                       |                        |   |
|     TB/HIV patients |                       |                        |   |
|     on ART          |                       |                        |   |
|                     |                       |                        |   |
| -   \% deaths       |                       |                        |   |
|     during TB       |                       |                        |   |
|     treatment       |                       |                        |   |
+---------------------+-----------------------+------------------------+---+

## 

## Annex D: USAID Mission Contact List & Addresses

  --------------------------- ---------------------- ------------------------ ------------------------
  **[Country]{.underline}**   **[Contact Name,       **[Official              **[Commercial
                              title]{.underline}**   Address]{.underline}**   Address]{.underline}**

  **[New Partner, Innovation                                                  
  Categories]{.underline}**                                                   

  ***[ASIA NEAR                                                               
  EAST]{.underline}***                                                        

  Afghanistan                 **Faiz Mohammad**      USAID/Afghanistan 6180   USAID/Afghanistan U.S.
                              Health Team Leader     Kabul Place Dulles, VA   Embassy Cafe Compound
                              fmohammad@usaid.gov    20189-6180               Great Masood Road Kabul,
                              873-762-311-955                                 Afghanistan
                              202.216.6288                                    

  Bangladesh                  **Dr. Sukumar Sarker** USAID/Bangladesh         USAID/Bangladesh Madani
                              Project Management     Department of State      Avenue Baridhara Dhaka
                              Specialist             Washington, DC           1212 Bangladesh
                              ssarker@usaid.gov      20521-6120               
                              8855500-22 Ext. 2313                            

  Cambodia                    **Mary Lynn McKeon**   USAID/Cambodia US        USAID Cambodia US
                              Team Leader, Maternal  Embassy \# 1 Street 96   Embassy \# 1 Street 96
                              Child and Reproductive Phnom Penh, Cambodia     Phnom Penh, Cambodia
                              Health                                          
                              mmckeon@usaid.gov                               
                              855-23-728316                                   

  East Timor                  **Teodulo Ximenes**    USAID/ East Timor 8250   USAID/East Timor Dr.
                              Health Officer         Dili Place\              Sergio Vieira de Mello
                              tximenes@usaid.gov 670 Washington, DC           Road\
                              332-2211/2, Ext. 2032  20521-8250               Lighthouse Area, Farol\
                                                                              Dili, Timor-Leste

  India                       **Manju Ranjan Seth**  USAID/New Delhi          USAID/ India American
                              Program Management     Department of State      Embassy Chanakypuri New
                              Associate              Washington, DC           Delhi 110 021 India
                              mranjan@usaid.gov 2419 20521-6120               
                              8400 (X: 8491)                                  

  Indonesia                   **Charles Oliver**     USAID/Indonesia American USAID/Indonesia American
                              Health Team Leader     Embassy Jakarta Unit     Embassy Jakarta Unit
                              coliver@usaid.gov      8135 APO AP 96520        8135 APO AP 96520
                              (6221) 3435-9394                                
  --------------------------- ---------------------- ------------------------ ------------------------

+--------+-------------------+-------------------+--------------------+
| *      | **[Contact Name,  | **[Official       | **[Commercial      |
| *[Coun | tit               | Addre             | Addr               |
| try]{. | le]{.underline}** | ss]{.underline}** | ess]{.underline}** |
| underl |                   |                   |                    |
| ine}** |                   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Laos   | **Cathy Jane      | USAID/Regional    | USAID/Regional     |
|        | Bowes** Director, | Development       | Dev. Mission Asia  |
|        | Office of Public  | Mission American  |                    |
|        | Health            | Embassy Bangkok   | Diethelm Towers    |
|        | cbowes@usaid.gov  | Unit 8135 USAID   | Tower A Third      |
|        | 662-263-7404      | APO AP 96546      | Floor Suite 303    |
|        |                   |                   | 93/1 Wireless RD   |
|        |                   |                   | Bangkok 10330 Laos |
+--------+-------------------+-------------------+--------------------+
| Nepal  | **Dharmpal        | USAID/Kathmandu   | USAID P.O. Box 295 |
|        | Raman** Program   | Department of     | US Embassy Mission |
|        | Specialist        | State Washington, | Maharajgunj,       |
|        | draman@usaid.gov  | DC 20521-6330     | Chakrapath         |
|        | +977-1-400-7200   |                   | Kathmandu Nepal    |
|        | Ext. 4147         |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Papua  | **Cathy Jane      | USAID/Regional    | USAID/US Regional  |
| New    | Bowes** Director, | Development       | Dev. Mission Asia  |
| Guinea | Office of Public  | Mission/Asia      |                    |
|        | Health            | American Embassy  | Diethelm Towers,   |
|        | cbowes@usaid.gov  | Bangkok Unit 8135 |                    |
|        | 662-263-7404      | USAID APO AP      | Tower A Third      |
|        |                   | 96546             | Floor, Suite 303,  |
|        |                   |                   | 93/1 Wireless RD   |
|        |                   |                   | Bangkok 10330      |
|        |                   |                   | Papua              |
+--------+-------------------+-------------------+--------------------+
| Phili  | **Maria Paz G. de | USAID/Philippines | USAID/Philippines  |
| ppines | Sagun** Deputy    | P.O.Box EA423     | PSC 502 Box 1 FPO  |
|        | Chief, Office of  | 1000 Ermita       | AP 96515-1200      |
|        | Health            | Manila            |                    |
|        | mde@usaid.gov     | Philippines       |                    |
|        | (632) 552-9866    |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Th     | **Cathy Jane      | USAID/Regional    | USAID/Regional     |
| ailand | Bowes** Director, | Development       | Dev. Mission/Asia  |
|        | Office of Public  | Mission/Asia      | Diethelm Towers    |
|        | Health            | American Embassy  | Tower A 3rd Fl,    |
|        | cbowes@usaid.gov  | Bangkok Unit 8135 | Suite 303 93/1     |
|        | 662-263-7404      | USAID APO AP      | Wireless Road      |
|        |                   | 96546             | Bangkok 10330      |
|        |                   |                   | Thailand           |
+--------+-------------------+-------------------+--------------------+
| V      | **Loi Tien Ngo**  | USAID/Vietnam     | USAID/Vietnam 15/F |
| ietnam | Development       | 4550 Hanoi Place  | Tung Shing Square  |
|        | Specialist        | Washington, DC    | #2 Ngo Quyen       |
|        | Ingo@usaid.gov    | 20521-4550        | Street Hanoi,      |
|        | 84-4-935-1260     |                   | Vietnam            |
+--------+-------------------+-------------------+--------------------+
| Yemen  | **Iman Awad**     | USAID/Yemen       | USAID/Yemen c/o    |
|        | Senior Health     | Department of     | American Embassy   |
|        | Advisor and Team  | State Washington, | Sa\'awan Street    |
|        | Leader            | DC 20521-6330     | P.O. Box 22347     |
|        | awadia@state.gov  |                   | SanaaYemen         |
|        | 00-9671-755-2084  |                   |                    |
+--------+-------------------+-------------------+--------------------+

+--------+-------------------+-------------------+--------------------+
| *      | **[Contact Name,  | **[Official       | **[Commercial      |
| *[Coun | tit               | Addre             | Addr               |
| try]{. | le]{.underline}** | ss]{.underline}** | ess]{.underline}** |
| underl |                   |                   |                    |
| ine}** |                   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| ***    |                   |                   |                    |
| [AFRIC |                   |                   |                    |
| A]{.un |                   |                   |                    |
| derlin |                   |                   |                    |
| e}***  |                   |                   |                    |
|        |                   |                   |                    |
|        |                   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Angola | **Francesca       | USAID/LUANDA      | USAID/Angola c/o   |
|        | Nelso** Deputy    | Department of     | U.S. Embassy\      |
|        | Director of       | State Washington, | Rua Houari         |
|        | Technical         | DC 20521-6330     | Boumedienne #32    |
|        | Programs          |                   | Miramar Luanda,    |
|        | fnelson@usaid.gov |                   | Angola             |
|        | 244-222-641-008   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Benin  | **Pascal          | USAID 2120        | USAID/Benin        |
|        | Zinzindohoue**    | Cotonou PL        | Ambassade          |
|        | Family Health     | Washington DC     | Americaine 01 B.P. |
|        | Team Leader       | 20521             | 2012 Cotonou Benin |
|        | pazinzi           |                   |                    |
|        | ndohoue@usaid.gov |                   |                    |
|        | 229-21-30-05-00   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| B      | **Paul Hoedom     | USAID/WARP        | USAID/Burkina Faso |
| urkina | Sossa** Senior    | Department of     | (WARP) E. 45/3     |
| Faso   | Reproductive and  | State Washington, | Independence       |
|        | Family Health     | DC 20521-2010     | Avenue P.O. Box    |
|        | Specialist        |                   | 1630 Accra,        |
|        | psossa@usaid.gov  |                   | Burkina            |
|        | 00-233-21-741-200 |                   |                    |
|        | 0                 |                   |                    |
|        | 0-233-244-329-941 |                   |                    |
+--------+-------------------+-------------------+--------------------+
| B      | **Dr. Donatien    | USAID/Bujumbura   | USAID/Burundi      |
| urundi | Ntakarutimana MD, | Department of     | co/US Embassy      |
|        | MPH** Program     | State APO AE      | Bujumbura Burundi  |
|        | Development       | 09831-4102        | 1 Avenue des       |
|        | Specialist        | Washington, DC    | Etats- Unis P.O.   |
|        | (Health)          |                   | Box 1720 Bujumbura |
|        | Ntakaruti         |                   | Bujumbura Burundi  |
|        | mananDM@state.gov |                   |                    |
|        | 257-222-436-25    |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Ca     | **Paul Hoedom     | USAID/WARP        | USAID/Cameroon     |
| meroon | Sossa** Senior    | Department of     | (WARP) E. 45/3     |
|        | Reproductive and  | State Washington, | Independence       |
|        | Family Health     | DC 20521-2010     | Avenue P.O. Box    |
|        | Specialist        |                   | 1630 Accra,        |
|        | psossa@usaid.gov  |                   | Cameroon           |
|        | 00-233-21-741-200 |                   |                    |
|        | 0                 |                   |                    |
|        | 0-233-244-329-941 |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Cape   | **Paul Hoedom     | USAID/WARP        | USAID/Cape Verde   |
| Verde  | Sossa** Senior    | Department of     | (WARP) E. 45/3     |
|        | Reproductive and  | State Washington, | Independence       |
|        | Family Health     | DC 20521-2010     | Avenue P.O. Box    |
|        | Specialist        |                   | 1630 Accra, Cape   |
|        | psossa@usaid.gov  |                   | Verde              |
|        | 00-233-21-741-200 |                   |                    |
|        | 0                 |                   |                    |
|        | 0-233-244-329-941 |                   |                    |
+--------+-------------------+-------------------+--------------------+

  --------------------------- ---------------------- ------------------------ ------------------------
  **[Country]{.underline}**   **[Contact Name,       **[Official              **[Commercial
                              title]{.underline}**   Address]{.underline}**   Address]{.underline}**

  Chad                        **Paul Hoedom Sossa**  USAID/WARP Department of USAID/Chad (WARP) E.
                              Senior Reproductive    State Washington, DC     45/3 Independence Avenue
                              and Family Health      20521-2010               P.O. Box 1630 Accra,
                              Specialist                                      Chad
                              psossa@usaid.gov                                
                              00-233-21-741-200                               
                              00-233-244-329-941                              

  Cote d\'Ivoire              **Paul Hoedom Sossa**  USAID/WARP Department of USAID/Cote d\'Ivoire
                              Senior Reproductive    State Washington, DC     (WARP) E. 45/3
                              and Family Health      20521-2010               Independence Avenue P.O.
                              Specialist                                      Box 1630 Accra, Cote
                              psossa@usaid.gov                                
                              00-233-21-741-200                               
                              00-233-244-329-941                              

  Ethiopia                    **Dr. Mulugeta Wolde   USAID/Addis Ababa        USAID/Ethiopia Riverside
                              Yohannes** Public      Department of State      Building, off Haile
                              Health Specialist      Washington, DC 0521-2030 G/Selassie Rd. P.O. Box
                              mwyohannes@usaid.gov                            1014 Addis Ababa
                              251-11-551-0088 Ext.                            Ethiopia
                              231                                             

  Equatorial Guinea           **Paul Hoedom Sossa**  USAID/WARP Department of USAID/Equatorial Guinea
                              Senior Reproductive    State Washington, DC     (WARP) E. 45/3
                              and Family Health      20521-2010               Independence Avenue P.O.
                              Specialist                                      Box 1630
                              psossa@usaid.gov                                Accra,Equatorial Guinea
                              00-233-21-741-200                               
                              00-233-244-329-941                              

  Gabon                       **Paul Hoedom Sossa**  USAID/WARP Department of USAID/Gabon (WARP) E.
                              Senior Reproductive    State Washington, DC     45/3 Independence Avenue
                              and Family Health      20521-2010               P.O. Box 1630 Accra,
                              Specialist                                      Gabon
                              psossa@usaid.gov                                
                              00-233-21-741-200                               
                              00-233-244-329-941                              

  The Gambia                  **Paul Hoedom Sossa**  USAID/WARP Department of USAID/The Gambia (WARP)
                              Senior Reproductive    State Washington, DC     E. 45/3 Independence
                              and Family Health      20521-2010               Avenue P.O. Box 1630
                              Specialist                                      Accra, The Gambia
                              psossa@usaid.gov                                
                              00-233-21-741-200                               
                              00-233-244-329-941                              
  --------------------------- ---------------------- ------------------------ ------------------------

  --------------------------- ---------------------------- ------------------------ ------------------------
  **[Country]{.underline}**   **[Contact Name,             **[Official              **[Commercial
                              title]{.underline}**         Address]{.underline}**   Address]{.underline}**

  Ghana                       **Juliana A. Pwamang**       USAID/WARP Department of USAID/Ghana No. 24
                              Health Program Specialist    State Washington, DC     Fourth Circular Rd
                              jpwamang@usaid.gov           20521-2010               Cantonments P. O. Box
                              233-21-741-200 Ext. 1719                              1630 Accra, Ghana West
                              233-21-741-719                                        Africa

  Guinea                      **Dr. Mariama Cire Bah, MD,  USAID/Guinea\            USAID/Guinea c/o
                              MPH** Reproductive Health    Department of State 2110 American Embassy Centre
                              Specialist mbah@usaid.gov    Conakry Place Washington Administrative Koloma\
                              (224) 65 10 40 00 Ext. 4688\ DC. 20521-2110           Transversale No. 2 BP
                              (224) 64 45 17 34                                     603 Conakry Repulic of
                                                                                    Guinea

  Guinea-Bissau               **Paul Hoedom Sossa** Senior USAID/WARP Department of USAID/Guinea
                              Reproductive and Family      State Washington, DC     Bissau(WARP) E. 45/3
                              Health Specialist            20521-2010               Independence Avenue P.O.
                              psossa@usaid.gov                                      Box 1630 Accra, Guinea
                              00-233-21-741-200                                     Bissau
                              00-233-244-329-941                                    

  Kenya                       **Dr. Sheila N. Macharia**   USAID/Kenya Unit 64102   USAID/Kenya c/o US
                              Reproductive Health Serices  APO AE 09831-4102        Embassy United Nations
                              Specialist                                            Avenue Gigiri Nairobi,
                              smacharia@usaid.gov                                   Kenya
                              254.20.862.2234                                       

  Liberia                     **Christopher McDermott**    USAID/Monrovia           USAID/West Africa
                              Health Team Leader           Department of State      Regional Mission E. 45/3
                              cmcdermott@usaid.gov         Washington, DC           Independence Avenue
                              231-770-54826 ext. 1829      20521-2010               P.O.Box 1630 Accra,
                                                                                    Liberia

  Madagascar                  **Benjamin Andriamitantsoa** USAID/Antananarivo       USAID/Madagascar Tour
                              Child Survival, Nutrition    Department of State      Zital, 6th floor ZI
                              and Family Planning Manager  Washington, DC           Taloumis Ankorondrano
                              bandriamitantsoa@usaid.gov   20521-2040               B.P. 5253 Antananarivo,
                              261.20.22.539.20                                      Madagascar

  Malawi                      **Catherine Chipazi** Child  USAID/Malawi P.O. Box    USAID/Malawi NICO House
                              Health Specialist            30455 Lilongwe 3.Malawi  City Centre Lilongwe
                              cchipazi@usaid.gov                                    Malawi
                              265-1-772-455                                         
  --------------------------- ---------------------------- ------------------------ ------------------------

  --------------------------- ---------------------- ------------------------ ------------------------
  **[Country]{.underline}**   **[Contact Name,       **[Official              **[Commercial
                              title]{.underline}**   Address]{.underline}**   Address]{.underline}**

  Mali                        **Bob de Wolfe**       USAID/Bamako Department  USAID/Mali US Embassy BP
                              Deputy Team Leader -   of State Washington, DC  34 Bamako
                              Health                 20521-2010               
                              bdewolfe@usaid.gov                              
                              223-270-2728                                    

  Mauritania                  **Paul Hoedom Sossa**  USAID/WARP Department of USAID/Mauritania (WARP)
                              Senior Reproductive    State Washington, DC     E. 45/3 Independence
                              and Family Health      20521-2010               Avenue P.O. Box 1630
                              Specialist                                      Accra, Mauritania
                              psossa@usaid.gov                                
                              00-233-21-741-200                               
                              00-233-244-329-941                              

  Mozambique                  **Jeri Dible**         USAID/ Mozambique 2330   USAID/Mozambique JAT
                              Population, Health,    Maputo Place Dulles, VA  Complex, Rua 1231, No.
                              Nutrition Officer      20189                    41 P.O. Box 73 Maputo
                              jdible@usaid.gov                                Mozambique
                              258-213-250-66                                  

  Namibia                     **Sangita Patel**      USAID/Namibia 2540       USAID/Namibia Channel
                              Health and Development Windhoek Place Dulles,   Life Tower 6th Floor 39
                              Officer                VA 20189                 Post Street Mall
                              spatal@usaid.gov                                Windhoek, Namibia
                              264-61-273-710                                  

  Niger                       **Paul Hoedom Sossa**  USAID/WARP Department of USAID/Niger(WARP) E.
                              Senior Reproductive    State Washington, DC     45/3 Independence Avenue
                              and Family Health      20521-2010               P.O. Box 1630 Accra,
                              Specialist                                      Niger
                              psossa@usaid.gov                                
                              00-233-21-741-200                               
                              00-233-244-329-941                              

  Nigeria                     **Garba Adbu** Senior  USAID/Nigeria 7-9        USAID/Nigeria P.M.B 519
                              Program Manager, Child Mambilla Street Abuja    Garki Abuja Nigeria
                              Survival               Nigeria                  
                              gabdu@usaid.gov                                 
                              234-9-461-9389                                  

  Rwanda                      **Patrick Condo**      USAID/Kigali Department  USAID/Rwanda 55 Avenue
                              Malaria Program        of State Washington, DC  Paul VI Kigali Rwanda
                              Specialist             20521-2210               
                              pcondo@usaid.gov                                
                              250-596-800                                     
  --------------------------- ---------------------- ------------------------ ------------------------

  --------------------------- ---------------------- ------------------------ ------------------------
  **[Country]{.underline}**   **[Contact Name,       **[Official              **[Commercial
                              title]{.underline}**   Address]{.underline}**   Address]{.underline}**

  Sao Tome/Principe           **Paul Hoedom Sossa**  USAID/WARP Department of USAID/Sao
                              Senior Reproductive    State Washington, DC     Tome/Principe(WARP) E.
                              and Family Health      20521-2010               45/3 Independence Avenue
                              Specialist                                      P.O. Box 1630 Accra Sao
                              psossa@usaid.gov                                Tome/Principe
                              00-233-21-741-200                               
                              00-233-244-329-941                              

  Senegal                     **Amadou Baye Mbow**   USAID/Dakar Department   USAID/Senegal\
                              MCH Specialist         of State Washington, DC  Ngor Diarama, Petit
                              ambow@usaid.gov        20521-2010               Ngor\
                              221-33-869-6194                                 B.P. 49 Dakar, Senegal

  Sierra Leone                **Paul Hoedom Sossa**  USAID/WARP Department of USAID/Sierra Leone
                              Senior Reproductive    State Washington, DC     (WARP) E. 45/3
                              and Family Health      20521-2010               Independence Avenue P.O.
                              Specialist                                      Box 1630 Accra, Sierra
                              psossa@usaid.gov                                Leone
                              00-233-21-741-200                               
                              00-233-244-329-941                              

  Somalia                     **Marua Barry**        Somalia Field Ofc.       USAID/Somalia USAID
                              Somalia Program        REDSO/ESA Department of  Nairobi Complex Annex
                              Manager                State Washington,        c/o American Embassy
                              mabarry@usaid.gov      DC20521-8900             United Nations Avenue
                              254-20-862-20-00 Ext.                           Gigiri Nairobi Somalia
                              2205                                            

  South Africa                **Anne Gaven**         USAID/South Africa P.O.  USAID/Pretoria 100
                              Population, Health and Box 43 Pretoria 0027     Totius Street Groenkloof
                              Nutrition Officer                               Pretoria
                              ageven@usaid.gov                                
                              012-452-2245                                    

  Sudan                       **Khakijat L. Mojidi** American Embassy/USAID   USAID/Sudan USAID
                              Health Office/Team     Unit 63900 APO AE        Nairobi Complex Annex,
                              Leader                 09829-3900               c/o American Embassy
                              kmojidi@usaid.gov                               United Nations Avenue
                              202-216-6279 Ext. 113                           Gigiri Nairobi Sudan
  --------------------------- ---------------------- ------------------------ ------------------------

+--------+-------------------+-------------------+--------------------+
| *      | **[Contact Name,  | **[Official       | **[Commercial      |
| *[Coun | tit               | Addre             | Addr               |
| try]{. | le]{.underline}** | ss]{.underline}** | ess]{.underline}** |
| underl |                   |                   |                    |
| ine}** |                   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Ta     | **Dr. Sithara     | USAID Tanzania    | USAID Tanzania 686 |
| nzania | Batcha** Mission  | 686 Old Bagamoyo  | Old Bagamoyo Rd.   |
|        | CSHGP T.O.        | Rd. Msasani Dar   | Msasani Dar es     |
|        | sbatcha@usaid.gov | es Salaam,        | Salaam, Tanzania   |
|        | 255-22-266-8490   | Tanzania          |                    |
|        | Ext. 8072         |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Togo   | **Paul Hoedom     | USAID/WARP        | USAID/Togo(WARP)   |
|        | Sossa** Senior    | Department of     | E. 45/3            |
|        | Reproductive and  | State Washington, | Independence       |
|        | Family Health     | DC 20521-2010     | Avenue P.O. Box    |
|        | Specialist        |                   | 1630 Accra, Togo   |
|        | psossa@usaid.gov  |                   |                    |
|        | 00-233-21-741-200 |                   |                    |
|        | 0                 |                   |                    |
|        | 0-233-244-329-941 |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Uganda | **Rachel          | USAID/Uganda 42   | USAID/Uganda 42    |
|        | Cintron** PHN     | Nakasero Road     | Nakasero Road      |
|        | Officer           | Kampala, Uganda   | Kampala, Uganda    |
|        | r                 |                   |                    |
|        | cintron@usaid.gov |                   |                    |
|        | 0                 |                   |                    |
|        | 11-256-41-306-574 |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Zambia | **Dr. Oliver      | USAID/Lusaka      | USAID/Zambia       |
|        | Lulembo**         | Department of     | Mission 351        |
|        | o                 | State Washington, | Independence Ave   |
|        | lulembo@usaid.gov | DC 20521-2310     | Lusaka Zambia      |
|        | 260-211-254-303   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| ***[   |                   |                   |                    |
| EUROPE |                   |                   |                    |
| &      |                   |                   |                    |
| EURASI |                   |                   |                    |
| A]{.un |                   |                   |                    |
| derlin |                   |                   |                    |
| e}***  |                   |                   |                    |
|        |                   |                   |                    |
|        |                   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| A      | **Astghik         | USAID/Yerevan     | USAID Armenia 1    |
| rmenia | Grigoryan**       | Department of     | American Avenue    |
|        | Project           | State Washington, | Yerevan, 0082      |
|        | Management        | DC 20521-2310     | Armenia            |
|        | Specialist        |                   |                    |
|        | agr               |                   |                    |
|        | igoryan@usaid.gov |                   |                    |
|        | 374-10-464-700    |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Azer   | **Tara Milani**   | USAID Azerbaijan  | USAID Azerbaijan   |
| baijan | Health            | 83 Azadlig Avenue | 83 Azadlig Avenue  |
|        | Development       | Baku, Azerbaijan  | Baku, Azerbaijan   |
|        | Officer           |                   |                    |
|        | tmilani@usaid.gov |                   |                    |
|        | 994-12-498-1835   |                   |                    |
|        | Ext. 114          |                   |                    |
+--------+-------------------+-------------------+--------------------+
| G      | **Tamara          | USAID/Tblisi      | USAID Caucasus     |
| eorgia | Sirbilazdze**     | Department of     | Mission 25 Atoneli |
|        | Health Specialist | State Washington, | Street Tblisi,     |
|        | tsir              | DC 20251-7060     | Georgia            |
|        | biladze@usaid.gov |                   |                    |
|        | 995-32-778-540,   |                   |                    |
|        | 995-33-001-013    |                   |                    |
+--------+-------------------+-------------------+--------------------+

+--------+-------------------+-------------------+--------------------+
| *      | **[Contact Name,  | **[Official       | **[Commercial      |
| *[Coun | tit               | Addre             | Addr               |
| try]{. | le]{.underline}** | ss]{.underline}** | ess]{.underline}** |
| underl |                   |                   |                    |
| ine}** |                   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Kyrg   | **Damira          | USAID/Bishkek     | U.S. Embassy to    |
| yzstan | Bibosunova**      | Department of     | Kyrgyz Republic    |
|        | Health Specialist | State Washington, | 171 Mir Prospect   |
|        | dbib              | DC 20521-2310     | Bishkek 720016     |
|        | osunova@usaid.gov |                   | Kyrgyz Republic    |
|        | 10-               |                   |                    |
|        | 88-216-711-043-20 |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Russia | **Alyssa Wilson   | American          | USAID/Russia       |
|        | Leggoe** Deputy   | Emb               | American           |
|        | Director Office   | assy/USAID/Moscow | Embassy/Moscow     |
|        | of Health         | PSC 77 APO AE     | 19/23, Novinsky    |
|        | a                 | 09721             | Boulevard 121099   |
|        | lleggoe@usaid.gov |                   | Moscow RUSSIA      |
|        | 7-495-728-5143    |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Taji   | **Malika          | USAID/Dushanbe    | US                 |
| kistan | Makhkambaeva**    | Department of     | AID/CAR/Tajikistan |
|        | Health Specialist | State Washington, | c/o U.S. Embassy   |
|        | mmakhk            | DC 20189-7090     | Dushanbe 109-A     |
|        | ambaeva@usaid.gov |                   | Ismoili Somoni     |
|        | 1                 |                   | Avenue Dushanbe    |
|        | 0-992-37-229-2000 |                   | 734019 Tajikistan  |
+--------+-------------------+-------------------+--------------------+
| Turkme | **Elena           | USAID/Ashgabad    | USAID Turkmenistan |
| nistan | Samarkina**       | Department of     | 1, Yunus Emre Str. |
|        | Health Specialist | State             | International      |
|        | esa               |                   | Business Center    |
|        | markina@usaid.gov | Washington DC     | 744017, Ashgabad   |
|        | 10-993-12-456-130 | 20521-6360        | Turkmenistan       |
+--------+-------------------+-------------------+--------------------+
| U      | **Leslie Perry**  | USAID Ukraine 19  | USAID Ukraine 19   |
| kraine | lperry@usaid.gov  | Nizhniy Val,      | Nizhniy Val, 04071 |
|        | 01                | 04071 Kyiv,       | Kyiv, Ukraine      |
|        | 1-380-445-374-602 | Ukraine           |                    |
+--------+-------------------+-------------------+--------------------+
| Uzbe   | **Ben Mills**     | DOS/USAID\        | USAID Uzbekistan 3 |
| kistan | Health Officer    | 7110 Tashkent     | Moyqorghon Street  |
|        | bmills@usaid.gov  | Place\            | 5th Block,         |
|        | 10                | Washington, DC    | Yunusobod District |
|        | -998-71-140-24-86 | 20521             | 100093 Tashkent    |
|        |                   |                   | Uzbekistan         |
+--------+-------------------+-------------------+--------------------+

+--------+-------------------+-------------------+--------------------+
| *      | **[Contact Name,  | **[Official       | **[Commercial      |
| *[Coun | tit               | Addre             | Addr               |
| try]{. | le]{.underline}** | ss]{.underline}** | ess]{.underline}** |
| underl |                   |                   |                    |
| ine}** |                   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| ***    |                   |                   |                    |
| [LATIN |                   |                   |                    |
| A      |                   |                   |                    |
| MERICA |                   |                   |                    |
| &      |                   |                   |                    |
| C      |                   |                   |                    |
| ARIBBE |                   |                   |                    |
| AN]{.u |                   |                   |                    |
| nderli |                   |                   |                    |
| ne}*** |                   |                   |                    |
|        |                   |                   |                    |
|        |                   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Dom    | **Angela Franklyn | USAID/Santo       | USAID/Santo        |
| inican | Lord** Mission    | Domingo Unit      | Domingo Calle      |
| Re     | Technical Officer | #5541 APO AA      | Leopoldo Navarro   |
| public | alord@usaid.gov   | 34041-5541        | #12, Gazcue Santo  |
|        | 809-731-7014      |                   | Domingo Dominican  |
|        |                   |                   | Republic           |
+--------+-------------------+-------------------+--------------------+
| E      | **Paulyna         | USAID Ecudaor     | USAID Ecudaor Ave. |
| cuador | Martinez**        | Ave. Avigiras     | Avigiras E12-170 y |
|        | Program           | E12-170 y Ave.    | Ave. Eloy Alfaro   |
|        | Development       | Eloy Alfaro       |                    |
|        | Specialist        |                   |                    |
|        | pm                |                   |                    |
|        | artinez@usaid.gov |                   |                    |
|        | 593-2-398-5591    |                   |                    |
+--------+-------------------+-------------------+--------------------+
| El     | **Silvia          | USAID/El Salvador | USAID El Salvador  |
| Sa     | Gonzalez**,       | APO AA 34023      | c/o US Embassy     |
| lvador | Budget Analysy    |                   | Urbanizacion y     |
|        | Strategic         |                   | Bulevar Santa      |
|        | Development       |                   | Elena Antigua      |
|        | Office            |                   | Cuscatlan, La      |
|        | sg                |                   | Libertad El        |
|        | onzalez@usaid.gov |                   | Salvador           |
|        | 011-503-2501-3493 |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Haiti  | **Reginalde       | USA               | USAID Haiti U.S.   |
|        | Masse**           | ID/Port-au-Prince | Embassy, Tabarre   |
|        | rmasse@usaid.gov  | Department of     | 41 Tabarre Haiti   |
|        | 011-509-229-3166  | State Washington  |                    |
|        |                   | DC 20521          |                    |
+--------+-------------------+-------------------+--------------------+
| Ho     | **Emma Iriarte**  | USAID/Tegucigalpa | USAID, Oficina de  |
| nduras | Health Office     | Unit# 2927 APO AA | Salud, Frente      |
|        | e                 | 34022             | Consulado Embajada |
|        | iriarte@usaid.gov |                   | EEUU, Av. La Paz,  |
|        | 504-236-9320 Ext  |                   | Tegucigalpa        |
|        | 4735              |                   | HONDURAS           |
+--------+-------------------+-------------------+--------------------+
| Nic    | **Dr. Ivan        | American          | USAID, Embajada    |
| aragua | Tercero** Health  | Emba              | Americanan, Lm 5.5 |
|        | Coordinator       | ssy/USAID/Managua | Carretera Sur,     |
|        | it                |                   | Managua Nicaragua  |
|        | ercerta@usaid.gov |                   |                    |
|        | 011-505-252-7203  |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Peru   | **Luis            | USAID/Lima        | USAID/Peru Av. La  |
|        | Seminario**       | Department of     | Encalada s/n       |
|        | Project Manager   | State Washington, | Monterrico, Surco  |
|        | Office of Health  | DC 20521-3230     | Apartado Postal    |
|        | les               |                   | 1995, Lima 1 Lima, |
|        | minario@usaid.gov |                   | Peru               |
|        | 511-618-1268      |                   |                    |
+--------+-------------------+-------------------+--------------------+

+--------+-------------------+-------------------+--------------------+
| *      | **[Contact Name,  | **[Official       | **[Commercial      |
| *[Coun | tit               | Addre             | Addr               |
| try]{. | le]{.underline}** | ss]{.underline}** | ess]{.underline}** |
| underl |                   |                   |                    |
| ine}** |                   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| **[TB  |                   |                   |                    |
| Categ  |                   |                   |                    |
| ory]{. |                   |                   |                    |
| underl |                   |                   |                    |
| ine}** |                   |                   |                    |
|        |                   |                   |                    |
|        |                   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| **     |                   |                   |                    |
| *[AFRI |                   |                   |                    |
| CA]{.u |                   |                   |                    |
| nderli |                   |                   |                    |
| ne}*** |                   |                   |                    |
|        |                   |                   |                    |
|        |                   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| DR     | **Michele         | USAID/Kinshasa    | USAID/DR Congo 198 |
| Congo  | Russell** Health  | Unit 31550 APO AE | Isiro Avenue       |
|        | Officer           | 09828             | Kinshasa/Gombe DR  |
|        | m                 |                   |                    |
|        | russell@usaid.gov |                   |                    |
|        | 243-81-950-0435   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Et     | **Mesrak Nadew**, | USAID/Ethiopia    | USAID/Ethiopia     |
| hiopia | **Dr**. Public    | Riverside         | Riverside          |
|        | Health Specialist | Building, Off     | Building, Off      |
|        | mnadew@usaid.gov  | Haile             | Haile              |
|        | 01                | Gebe              | Geb                |
|        | 1-251-11-551-0088 | reselasie/Olympia | ereselasie/Olympia |
|        | Ext. 445          | Road PO Box 1014  | Road PO Box 1014   |
|        |                   | Addis Ababa,      | Addis Ababa,       |
|        |                   | Ethiopia          | Ethiopia           |
+--------+-------------------+-------------------+--------------------+
| Moza   | **Jeri Dible**    | JAT Complex, Rua  | JAT Complex, Rua   |
| mbique | Population,       | 1231, No. 41, PO  | 1231, No. 41, PO   |
|        | Health, Nutrition | Box 73, Maputo,   | Box 73, Maputo,    |
|        | Officer           | Mozambique        | Mozambique         |
|        | jdible@usaid.gov  |                   |                    |
|        | 011-258-213-52066 |                   |                    |
|        | **Alfredo         |                   |                    |
|        | MacArthur**       |                   |                    |
|        | Infectious        |                   |                    |
|        | Disease Advisor   |                   |                    |
|        | am                |                   |                    |
|        | carthur@usaid.gov |                   |                    |
|        | 01                |                   |                    |
|        | 1-258-213-522-106 |                   |                    |
+--------+-------------------+-------------------+--------------------+
| N      | **Temitayo        | USAID/Nigeria 7-9 | USAID/Nigeria 7-9  |
| igeria | Odusote**, Senior | Mambila Street,   | Mambila Street,    |
|        | Manager, TB and   | off Aso Drive     | off Aso Drive      |
|        | Clinical Care     | Maitama, Abuja,   | Maitama, Abuja,    |
|        | t                 | Nigeria           | Nigeria            |
|        | odusote@usaid.gov |                   |                    |
|        | **Siana Tackett** |                   |                    |
|        | Deputy Team       |                   |                    |
|        | Leader            |                   |                    |
|        | s                 |                   |                    |
|        | tackett@usaid.gov |                   |                    |
|        | 0                 |                   |                    |
|        | 11-234-9-461-9300 |                   |                    |
+--------+-------------------+-------------------+--------------------+
| South  | **Nellie Gqwaru** | USAID/Southern    | USAID/Southern     |
| Africa | HIV/AIDS & TB     | Africa 100 Totius | Africa 100 Totius  |
|        | Project           | Street Groenkloof | Street Groenkloof  |
|        | Specialist        | Pretoria, South   | Pretoria, South    |
|        | ngqwaru@usaid.gov | Africa            | Africa             |
|        | 0                 |                   |                    |
|        | 11-27-12-452-2237 |                   |                    |
+--------+-------------------+-------------------+--------------------+

+--------+-------------------+-------------------+--------------------+
| *      | **[Contact Name,  | **[Official       | **[Commercial      |
| *[Coun | tit               | Addre             | Addr               |
| try]{. | le]{.underline}** | ss]{.underline}** | ess]{.underline}** |
| underl |                   |                   |                    |
| ine}** |                   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Ta     | **Patrick Swai**  | USAID Tanzania PO | USAID Tanzania DHL |
| nzania | pswai@usaid.gov   | Box 9130 Dar Es   | International,     |
|        | 01                | Salaam, Tanzania  | Plot 12D Nyerere   |
|        | 1-255-22-266-8490 |                   | Road PO Box 3405   |
|        | Ext. 8229         |                   | Dar Es Salaam      |
|        |                   |                   | +255-22-286-1000   |
+--------+-------------------+-------------------+--------------------+
| Uganda | **Rachel          | USAID/Uganda 42   | USAID/Uganda 42    |
|        | Cintron** PHN     | Nakasero Road,    | Nakasero Road      |
|        | Officer           | Kampala, Uganda   | Kampala, Uganda    |
|        | r                 |                   |                    |
|        | cintron@usaid.gov |                   |                    |
|        | 0                 |                   |                    |
|        | 11-256-41-306-574 |                   |                    |
+--------+-------------------+-------------------+--------------------+
| ***[   |                   |                   |                    |
| EUROPE |                   |                   |                    |
| &      |                   |                   |                    |
| EURAS  |                   |                   |                    |
| IA]{.u |                   |                   |                    |
| nderli |                   |                   |                    |
| ne}*** |                   |                   |                    |
|        |                   |                   |                    |
|        |                   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Russia | **Nikita          | USAID/Russia      | USAID/Russia 19/23 |
|        | Afanasiev** TB    | 19/23 Novinskiy   | Novinskiy          |
|        | Control Program   | Boulevard Moscow  | Boulevard Moscow   |
|        | Manager           | 121099, Russia    | 121099, Russia     |
|        | naf               |                   |                    |
|        | anasiev@usaid.gov |                   |                    |
|        | 011-7495-728-5000 |                   |                    |
|        | Ext. 4943         |                   |                    |
+--------+-------------------+-------------------+--------------------+
| U      | **Leslie Perry**  | USAID Ukraine 19  | USAID Ukraine 19   |
| kraine | lperry@usaid.gov  | Nizhniy Val,      | Nizhniy Val, 04071 |
|        | 01                | 04071 Kyiv,       | Kyiv, Ukraine      |
|        | 1-380-445-374-602 | Ukraine           |                    |
+--------+-------------------+-------------------+--------------------+
| **     |                   |                   |                    |
| *[ASIA |                   |                   |                    |
| NEAR   |                   |                   |                    |
| EA     |                   |                   |                    |
| ST]{.u |                   |                   |                    |
| nderli |                   |                   |                    |
| ne}*** |                   |                   |                    |
|        |                   |                   |                    |
|        |                   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Ca     | **Dr. Chantha     | American Embassy/ | USAID/ Cambodia    |
| mbodia | Chak** Infectious | USAID Box P APO   | Building No.       |
|        | Disease Team      | AE 96546          | 16/18, Street      |
|        | Leader            |                   | Samdeeh Mongkol    |
|        | cchak@usaid.gov   |                   | Iem (Street No.    |
|        | 855-12-810-213    |                   | 228) Phnom Penh    |
|        |                   |                   | Cambodia           |
+--------+-------------------+-------------------+--------------------+
| ***    |                   |                   |                    |
| [LATIN |                   |                   |                    |
| A      |                   |                   |                    |
| MERICA |                   |                   |                    |
| & THE  |                   |                   |                    |
| C      |                   |                   |                    |
| ARIBBE |                   |                   |                    |
| AN]{.u |                   |                   |                    |
| nderli |                   |                   |                    |
| ne}*** |                   |                   |                    |
|        |                   |                   |                    |
|        |                   |                   |                    |
+--------+-------------------+-------------------+--------------------+
| Brazil | **Patricia        | American Embassy/ | USAID/Brazil SES   |
|        | Paine**           | Brasilia Unit     | Avenida das Nacoes |
|        | HIV-AIDS/TB       | 3500 USAID APO AA |                    |
|        | Technical Advisor | 34030             | Quadra 801 Lote 3  |
|        | ppaine@usaid.gov  |                   | Brasilia-          |
|        | 055-61-3312-7255  |                   | DF-70403-900       |
|        |                   |                   | Brazil             |
+--------+-------------------+-------------------+--------------------+

## Annex E: Application Screening Form

FY 2009 RFA Child Survival and Health Grants Program Application
Screening Form

**Name of Applicant Organization:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Country applying
for:** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Duration of Program:** \_\_\_\_years **Funding** **Category**: \_\_New
Partner \_\_Innovation \_\_Tuberculosis

**Interventions (must include %)**: (Total = 100%)

<table>
<colgroup>
<col style="width: 8%" />
<col style="width: 7%" />
<col style="width: 11%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 9%" />
<col style="width: 8%" />
<col style="width: 9%" />
<col style="width: 11%" />
<col style="width: 8%" />
<col style="width: 10%" />
</colgroup>
<tbody>
<tr class="odd">
<td><strong>IMM</strong></td>
<td><strong>IYCF</strong></td>
<td><strong>Vit A/ Micro-nutrient</strong></td>
<td><strong>CDD</strong></td>
<td><strong>PCM</strong></td>
<td><strong>Malaria</strong></td>
<td><strong>MNC</strong></td>
<td><p><strong>HIV/</strong></p>
<p><strong>AIDS</strong></p></td>
<td><strong>Child Injury Prev</strong></td>
<td><strong>TB</strong></td>
<td><strong>TOTAL</strong></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>100%</td>
</tr>
</tbody>
</table>

**[Resubmission (please circle):]{.underline} Yes No**

**[Eligibility Criteria from RFA]{.underline}**

**[Yes/No/NA (Page #)]{.underline}** **(Indicate yes, no, or not
applicable; cite page \# or location in application as
appropriate[)]{.underline}:**

1\. \_\_\_\_\_\_\_\_\_ **Status 1**: **U.S. PVO registered, or in the
process of registration, with USAID**

***or***

**\_\_\_\_\_\_\_\_\_ Status 2: U.S. non-profit NGO (New Partner
applicants only)**

2\. \_\_\_\_\_\_\_\_\_ **New Partner Category Applicant Financial
Restriction:** Applicant is within USG funding restriction of
[\<]{.underline} 5 million in the last 5 fiscal years.

3\. \_\_\_\_\_\_\_\_\_ **PVO/NGO proposes Cost Share at 25% of total
budget** ([\$]{.underline} )

4\. \_\_\_\_\_\_\_\_\_ Applicant has **Country Presence** (Attachments
--include page numbers and signed document from host country government
providing organization with legal status to operate in country)

5\. \_\_\_\_\_\_\_\_\_ **Health Development Experience** (Innovation &
TB Category Applicants): Applicant demonstrates at least 5 years of
relevant **health development experience**)

6\. \_\_\_\_\_\_\_\_\_ **Eligible Country** (Proposed program is in an
eligible country, see RFA eligible country lists)

7\. \_\_\_\_\_\_\_\_\_ If **two applications** are submitted by the
organization, one is submitted in the Tuberculosis category.

8\. \_\_\_\_\_\_\_\_\_ Applicant has [no more than]{.underline} **5
cooperative agreements** with CSHGP as of Oct. 1, 2009

9\. \_\_\_\_\_\_\_\_\_ If **HIV/AIDS** is proposed in New Partner or
Innovation Categories, it is at a level of effort not

higher than **30%**.

10\. \_\_\_\_\_\_\_\_\_ If **Tuberculosis** is proposed as a technical
intervention area, it is within a submission for the Tuberculosis
Category.

11\. \_\_\_\_\_\_\_\_\_ Application is **30 pages** or less (excluding
attachments, preliminary matter, and this screening form).

## Annex F: Beneficiary Calculation Guidelines 

Beneficiary population numbers help reviewers determine if proposals
target a reasonable number of people in relation to the project area and
proposed interventions. Beneficiary population numbers are also used to
calculate cost per beneficiary. For its annual portfolio review, CSHGP
must report on the total number of beneficiaries reached by all the
grants during the year and the total number of beneficiaries reached by
the program since its inception in 1985. Grantees need to know the
number of beneficiaries in order to plan activities on a yearly basis
and over the life of the project. This document contains recommended
guidance to help applicants report beneficiary numbers in a standardized
manner.

It is expected that CSHGP projects, either directly or indirectly,
benefit all children less than 5 years and women of reproductive age
(15-49) in the project area; therefore, for these grants the following
definition of the beneficiary population is used:

+-----------------------------------------------------------------------+
| > Definition: a beneficiary is a child under the age of 5 or women of |
| > reproductive age (15-49) who lives in the project target area.[^12] |
+-----------------------------------------------------------------------+

[Guidance:]{.underline}

-   Applicants must provide information on beneficiary population based
    on the population in the target geographic area (or areas) ***at the
    beginning of the project***.

-   Applicants must state the source of population numbers for the
    project area, the date when this information was collected, and
    information as to whether or not these numbers were determined by
    official projections. For example, did they perform a census of the
    project area or did they use an official source? How did they
    determine the percent of total population for women of reproductive
    age and children under 5 (broken down by age categories)? The
    following are links to official sites for population figures:

    -   CENSUS BUREAU SITE:
        <http://www.census.gov/ipc/www/idb/index.html>

    -   UNICEF: <http://childinfo.org/>

**Illustration of Beneficiary Calculation for Project X**:

[Explanation of calculation:]{.underline} Numbers are calculated before
the initiation of the project. The Project X team calculated the
population breakdown based on official guidance from the regional health
office, which stated that of the total population in the district where
the population operates, 4% are infants 0-11 months, 4% are children
12-23 months, 20% are children 0-59 months, and 22% are women of
reproductive age (15-49). They obtained the total population numbers
from the National Census Bureau.

**Beneficiary Population Numbers for Project X:**

  --------------------------------- -------------------------------------
  **Beneficiary Population**        **Number**

  Infants: 0-11 months              5,193

  Children: 12-23 months            5,193

  Children: 24-59 months            15,580

  Children 0-59 months              25,966

  Women 15-49 years                 28,561

  Total Population                  129,830
  --------------------------------- -------------------------------------

##  Annex G: Program Matrix 

**Example of a Program Matrix to**

**Display Program Goals and Objectives**

Goal:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

+---------------+---------------+------------------+------------------+
| OBJECTIVES    | INDICATORS    | MEASUREMENT      | MAJOR PLANNED    |
|               |               | METHODS          | ACTIVITIES       |
+---------------+---------------+------------------+------------------+
| \* Objective  | \*            | \* measurement   | \* activity(s)   |
| 1             | indicator(s)  | method(s)        |                  |
|               |               |                  | \* activity      |
| \* Objective  | \* indicator  | \* measurement   |                  |
| 2             |               | method           | \* activity      |
|               | \* indicator  |                  |                  |
| \* Objective  |               | \* measurement   | \* activity      |
| 3             | \* indicator  | method           |                  |
|               |               |                  | \* activity      |
|               | \* indicator  |                  |                  |
|               |               |                  | \* activity      |
|               | \* indicator  |                  |                  |
|               |               |                  |                  |
|               | \* indicator  |                  |                  |
+---------------+---------------+------------------+------------------+

**Definitions**

Goal: A statement of the long-term aim of the project. While the
complete fulfillment of a goal may not be possible or verifiable within
the life-span of the project, the achievement of the project\'s more
specific objectives should contribute to the realization of the goal.

Objective: A statement of what the program plans to achieve during the
life of the project. This achievement is the highest level result that a
program can materially affect with its efforts.

Indicator: An indicator specifies [what]{.underline} is measured to
determine whether the objective has been achieved. This includes both
process and outcome.

Targets: A target is the planned value of the indicator at the end of
the project (e.g., 70% of children fully immunized by project end). In
the above matrix, targets can be stated in the objective statement or in
the indicators. Illustrative, end-of-program targets should be provided
in the application. If the program is funded, targets can be adjusted in
the DIP according to baseline survey results.

Measurement

Method: The measurement method identifies the source of the data for
each of the identified indicators. (e.g., initial and final KPC Survey).

Planned

Activities: Activities support the achievement of the objective. These
include inputs, processes and outputs of the program.

## Annex H: SF 424 Forms

**Standard Form 424** OMB Approval No. 0348-0043

+--------+--------+---+---+--------+-----------------+--------+---+---+
| ###### |        |   |   |        | 2\. DATE        | App    |   |   |
| # APPL |        |   |   |        | SUBMITTED       | licant |   |   |
| ICATIO |        |   |   |        |                 | Iden   |   |   |
| N FOR  |        |   |   |        |                 | tifier |   |   |
| FEDERA |        |   |   |        |                 |        |   |   |
| L ASSI |        |   |   |        |                 |        |   |   |
| STANCE |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 | NA     |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 1\.    |        |   |   |        | 3\. DATE        | State  |   |   |
| TYPE   |        |   |   |        | RECEIVED BY     | Appli  |   |   |
| OF     |        |   |   |        | STATE           | cation |   |   |
| SUBMI  |        |   |   |        |                 | Iden   |   |   |
| SSION: |        |   |   |        |                 | tifier |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| Appli  |        | R |   |        | NA              | NA     |   |   |
| cation |        | e |   |        |                 |        |   |   |
|        |        | a |   |        |                 |        |   |   |
|        |        | p |   |        |                 |        |   |   |
|        |        | p |   |        |                 |        |   |   |
|        |        | l |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | a |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | o |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
|        |        | N |   |        |                 |        |   |   |
|        |        | A |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| Constr |        | C |   |        | 4\. DATE        | F      |   |   |
| uction |        | o |   |        | RECEIVED BY     | ederal |   |   |
|        |        | n |   |        | FEDERAL AGENCY  | Iden   |   |   |
|        |        | s |   |        |                 | tifier |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | r |   |        |                 |        |   |   |
|        |        | u |   |        |                 |        |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | o |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| X      |        | N |   |        |                 | NA     |   |   |
| Non-   |        | o |   |        |                 |        |   |   |
| Constr |        | n |   |        |                 |        |   |   |
| uction |        | - |   |        |                 |        |   |   |
|        |        | C |   |        |                 |        |   |   |
|        |        | o |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
|        |        | s |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | r |   |        |                 |        |   |   |
|        |        | u |   |        |                 |        |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | o |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 5\.    |        |   |   |        |                 |        |   |   |
| APPLI  |        |   |   |        |                 |        |   |   |
| CATION |        |   |   |        |                 |        |   |   |
| INFOR  |        |   |   |        |                 |        |   |   |
| MATION |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| *      |        |   |   |        | ######## Orga   |        |   |   |
| *Legal |        |   |   |        | nizational Unit |        |   |   |
| N      |        |   |   |        |                 |        |   |   |
| ame:** |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| A      |        |   |   |        | Name and        |        |   |   |
| ddress |        |   |   |        | telephone       |        |   |   |
| (give  |        |   |   |        | number of       |        |   |   |
| only   |        |   |   |        | person to be    |        |   |   |
| c      |        |   |   |        | contacted on    |        |   |   |
| ounty, |        |   |   |        | matters         |        |   |   |
| state, |        |   |   |        | involving this  |        |   |   |
| and    |        |   |   |        | application     |        |   |   |
| zip    |        |   |   |        | (give area      |        |   |   |
| code): |        |   |   |        | code)           |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 6\.    |        |   |   |        | 7\. TYPE OF     |        | M |   |
| EM     |        |   |   |        | APPLICATION:    |        |   |   |
| PLOYER |        |   |   |        | (enter          |        |   |   |
| ID     |        |   |   |        | appropriate     |        |   |   |
| ENTIFI |        |   |   |        | letter in box)  |        |   |   |
| CATION |        |   |   |        |                 |        |   |   |
| NUMBER |        |   |   |        |                 |        |   |   |
| (EIN): |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        | A. State        | H.     |   |   |
|        |        |   |   |        |                 | Indep  |   |   |
|        |        |   |   |        |                 | endent |   |   |
|        |        |   |   |        |                 | School |   |   |
|        |        |   |   |        |                 | Dist   |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 8\.    |        |   |   |        | B. County       | I.     |   |   |
| TYPE   |        |   |   |        |                 | State  |   |   |
| OF     |        |   |   |        |                 | Cont   |   |   |
| APPLI  |        |   |   |        |                 | rolled |   |   |
| CATION |        |   |   |        |                 | Insti  |   |   |
|        |        |   |   |        |                 | tution |   |   |
|        |        |   |   |        |                 | of     |   |   |
|        |        |   |   |        |                 | Higher |   |   |
|        |        |   |   |        |                 | Le     |   |   |
|        |        |   |   |        |                 | arning |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| [X]    |        |   |   |        | C. Municipal    | J.     |   |   |
| {.unde |        |   |   |        |                 | Indian |   |   |
| rline} |        |   |   |        |                 | Tribe  |   |   |
| New    |        |   |   |        |                 |        |   |   |
| Contin |        |   |   |        |                 |        |   |   |
| uation |        |   |   |        |                 |        |   |   |
| Re     |        |   |   |        |                 |        |   |   |
| vision |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| If     |        |   |   |        | D. Township     | K.     |   |   |
| Rev    |        |   |   |        |                 | Indi   |   |   |
| ision, |        |   |   |        |                 | vidual |   |   |
| enter  |        |   |   |        |                 |        |   |   |
| appro  |        |   |   |        |                 |        |   |   |
| priate |        |   |   |        |                 |        |   |   |
| let    |        |   |   |        |                 |        |   |   |
| ter(s) |        |   |   |        |                 |        |   |   |
| in     |        |   |   |        |                 |        |   |   |
| b      |        |   |   |        |                 |        |   |   |
| ox(es) |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| A.     |        | D |   |        | E. Interstate   | L.     |   |   |
| In     |        | . |   |        |                 | Profit |   |   |
| crease |        | D |   |        |                 | Organi |   |   |
| Award  |        | e |   |        |                 | zation |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | r |   |        |                 |        |   |   |
|        |        | e |   |        |                 |        |   |   |
|        |        | a |   |        |                 |        |   |   |
|        |        | s |   |        |                 |        |   |   |
|        |        | e |   |        |                 |        |   |   |
|        |        | D |   |        |                 |        |   |   |
|        |        | u |   |        |                 |        |   |   |
|        |        | r |   |        |                 |        |   |   |
|        |        | a |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | o |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| B.     |        | E |   |        | F.              | M.     |   |   |
| De     |        | . |   |        | Inter-municipal | Other  |   |   |
| crease |        | O |   |        |                 | (sp    |   |   |
| Award  |        | t |   |        |                 | ecify) |   |   |
|        |        | h |   |        |                 |        |   |   |
|        |        | e |   |        |                 |        |   |   |
|        |        | r |   |        |                 |        |   |   |
|        |        | ( |   |        |                 |        |   |   |
|        |        | s |   |        |                 |        |   |   |
|        |        | p |   |        |                 |        |   |   |
|        |        | e |   |        |                 |        |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | f |   |        |                 |        |   |   |
|        |        | y |   |        |                 |        |   |   |
|        |        | ) |   |        |                 |        |   |   |
|        |        | : |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| C.     |        |   |   |        | G. Special      |        |   |   |
| In     |        |   |   |        | Dist.           |        |   |   |
| crease |        |   |   |        |                 |        |   |   |
| Du     |        |   |   |        |                 |        |   |   |
| ration |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 10\.   |        |   |   |        | 9\. NAME OF     |        |   |   |
| C      |        |   |   |        | FEDERAL AGENCY  |        |   |   |
| ATALOG |        |   |   |        |                 |        |   |   |
| OF     |        |   |   |        |                 |        |   |   |
| F      |        |   |   |        |                 |        |   |   |
| EDERAL |        |   |   |        |                 |        |   |   |
| DO     |        |   |   |        |                 |        |   |   |
| MESTIC |        |   |   |        |                 |        |   |   |
| ASSI   |        |   |   |        |                 |        |   |   |
| STANCE |        |   |   |        |                 |        |   |   |
| N      |        |   |   |        |                 |        |   |   |
| UMBER: |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| NA     |        |   |   |        | USAID/GH/HIDN   |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| TITLE: |        |   |   |        | 11\.            |        |   |   |
|        |        |   |   |        | DESCRIPTIVE     |        |   |   |
|        |        |   |   |        | TITLE OF        |        |   |   |
|        |        |   |   |        | APPLICANT\'S    |        |   |   |
|        |        |   |   |        | PROJECT:        |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 12\.   |        |   |   |        |                 |        |   |   |
| AREAS  |        |   |   |        |                 |        |   |   |
| AF     |        |   |   |        |                 |        |   |   |
| FECTED |        |   |   |        |                 |        |   |   |
| (C     |        |   |   |        |                 |        |   |   |
| ities, |        |   |   |        |                 |        |   |   |
| Cou    |        |   |   |        |                 |        |   |   |
| nties, |        |   |   |        |                 |        |   |   |
| S      |        |   |   |        |                 |        |   |   |
| tates, |        |   |   |        |                 |        |   |   |
| etc.): |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 13\.   |        | 1 |   |        |                 |        |   |   |
| PR     |        | 4 |   |        |                 |        |   |   |
| OPOSED |        | \ |   |        |                 |        |   |   |
| P      |        | . |   |        |                 |        |   |   |
| ROJECT |        | C |   |        |                 |        |   |   |
|        |        | O |   |        |                 |        |   |   |
|        |        | N |   |        |                 |        |   |   |
|        |        | G |   |        |                 |        |   |   |
|        |        | R |   |        |                 |        |   |   |
|        |        | E |   |        |                 |        |   |   |
|        |        | S |   |        |                 |        |   |   |
|        |        | S |   |        |                 |        |   |   |
|        |        | I |   |        |                 |        |   |   |
|        |        | O |   |        |                 |        |   |   |
|        |        | N |   |        |                 |        |   |   |
|        |        | A |   |        |                 |        |   |   |
|        |        | L |   |        |                 |        |   |   |
|        |        | D |   |        |                 |        |   |   |
|        |        | I |   |        |                 |        |   |   |
|        |        | S |   |        |                 |        |   |   |
|        |        | T |   |        |                 |        |   |   |
|        |        | R |   |        |                 |        |   |   |
|        |        | I |   |        |                 |        |   |   |
|        |        | C |   |        |                 |        |   |   |
|        |        | T |   |        |                 |        |   |   |
|        |        | S |   |        |                 |        |   |   |
|        |        | O |   |        |                 |        |   |   |
|        |        | F |   |        |                 |        |   |   |
|        |        | : |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| START  | END    | a |   |        | b\. Project     |        |   |   |
| DATE   | DATE   | \ |   |        |                 |        |   |   |
|        |        | . |   |        |                 |        |   |   |
|        |        | A |   |        |                 |        |   |   |
|        |        | p |   |        |                 |        |   |   |
|        |        | p |   |        |                 |        |   |   |
|        |        | l |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | a |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        | N |   |        | NA              |        |   |   |
|        |        | A |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 15\.   |        |   |   |        | 16\. IS         |        |   |   |
| EST    |        |   |   |        | APPLICATION     |        |   |   |
| IMATED |        |   |   |        | SUBJECT TO      |        |   |   |
| FU     |        |   |   |        | REVIEW BY STATE |        |   |   |
| NDING: |        |   |   |        | EXECUTIVE ORDER |        |   |   |
|        |        |   |   |        | 12372 PROCESS?  |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| a\.    | \$     |   |   |        |                 |        |   |   |
| F      |        |   |   |        |                 |        |   |   |
| ederal |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| b      | \$     |   |   |        | a\. YES. THIS   |        |   |   |
| App    |        |   |   |        | PREAPPLICAT     |        |   |   |
| licant |        |   |   |        | ION/APPLICATION |        |   |   |
|        |        |   |   |        | WAS MADE        |        |   |   |
|        |        |   |   |        | AVAILABLE TO    |        |   |   |
|        |        |   |   |        | THE STATE       |        |   |   |
|        |        |   |   |        | EXECUTIVE ORDER |        |   |   |
|        |        |   |   |        | 12372 PROCESS   |        |   |   |
|        |        |   |   |        | REVIEW ON:      |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| c\.    | \$ NA  |   |   |        |                 |        |   |   |
| State  |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| d\.    | \$ NA  |   |   |        | DATE            |        |   |   |
| Local  |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| e\.    | \$     |   |   |        | B. NO.          |        |   |   |
| Other  |        |   |   |        | [X]{.underline} |        |   |   |
|        |        |   |   |        | PROGRAM IS NOT  |        |   |   |
|        |        |   |   |        | COVERED BY E.O. |        |   |   |
|        |        |   |   |        | 12372           |        |   |   |
|        |        |   |   |        |                 |        |   |   |
|        |        |   |   |        | [X]{.underline} |        |   |   |
|        |        |   |   |        | OR PROGRAM HAS  |        |   |   |
|        |        |   |   |        | NOT BEEN        |        |   |   |
|        |        |   |   |        | SELECTED BY     |        |   |   |
|        |        |   |   |        | STATE FOR       |        |   |   |
|        |        |   |   |        | REVIEW          |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| f\.    | \$     |   |   |        |                 |        |   |   |
| P      |        |   |   |        |                 |        |   |   |
| rogram |        |   |   |        |                 |        |   |   |
| Income |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| g\.    | \$     |   |   |        |                 |        |   |   |
| TOTAL  |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 17\.   |        |   |   |        | Yes If \"Yes\", | No     |   |   |
| IS THE |        |   |   |        | attach an       |        |   |   |
| APP    |        |   |   |        | explanation     |        |   |   |
| LICANT |        |   |   |        |                 |        |   |   |
| DELI   |        |   |   |        |                 |        |   |   |
| NQUENT |        |   |   |        |                 |        |   |   |
| ON ANY |        |   |   |        |                 |        |   |   |
| F      |        |   |   |        |                 |        |   |   |
| EDERAL |        |   |   |        |                 |        |   |   |
| DEBT?  |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 18\.   |        |   |   |        |                 |        |   |   |
| TO THE |        |   |   |        |                 |        |   |   |
| BEST   |        |   |   |        |                 |        |   |   |
| OF MY  |        |   |   |        |                 |        |   |   |
| KNO    |        |   |   |        |                 |        |   |   |
| WLEDGE |        |   |   |        |                 |        |   |   |
| AND    |        |   |   |        |                 |        |   |   |
| B      |        |   |   |        |                 |        |   |   |
| ELIEF, |        |   |   |        |                 |        |   |   |
| ALL    |        |   |   |        |                 |        |   |   |
| DATA   |        |   |   |        |                 |        |   |   |
| IN     |        |   |   |        |                 |        |   |   |
| THIS   |        |   |   |        |                 |        |   |   |
| AP     |        |   |   |        |                 |        |   |   |
| PLICAT |        |   |   |        |                 |        |   |   |
| ION/PR |        |   |   |        |                 |        |   |   |
| EAPPLI |        |   |   |        |                 |        |   |   |
| CATION |        |   |   |        |                 |        |   |   |
| ARE    |        |   |   |        |                 |        |   |   |
| TRUE   |        |   |   |        |                 |        |   |   |
| AND    |        |   |   |        |                 |        |   |   |
| CO     |        |   |   |        |                 |        |   |   |
| RRECT, |        |   |   |        |                 |        |   |   |
| THE    |        |   |   |        |                 |        |   |   |
| DO     |        |   |   |        |                 |        |   |   |
| CUMENT |        |   |   |        |                 |        |   |   |
| HAS    |        |   |   |        |                 |        |   |   |
| BEEN   |        |   |   |        |                 |        |   |   |
| DULY   |        |   |   |        |                 |        |   |   |
| AUTH   |        |   |   |        |                 |        |   |   |
| ORIZED |        |   |   |        |                 |        |   |   |
| BY THE |        |   |   |        |                 |        |   |   |
| GOV    |        |   |   |        |                 |        |   |   |
| ERNING |        |   |   |        |                 |        |   |   |
| BODY   |        |   |   |        |                 |        |   |   |
| OF THE |        |   |   |        |                 |        |   |   |
| APP    |        |   |   |        |                 |        |   |   |
| LICANT |        |   |   |        |                 |        |   |   |
| AND    |        |   |   |        |                 |        |   |   |
| THE    |        |   |   |        |                 |        |   |   |
| APP    |        |   |   |        |                 |        |   |   |
| LICANT |        |   |   |        |                 |        |   |   |
| WILL   |        |   |   |        |                 |        |   |   |
| COMPLY |        |   |   |        |                 |        |   |   |
| WITH   |        |   |   |        |                 |        |   |   |
| THE    |        |   |   |        |                 |        |   |   |
| AT     |        |   |   |        |                 |        |   |   |
| TACHED |        |   |   |        |                 |        |   |   |
| ASSU   |        |   |   |        |                 |        |   |   |
| RANCES |        |   |   |        |                 |        |   |   |
| IF THE |        |   |   |        |                 |        |   |   |
| ASSI   |        |   |   |        |                 |        |   |   |
| STANCE |        |   |   |        |                 |        |   |   |
| IS     |        |   |   |        |                 |        |   |   |
| AW     |        |   |   |        |                 |        |   |   |
| ARDED. |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| a\.    |        |   |   |        | b\. Title       | c\.    |   |   |
| Type   |        |   |   |        |                 | Tel    |   |   |
| Name   |        |   |   |        |                 | ephone |   |   |
| of     |        |   |   |        |                 | Number |   |   |
| Auth   |        |   |   |        |                 |        |   |   |
| orized |        |   |   |        |                 |        |   |   |
| Re     |        |   |   |        |                 |        |   |   |
| presen |        |   |   |        |                 |        |   |   |
| tative |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| d\.    |        |   |   |        |                 | e\.    |   |   |
| Sig    |        |   |   |        |                 | Date   |   |   |
| nature |        |   |   |        |                 | Signed |   |   |
| of     |        |   |   |        |                 |        |   |   |
| Auth   |        |   |   |        |                 |        |   |   |
| orized |        |   |   |        |                 |        |   |   |
| Re     |        |   |   |        |                 |        |   |   |
| presen |        |   |   |        |                 |        |   |   |
| tative |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| ###### |        |   |   |        | 2\. DATE        | App    |   |   |
| # APPL |        |   |   |        | SUBMITTED       | licant |   |   |
| ICATIO |        |   |   |        |                 | Iden   |   |   |
| N FOR  |        |   |   |        |                 | tifier |   |   |
| FEDERA |        |   |   |        |                 |        |   |   |
| L ASSI |        |   |   |        |                 |        |   |   |
| STANCE |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 | NA     |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 1\.    |        |   |   |        | 3\. DATE        | State  |   |   |
| TYPE   |        |   |   |        | RECEIVED BY     | Appli  |   |   |
| OF     |        |   |   |        | STATE           | cation |   |   |
| SUBMI  |        |   |   |        |                 | Iden   |   |   |
| SSION: |        |   |   |        |                 | tifier |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| Appli  |        | R |   |        | NA              | NA     |   |   |
| cation |        | e |   |        |                 |        |   |   |
|        |        | a |   |        |                 |        |   |   |
|        |        | p |   |        |                 |        |   |   |
|        |        | p |   |        |                 |        |   |   |
|        |        | l |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | a |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | o |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
|        |        | N |   |        |                 |        |   |   |
|        |        | A |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| Constr |        | C |   |        | 4\. DATE        | F      |   |   |
| uction |        | o |   |        | RECEIVED BY     | ederal |   |   |
|        |        | n |   |        | FEDERAL AGENCY  | Iden   |   |   |
|        |        | s |   |        |                 | tifier |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | r |   |        |                 |        |   |   |
|        |        | u |   |        |                 |        |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | o |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| X      |        | N |   |        |                 | NA     |   |   |
| Non-   |        | o |   |        |                 |        |   |   |
| Constr |        | n |   |        |                 |        |   |   |
| uction |        | - |   |        |                 |        |   |   |
|        |        | C |   |        |                 |        |   |   |
|        |        | o |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
|        |        | s |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | r |   |        |                 |        |   |   |
|        |        | u |   |        |                 |        |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | o |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 5\.    |        |   |   |        |                 |        |   |   |
| APPLI  |        |   |   |        |                 |        |   |   |
| CATION |        |   |   |        |                 |        |   |   |
| INFOR  |        |   |   |        |                 |        |   |   |
| MATION |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| *      |        |   |   |        | ######## Orga   |        |   |   |
| *Legal |        |   |   |        | nizational Unit |        |   |   |
| N      |        |   |   |        |                 |        |   |   |
| ame:** |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| A      |        |   |   |        | Name and        |        |   |   |
| ddress |        |   |   |        | telephone       |        |   |   |
| (give  |        |   |   |        | number of       |        |   |   |
| only   |        |   |   |        | person to be    |        |   |   |
| c      |        |   |   |        | contacted on    |        |   |   |
| ounty, |        |   |   |        | matters         |        |   |   |
| state, |        |   |   |        | involving this  |        |   |   |
| and    |        |   |   |        | application     |        |   |   |
| zip    |        |   |   |        | (give area      |        |   |   |
| code): |        |   |   |        | code)           |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 6\.    |        |   |   |        | 7\. TYPE OF     |        | M |   |
| EM     |        |   |   |        | APPLICATION:    |        |   |   |
| PLOYER |        |   |   |        | (enter          |        |   |   |
| ID     |        |   |   |        | appropriate     |        |   |   |
| ENTIFI |        |   |   |        | letter in box)  |        |   |   |
| CATION |        |   |   |        |                 |        |   |   |
| NUMBER |        |   |   |        |                 |        |   |   |
| (EIN): |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        | A. State        | H.     |   |   |
|        |        |   |   |        |                 | Indep  |   |   |
|        |        |   |   |        |                 | endent |   |   |
|        |        |   |   |        |                 | School |   |   |
|        |        |   |   |        |                 | Dist   |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 8\.    |        |   |   |        | B. County       | I.     |   |   |
| TYPE   |        |   |   |        |                 | State  |   |   |
| OF     |        |   |   |        |                 | Cont   |   |   |
| APPLI  |        |   |   |        |                 | rolled |   |   |
| CATION |        |   |   |        |                 | Insti  |   |   |
|        |        |   |   |        |                 | tution |   |   |
|        |        |   |   |        |                 | of     |   |   |
|        |        |   |   |        |                 | Higher |   |   |
|        |        |   |   |        |                 | Le     |   |   |
|        |        |   |   |        |                 | arning |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| [X]    |        |   |   |        | C. Municipal    | J.     |   |   |
| {.unde |        |   |   |        |                 | Indian |   |   |
| rline} |        |   |   |        |                 | Tribe  |   |   |
| New    |        |   |   |        |                 |        |   |   |
| Contin |        |   |   |        |                 |        |   |   |
| uation |        |   |   |        |                 |        |   |   |
| Re     |        |   |   |        |                 |        |   |   |
| vision |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| If     |        |   |   |        | D. Township     | K.     |   |   |
| Rev    |        |   |   |        |                 | Indi   |   |   |
| ision, |        |   |   |        |                 | vidual |   |   |
| enter  |        |   |   |        |                 |        |   |   |
| appro  |        |   |   |        |                 |        |   |   |
| priate |        |   |   |        |                 |        |   |   |
| let    |        |   |   |        |                 |        |   |   |
| ter(s) |        |   |   |        |                 |        |   |   |
| in     |        |   |   |        |                 |        |   |   |
| b      |        |   |   |        |                 |        |   |   |
| ox(es) |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| A.     |        | D |   |        | E. Interstate   | L.     |   |   |
| In     |        | . |   |        |                 | Profit |   |   |
| crease |        | D |   |        |                 | Organi |   |   |
| Award  |        | e |   |        |                 | zation |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | r |   |        |                 |        |   |   |
|        |        | e |   |        |                 |        |   |   |
|        |        | a |   |        |                 |        |   |   |
|        |        | s |   |        |                 |        |   |   |
|        |        | e |   |        |                 |        |   |   |
|        |        | D |   |        |                 |        |   |   |
|        |        | u |   |        |                 |        |   |   |
|        |        | r |   |        |                 |        |   |   |
|        |        | a |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | o |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| B.     |        | E |   |        | F.              | M.     |   |   |
| De     |        | . |   |        | Inter-municipal | Other  |   |   |
| crease |        | O |   |        |                 | (sp    |   |   |
| Award  |        | t |   |        |                 | ecify) |   |   |
|        |        | h |   |        |                 |        |   |   |
|        |        | e |   |        |                 |        |   |   |
|        |        | r |   |        |                 |        |   |   |
|        |        | ( |   |        |                 |        |   |   |
|        |        | s |   |        |                 |        |   |   |
|        |        | p |   |        |                 |        |   |   |
|        |        | e |   |        |                 |        |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | f |   |        |                 |        |   |   |
|        |        | y |   |        |                 |        |   |   |
|        |        | ) |   |        |                 |        |   |   |
|        |        | : |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| C.     |        |   |   |        | G. Special      |        |   |   |
| In     |        |   |   |        | Dist.           |        |   |   |
| crease |        |   |   |        |                 |        |   |   |
| Du     |        |   |   |        |                 |        |   |   |
| ration |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 10\.   |        |   |   |        | 9\. NAME OF     |        |   |   |
| C      |        |   |   |        | FEDERAL AGENCY  |        |   |   |
| ATALOG |        |   |   |        |                 |        |   |   |
| OF     |        |   |   |        |                 |        |   |   |
| F      |        |   |   |        |                 |        |   |   |
| EDERAL |        |   |   |        |                 |        |   |   |
| DO     |        |   |   |        |                 |        |   |   |
| MESTIC |        |   |   |        |                 |        |   |   |
| ASSI   |        |   |   |        |                 |        |   |   |
| STANCE |        |   |   |        |                 |        |   |   |
| N      |        |   |   |        |                 |        |   |   |
| UMBER: |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| NA     |        |   |   |        | USAID/GH/HIDN   |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| TITLE: |        |   |   |        | 11\.            |        |   |   |
|        |        |   |   |        | DESCRIPTIVE     |        |   |   |
|        |        |   |   |        | TITLE OF        |        |   |   |
|        |        |   |   |        | APPLICANT\'S    |        |   |   |
|        |        |   |   |        | PROJECT:        |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 12\.   |        |   |   |        |                 |        |   |   |
| AREAS  |        |   |   |        |                 |        |   |   |
| AF     |        |   |   |        |                 |        |   |   |
| FECTED |        |   |   |        |                 |        |   |   |
| (C     |        |   |   |        |                 |        |   |   |
| ities, |        |   |   |        |                 |        |   |   |
| Cou    |        |   |   |        |                 |        |   |   |
| nties, |        |   |   |        |                 |        |   |   |
| S      |        |   |   |        |                 |        |   |   |
| tates, |        |   |   |        |                 |        |   |   |
| etc.): |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 13\.   |        | 1 |   |        |                 |        |   |   |
| PR     |        | 4 |   |        |                 |        |   |   |
| OPOSED |        | \ |   |        |                 |        |   |   |
| P      |        | . |   |        |                 |        |   |   |
| ROJECT |        | C |   |        |                 |        |   |   |
|        |        | O |   |        |                 |        |   |   |
|        |        | N |   |        |                 |        |   |   |
|        |        | G |   |        |                 |        |   |   |
|        |        | R |   |        |                 |        |   |   |
|        |        | E |   |        |                 |        |   |   |
|        |        | S |   |        |                 |        |   |   |
|        |        | S |   |        |                 |        |   |   |
|        |        | I |   |        |                 |        |   |   |
|        |        | O |   |        |                 |        |   |   |
|        |        | N |   |        |                 |        |   |   |
|        |        | A |   |        |                 |        |   |   |
|        |        | L |   |        |                 |        |   |   |
|        |        | D |   |        |                 |        |   |   |
|        |        | I |   |        |                 |        |   |   |
|        |        | S |   |        |                 |        |   |   |
|        |        | T |   |        |                 |        |   |   |
|        |        | R |   |        |                 |        |   |   |
|        |        | I |   |        |                 |        |   |   |
|        |        | C |   |        |                 |        |   |   |
|        |        | T |   |        |                 |        |   |   |
|        |        | S |   |        |                 |        |   |   |
|        |        | O |   |        |                 |        |   |   |
|        |        | F |   |        |                 |        |   |   |
|        |        | : |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| START  | END    | a |   |        | b\. Project     |        |   |   |
| DATE   | DATE   | \ |   |        |                 |        |   |   |
|        |        | . |   |        |                 |        |   |   |
|        |        | A |   |        |                 |        |   |   |
|        |        | p |   |        |                 |        |   |   |
|        |        | p |   |        |                 |        |   |   |
|        |        | l |   |        |                 |        |   |   |
|        |        | i |   |        |                 |        |   |   |
|        |        | c |   |        |                 |        |   |   |
|        |        | a |   |        |                 |        |   |   |
|        |        | n |   |        |                 |        |   |   |
|        |        | t |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        | N |   |        | NA              |        |   |   |
|        |        | A |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 15\.   |        |   |   |        | 16\. IS         |        |   |   |
| EST    |        |   |   |        | APPLICATION     |        |   |   |
| IMATED |        |   |   |        | SUBJECT TO      |        |   |   |
| FU     |        |   |   |        | REVIEW BY STATE |        |   |   |
| NDING: |        |   |   |        | EXECUTIVE ORDER |        |   |   |
|        |        |   |   |        | 12372 PROCESS?  |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| a\.    | \$     |   |   |        |                 |        |   |   |
| F      |        |   |   |        |                 |        |   |   |
| ederal |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| b      | \$     |   |   |        | a\. YES. THIS   |        |   |   |
| App    |        |   |   |        | PREAPPLICAT     |        |   |   |
| licant |        |   |   |        | ION/APPLICATION |        |   |   |
|        |        |   |   |        | WAS MADE        |        |   |   |
|        |        |   |   |        | AVAILABLE TO    |        |   |   |
|        |        |   |   |        | THE STATE       |        |   |   |
|        |        |   |   |        | EXECUTIVE ORDER |        |   |   |
|        |        |   |   |        | 12372 PROCESS   |        |   |   |
|        |        |   |   |        | REVIEW ON:      |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| c\.    | \$ NA  |   |   |        |                 |        |   |   |
| State  |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| d\.    | \$ NA  |   |   |        | DATE            |        |   |   |
| Local  |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| e\.    | \$     |   |   |        | B. NO.          |        |   |   |
| Other  |        |   |   |        | [X]{.underline} |        |   |   |
|        |        |   |   |        | PROGRAM IS NOT  |        |   |   |
|        |        |   |   |        | COVERED BY E.O. |        |   |   |
|        |        |   |   |        | 12372           |        |   |   |
|        |        |   |   |        |                 |        |   |   |
|        |        |   |   |        | [X]{.underline} |        |   |   |
|        |        |   |   |        | OR PROGRAM HAS  |        |   |   |
|        |        |   |   |        | NOT BEEN        |        |   |   |
|        |        |   |   |        | SELECTED BY     |        |   |   |
|        |        |   |   |        | STATE FOR       |        |   |   |
|        |        |   |   |        | REVIEW          |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| f\.    | \$     |   |   |        |                 |        |   |   |
| P      |        |   |   |        |                 |        |   |   |
| rogram |        |   |   |        |                 |        |   |   |
| Income |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| g\.    | \$     |   |   |        |                 |        |   |   |
| TOTAL  |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 17\.   |        |   |   |        | Yes If \"Yes\", | No     |   |   |
| IS THE |        |   |   |        | attach an       |        |   |   |
| APP    |        |   |   |        | explanation     |        |   |   |
| LICANT |        |   |   |        |                 |        |   |   |
| DELI   |        |   |   |        |                 |        |   |   |
| NQUENT |        |   |   |        |                 |        |   |   |
| ON ANY |        |   |   |        |                 |        |   |   |
| F      |        |   |   |        |                 |        |   |   |
| EDERAL |        |   |   |        |                 |        |   |   |
| DEBT?  |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| 18\.   |        |   |   |        |                 |        |   |   |
| TO THE |        |   |   |        |                 |        |   |   |
| BEST   |        |   |   |        |                 |        |   |   |
| OF MY  |        |   |   |        |                 |        |   |   |
| KNO    |        |   |   |        |                 |        |   |   |
| WLEDGE |        |   |   |        |                 |        |   |   |
| AND    |        |   |   |        |                 |        |   |   |
| B      |        |   |   |        |                 |        |   |   |
| ELIEF, |        |   |   |        |                 |        |   |   |
| ALL    |        |   |   |        |                 |        |   |   |
| DATA   |        |   |   |        |                 |        |   |   |
| IN     |        |   |   |        |                 |        |   |   |
| THIS   |        |   |   |        |                 |        |   |   |
| AP     |        |   |   |        |                 |        |   |   |
| PLICAT |        |   |   |        |                 |        |   |   |
| ION/PR |        |   |   |        |                 |        |   |   |
| EAPPLI |        |   |   |        |                 |        |   |   |
| CATION |        |   |   |        |                 |        |   |   |
| ARE    |        |   |   |        |                 |        |   |   |
| TRUE   |        |   |   |        |                 |        |   |   |
| AND    |        |   |   |        |                 |        |   |   |
| CO     |        |   |   |        |                 |        |   |   |
| RRECT, |        |   |   |        |                 |        |   |   |
| THE    |        |   |   |        |                 |        |   |   |
| DO     |        |   |   |        |                 |        |   |   |
| CUMENT |        |   |   |        |                 |        |   |   |
| HAS    |        |   |   |        |                 |        |   |   |
| BEEN   |        |   |   |        |                 |        |   |   |
| DULY   |        |   |   |        |                 |        |   |   |
| AUTH   |        |   |   |        |                 |        |   |   |
| ORIZED |        |   |   |        |                 |        |   |   |
| BY THE |        |   |   |        |                 |        |   |   |
| GOV    |        |   |   |        |                 |        |   |   |
| ERNING |        |   |   |        |                 |        |   |   |
| BODY   |        |   |   |        |                 |        |   |   |
| OF THE |        |   |   |        |                 |        |   |   |
| APP    |        |   |   |        |                 |        |   |   |
| LICANT |        |   |   |        |                 |        |   |   |
| AND    |        |   |   |        |                 |        |   |   |
| THE    |        |   |   |        |                 |        |   |   |
| APP    |        |   |   |        |                 |        |   |   |
| LICANT |        |   |   |        |                 |        |   |   |
| WILL   |        |   |   |        |                 |        |   |   |
| COMPLY |        |   |   |        |                 |        |   |   |
| WITH   |        |   |   |        |                 |        |   |   |
| THE    |        |   |   |        |                 |        |   |   |
| AT     |        |   |   |        |                 |        |   |   |
| TACHED |        |   |   |        |                 |        |   |   |
| ASSU   |        |   |   |        |                 |        |   |   |
| RANCES |        |   |   |        |                 |        |   |   |
| IF THE |        |   |   |        |                 |        |   |   |
| ASSI   |        |   |   |        |                 |        |   |   |
| STANCE |        |   |   |        |                 |        |   |   |
| IS     |        |   |   |        |                 |        |   |   |
| AW     |        |   |   |        |                 |        |   |   |
| ARDED. |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| a\.    |        |   |   |        | b\. Title       | c\.    |   |   |
| Type   |        |   |   |        |                 | Tel    |   |   |
| Name   |        |   |   |        |                 | ephone |   |   |
| of     |        |   |   |        |                 | Number |   |   |
| Auth   |        |   |   |        |                 |        |   |   |
| orized |        |   |   |        |                 |        |   |   |
| Re     |        |   |   |        |                 |        |   |   |
| presen |        |   |   |        |                 |        |   |   |
| tative |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
| d\.    |        |   |   |        |                 | e\.    |   |   |
| Sig    |        |   |   |        |                 | Date   |   |   |
| nature |        |   |   |        |                 | Signed |   |   |
| of     |        |   |   |        |                 |        |   |   |
| Auth   |        |   |   |        |                 |        |   |   |
| orized |        |   |   |        |                 |        |   |   |
| Re     |        |   |   |        |                 |        |   |   |
| presen |        |   |   |        |                 |        |   |   |
| tative |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+
|        |        |   |   |        |                 |        |   |   |
+--------+--------+---+---+--------+-----------------+--------+---+---+

Standard Form 424 (REV 4-92); Prescribed By OMB Circular A-102

**INSTRUCTIONS FOR THE SF 424**

Public reporting burden for this collection of information is estimated
to average 45 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other
aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget. Paperwork
Reduction Project (0348-0043), Washington, DC 20503.

**PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT
AND BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.**

This is a standard form used by applicants as a required facesheet for
preapplications and applications submitted for Federal assistance. It
will be used by Federal agencies to obtain applicant certification that
States which have established a review and comment procedure in response
to Executive Order 12372 and have selected the program to be included in
their process, have been given an opportunity to review the applicant\'s
submission.

Item: Entry:

1\. Self-explanatory.

2\. Date application submitted to Federal agency (or State if
applicable) & applicant\'s control number (if applicable).

3\. State use only (if applicable).

4\. If this application is to continue or revise an existing award,
enter present Federal identifier number. If for a new project, leave
blank.

5\. Legal name of applicant, name of primary organizational unit, which
will undertake the assistance activity, complete address of the
applicant, and the name and telephone number of the person to contact on
matters related to this application.

6\. Enter Employer Identification Number (EIN) as assigned by the
Internal Revenue Service.

7\. Enter the appropriate letter in the space provided.

8\. Check appropriate box and enter appropriate letter(s) in the
space(s) provided:

\- \"New\" means a new assistance award.

\- \"Continuation\" means an extension for an additional funding/budget
period for a project with a projected completion date.

\- \"Revision\" means any change in the Federal Government\'s financial
obligation or contingent liability from an existing obligation.

9\. Name of Federal agency from which assistance is being requested with
this application.

10\. Use the Catalog of Federal Domestic Assistance number and title of
the program under which assistance is requested.

Item: Entry:

11\. Enter a brief descriptive title of the project. If more than one
program is involved, you should append an explanation on a separate
sheet. If appropriate (e.g., construction or real property projects),
attach a map showing project location. For preapplications, use a
separate sheet to provide a summary description of this project.

12\. List only the largest political entities affected (e.g., State,
counties, cities).

13\. Self-explanatory.

14\. List the applicant\'s Congressional District and any District(s)
affected by the program or project.

15\. Amount requested or to be contributed during the first
funding/budget period by each contributor. Value of in-kind
contributions should be included on appropriate lines as applicable. If
the action will result in a dollar change to an existing award, indicate
only the amount of the change. For decreases, enclose the amounts in
parentheses. If both basic and supplemental amounts are included, show
breakdown on an attached sheet. For multiple program funding, use totals
and show breakdown using same categories as item 15.

16\. Applications should contact the State Single Point of Contact
(SPOC) for Federal Executive Order 12372 to determine whether the
application is subject to the State inter government review process.

17\. This question applies to the applicant organization, not the person
who signs as the authorized representative. Categories of debt include
delinquent audit disallowances loans and taxes.

18\. To be signed by the authorized representative of the applicant. A
copy of the governing body\'s authorization for you to sign this
application as official representative must be on file in the
applicant\'s office. (Certain Federal agencies may require that this
authorization be submitted as part of the application.)

**SF 424 Back (Rev. 4-92)**

**Budget Information - Non-Construction Programs**

<table style="width:100%;">
<colgroup>
<col style="width: 20%" />
<col style="width: 10%" />
<col style="width: 14%" />
<col style="width: 0%" />
<col style="width: 12%" />
<col style="width: 0%" />
<col style="width: 11%" />
<col style="width: 0%" />
<col style="width: 22%" />
<col style="width: 0%" />
<col style="width: 6%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="11"><strong>SECTION A - BUDGET SUMMARY</strong></td>
</tr>
<tr class="even">
<td><p>Grant Program</p>
<p>Function</p>
<p>Or Activity</p>
<p>{a}</p></td>
<td><p>Catalog of Federal</p>
<p>Domestic Assistance Number</p>
<p>{b}</p></td>
<td colspan="3">Estimated Unobligated Funds</td>
<td colspan="6">New or Revised Budget</td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td><p>Federal</p>
<p>{c}</p></td>
<td colspan="2"><p>Non-Federal</p>
<p>{d}</p></td>
<td colspan="3"><p>Federal</p>
<p>{e}</p></td>
<td colspan="2"><p>Non-Federal</p>
<p>{f}</p></td>
<td><p>Total</p>
<p>{g}</p></td>
</tr>
<tr class="even">
<td>1. Headquarters</td>
<td>$ NA</td>
<td>$ NA</td>
<td colspan="2">$ NA</td>
<td colspan="3">$</td>
<td colspan="2">$</td>
<td>$</td>
</tr>
<tr class="odd">
<td>2. Field</td>
<td>NA</td>
<td>NA</td>
<td colspan="2">NA</td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td>3. NA</td>
<td>NA</td>
<td>NA</td>
<td colspan="2">NA</td>
<td colspan="3">NA</td>
<td colspan="2">NA</td>
<td>NA</td>
</tr>
<tr class="odd">
<td>4. NA</td>
<td>NA</td>
<td>NA</td>
<td colspan="2">NA</td>
<td colspan="3">NA</td>
<td colspan="2">NA</td>
<td>NA</td>
</tr>
<tr class="even">
<td>5.TOTALS</td>
<td>$ NA</td>
<td>$ NA</td>
<td colspan="2">$ NA</td>
<td colspan="3">$</td>
<td colspan="2">$</td>
<td>$</td>
</tr>
<tr class="odd">
<td colspan="11"><p id="section-b-budget-categories"
class="heading">SECTION B – BUDGET CATEGORIES</p></td>
</tr>
<tr class="even">
<td colspan="2">6. Object Class Categories</td>
<td colspan="3">USAID PROGRAM</td>
<td colspan="5">RECIPIENT FUNDS</td>
<td><p>Total</p>
<p>{5}</p></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td>(1) Federal</td>
<td colspan="2">(2) Non-Federal</td>
<td colspan="3">{3}</td>
<td colspan="2">{4}</td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">a. Personnel (1)</td>
<td>$</td>
<td colspan="2">$</td>
<td colspan="3">$ NA</td>
<td colspan="2">$ NA</td>
<td>$</td>
</tr>
<tr class="odd">
<td colspan="2">b. Fringe Benefits (1)</td>
<td colspan="2"></td>
<td colspan="2"></td>
<td>NA</td>
<td colspan="2">NA</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2">c. Travel (1)</td>
<td></td>
<td colspan="2"></td>
<td colspan="3">NA</td>
<td colspan="2">NA</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">d. Equipment (3)</td>
<td></td>
<td colspan="2"></td>
<td colspan="3">NA</td>
<td colspan="2">NA</td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">e. Supplies (3)</td>
<td></td>
<td colspan="2"></td>
<td colspan="3">NA</td>
<td colspan="2">NA</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">f. Contractual (3)</td>
<td></td>
<td colspan="2"></td>
<td colspan="3">NA</td>
<td colspan="2">NA</td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">g. Construction N/A</td>
<td></td>
<td colspan="2"></td>
<td colspan="3">NA</td>
<td colspan="2">NA</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">h. Other (1), (2) (see notes)</td>
<td></td>
<td colspan="2"></td>
<td colspan="3">NA</td>
<td colspan="2">NA</td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">i. Total Direct Charges (sum of 6a-6h)</td>
<td></td>
<td colspan="2"></td>
<td colspan="3">NA</td>
<td colspan="2">NA</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">j. Indirect Charges (4)</td>
<td></td>
<td colspan="2"></td>
<td colspan="3">NA</td>
<td colspan="2">NA</td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">k. TOTALS (sum of 6i and 6j)</td>
<td>$</td>
<td colspan="2">$</td>
<td colspan="3">$</td>
<td colspan="2">$</td>
<td>$</td>
</tr>
<tr class="odd">
<td colspan="11"></td>
</tr>
<tr class="even">
<td colspan="2">7. Program Income</td>
<td>$</td>
<td colspan="2">$</td>
<td colspan="3">$</td>
<td colspan="2">$</td>
<td>$</td>
</tr>
</tbody>
</table>

STANDARD FORM 424A (cont\'d)

  ---------------------- ------- ----------- ----------- --------- ------------- --------- ------------- --------- --------
  **SECTION C -                                                                                                    
  NON-FEDERAL                                                                                                      
  RESOURCES**                                                                                                      

  \(a\) Grant Program            \(b\)                             \(c\) State             \(d\) Other             \(e\)
                                 Applicant                                                 Sources                 TOTALS

  8\. Headquarters               \$                                \$ NA                   \$                      \$

  9\. Field                                                        NA                                              

  10\. NA                        NA                                NA                      NA                      

  11\. NA                        NA                                NA                      NA                      

  12\. TOTAL (sum of             \$                                \$ NA                   \$                      \$
  lines 8-11)                                                                                                      

  **SECTION D -                                                                                                    
  FORECASTED CASH                                                                                                  
  NEEDS**                                                                                                          

  13\. Federal           Total               1st Quarter 2^nd^                   3rd                     4th       
                         for 1st                         Quarter                 Quarter                 quarter   
                         Year                                                                                      

                         \$                  \$          \$                      \$                      \$        

  14\. Non-Federal                                                                                                 

  15\. TOTAL (sum of                                                                                               
  lines 13 and 14)                                                                                                 

  **SECTION E - BUDGET                                                                                             
  ESTIMATES OF FEDERAL                                                                                             
  FUNDS NEEDED FOR                                                                                                 
  BALANCE OF THE                                                                                                   
  PROJECT**                                                                                                        

  \(a\) Grant Program            Future                                                                            
                                 Funding                                                                           
                                 Periods                                                                           

                                 \(b\) First                       \(c\) Second            \(d\) Third             \(e\)
                                                                                                                   Fourth

  16\. Headquarters              \$                                \$                      \$                      \$

  17\. Field                                                                                                       

  18\. NA                        NA                                NA                      NA                      NA

  19\. NA                        NA                                NA                      NA                      NA

  20\. TOTAL (sum of             \$                                \$                      \$                      \$
  lines 16-19)                                                                                                     

  **SECTION F - OTHER                                                                                              
  BUDGET INFORMATION**                                                                                             

  21\. Direct Charges:           22\.                                                                              
                                 Indirect                                                                          
                                 Charges:                                                                          

  23\. Remarks:                                                                                                    
  ---------------------- ------- ----------- ----------- --------- ------------- --------- ------------- --------- --------

**Authorized for Local Reproduction Standard Form 424 A (Rev. 4-92) Page
2**

**Standard Form 424A (cont\'d.)**

#####  INSTRUCTIONS FOR THE SF 424A

Public reporting burden for this collection of information is estimated
to average 180 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other
aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget. Paperwork
Reduction Project (0348-0044), Washington, DC 20503.

**PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT
AND BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.**

**General Instructions**

This form is designed so that application can be made for funds from one
or more grant programs. In preparing the budget, adhere to any existing
Federal grantor agency guidelines, which prescribe how, and whether
budgeted amounts should be separately show for different functions or
activities within the program. For some programs, grantor agencies may
require budgets to be separately shown by function or activity. For
other programs, grantor agencies may require a breakdown by function or
activity. Sections A, B, C and D should include budget estimates for the
whole project except when applying for assistance which requires Federal
authorization in annual or other funding period increments. In the
latter case, Section A, B, C and D should provide the budget for the
first budget period (usually a year) and Section E should present the
need for Federal assistance in the subsequent budget periods. All
applications should contain a breakdown by the object class categories
shown in Lines a-k of Section B.

**Section A. Budget Summary Lines 1-4 Columns (a) and (b)**

For applications pertaining to a *single* Federal grant program (Federal
Domestic Assistance Catalog number) and *not requiring* a functional or
activity breakdown, enter on Line 1 under Column (a) the catalog program
title and the catalog number in Column (b).

For applications pertaining to a *single* program *requiring* budget
amounts by multiple functions or activities, enter the name of each
activity or function on each line in Column (a), and enter the catalog
number in Column (b). For applications pertaining to multiple programs
where none of the programs require a breakdown by function or activity,
enter the catalog program title on each line in *Column (a)* and the
respective catalog number on each line in Column (b).

For applications pertaining to *multiple* programs where one or more
programs require a breakdown by function or activity, prepare a separate
sheet for each program requiring

the breakdown. Additional sheets should be used when one form does not
provide adequate space for all breakdown of

data required. However, when more than one sheet is used,

the first page should provide the summary totals by programs.

**Lines 1-4, Columns (c) through (g)**

*For new applications*, leave Columns (c) and (d) blank. For each line
Entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the
appropriate amounts of funds needed to support the project for the first
funding period (usually a year).

*For continuing grant program applications*, submit these forms before
the end of each funding period as required by the grantor agency. Enter
in Column (c) and (d) the estimated amounts of funds which will remain
unobligated at the end of the grant funding period only if the Federal
grantor agency instructions provide for this. Otherwise, leave these
columns blank. Enter in columns (e) and (f) the amounts of funds needed
for the upcoming period. The amount(s) in Column (g) should be the sum
of amounts in Columns (e) and (f).

*For supplemental grants and changes* to existing grants, do not use
Columns (c) and (d). Enter in Column (e) the amount of the increase or
decrease of Federal funds and enter in Column (f) the amount of the
increase of non-Federal funds. In Column (g) enter the new total
budgeted amount (Federal and non-Federal) which includes the total
previous authorized budgeted amounts plus or minus, as appropriate, the
amounts shown in Columns (e) and (f). The amounts(s) in Column (g)
should not equal the sum of amounts in Columns (e) and (f).

**Line 5 -** Show the totals for all columns used.

**SF 424A (Rev. 4-92) Page 3**

**Standard Form 424A (cont\'d.)**

**INSTRUCTIONS FOR THE SF 424A (continued)**

**Section B. Budget Categories**

In the column headings (1) enter Federal, and (2) enter Non-Federal.
When additional sheets are prepared for Section A, provide similar
column headings on each sheet. For each program, function or activity,
fill in the total requirements for funds (both Federal and non-Federal)
by object class categories.

**Lines 6a-i -** Show the totals of Lines 6a to 6h in each column.

**Line 6j** - Show the amount of indirect cost.

**Line 6k** - Enter the total of amounts on Lines 6i and 6j. For all
applications for new grants and continuation grants the total amount in
column (5), Line 6k, should be the same as the total amount shown in
Section A, Column (g), Line 5. For supplemental grants and changes to
grants, the total amount of the increase or decrease as shown in Columns
(1)-(4), Line 6k should be the same as the sum of the amounts in Section
A, Columns (e) and (f) on Line 5.

**Line 7** - Enter the estimated amount of income, if any, expected to
be generated from this project. Do not add or subtract this amount from
the total project amount. Show under the program narrative statement the
nature and source of income. The estimated amount of program income may
be considered by the federal grantor agency in determining the total
amount of the grant.

**Section C. Non-Federal Resources**

**Lines 8-11** - Enter amounts of non-Federal resources that will be
used on the grant. If in-kind contributions are included, provide a
brief explanation on a separate sheet.

**Column (a)** - Enter the program titles identical to Column (a),
Section A. A breakdown by function or activity is not necessary.

**Column (b)** - Enter the contribution to be made by the applicant.

**Column (c)** - Enter the amount of the State\'s cash and in-kind
contribution if the applicant is not a State or State agency. Applicants
who are a State or State agencies should leave this column blank.

**Column (d)** - Enter the amount of cash and in-kind contributions to
be made from all other sources.

**Column (e)** - Enter totals of Columns (b), (c), and (d).

**Line 12** - Enter the total for each of Columns (b)-(e). The amount in
Column (e) should be equal to the amount on Line 5, Column (f) Section
A.

**Section D. Forecasted Cash Needs**

**Line 13** - Enter the amount of cash needed by quarter from the
grantor agency during the first year.

**Line 14** - Enter the amount of cash from all other sources needed by
quarter during the first year.

**Line 15** - Enter the totals of amounts on Lines 13 and 14.

**Section E. Budget Estimates of Federal Funds Needed for Balance of the
Project**

**Lines 16-19** - Enter in Column (a) the same grant program titles
shown in Column (a), Section A. A breakdown by function or activity is
not necessary. For new applications and continuation grant applications,
enter in the proper columns amounts of Federal funds which will be
needed to complete the program or project over the succeeding funding
periods (usually in years). This section need not be completed for
revisions (amendments, changes, or supplements) to funds for the current
year of existing grants.

If more than four lines are needed to list the program titles, submit
additional schedules as necessary.

**Line 20** - Enter the total for each of the Columns (b)-(e). When
additional schedules are prepared for this Section, annotate accordingly
and show the overall totals on this line.

**Section F. Other Budget Information**

**Line 21** - Use this space to explain amounts for individual direct
object-class cost categories that may appear to be out of the ordinary
or to explain the details as required by Federal grantor agency.

**Line 22** - Enter the type of indirect rate (provisional,
predetermined, final or fixed) that will be in effect during the funding
period, the estimated amount of the base to which the rate is applied,
and the total indirect expense.

**Line 23** - Provide any other explanations or comments deemed
necessary.

**SF 424A (Rev. 4-92)** Page 4

**The following object class categories are those required on USAID Form
424A (Section B - Budget Categories):**

a\. **[Personnel]{.underline}**

The category includes the salary of each long-term and short-term, paid
position for the total estimated life-of-project, except consultants,
and the projected cost-of-living or bonus/merit increase for each
position.

b\. **[Fringe Benefits]{.underline}**

This category includes the amount and percentage of fringe benefits for
each headquarters and field personnel identified above. Include here all
allowances such as housing, schooling, leave benefits, and other items.

c\. **[Travel]{.underline}**

This category includes all projected travel, per diem and other related
costs for personnel **except** consultants. Include the method by which
airfare costs were determined; i.e. quotes for coach and if per-diems
are based on established policies.

d\. **[Equipment]{.underline}**

In accordance with 22 CFR 226, \'equipment\' means tangible
non-expendable personal property, including exempt property charged
directly to the award having a useful life of more than one year and an
acquisition cost of \$5,000 or more per unit. Information should be
included in the application on how pricing was determined for each piece
of the equipment.

There are statutory constraints relating to the purchase of agricultural
commodities, motor vehicles, pharmaceuticals, pesticides, rubber
compounding chemicals and plasticizers, used equipment and fertilizer
with USAID project funds. PVOs/NGOs may obtain specific information on
these regulations on USAID Web Site at http://www.usaid.gov/pubs/ads.

e\. **[Supplies]{.underline}**

In accordance with 22 CFR 226, \'supplies\' means all personal property
excluding equipment, intangible property, debt instruments and
interventions.

There are statutory constraints relating to the purchase of agricultural
commodities, motor vehicles, pharmaceuticals, pesticides, rubber
compounding chemicals and plasticizers, used equipment and fertilizer
with USAID project funds. PVOs/NGOs can obtain specific information on
these regulations on USAID Web Site at
http://www.usaid.gov/pubs/ads/300/312/htm.

f\. **[Contractual Services]{.underline}**

This category is for all subcontracts with organizations, which will
provide services to the project and any short- or long-term consultant
cost including fees, travel and perdiem. This category is not to be used
for sub-grants, which should be included in other.

g\. **[Construction]{.underline}**

N/A

h\. **[Other]{.underline}**

PVOs/NGOs are to identify all costs associated with training of project
personnel.

PVOs/NGOs planning to use USAID funds to send project staff or local
counterparts for training in the U.S. or a country other than the host
country, will be required to follow the guidance on USAID Participant
Training Regulations, which may be found on the USAID Web Site
<http://www.usaid.gov/pubs/ads>.

The PVO/NGO should provide information on any costs attributed to the
project not associated above; i.e. communications, facilities, fuel
vehicles, repair, maintenance and insurance.

Include in this budget class category all sub-grants.

i\. **[Indirect Charges]{.underline}**

Include a copy of the PVO's/NGO's most recent negotiated indirect cost
rate agreement (NICRA) from the cognizant audit agency showing the
overhead and/or general administrative rate.

USAID Form 424A, Section C should reflect the PVO's/NGO's and other
sources' cash contribution to this program. A cash match means that
funds are used to support the budget elements discussed above. This does
not include volunteer labor from U.S. or host country sources. The cash
value of donated equipment or supplies must be documented.

**A narrative that justifies the costs as appropriate and necessary for
the successful completion of the program should be attached to USAID
Form 424.**

The Cooperative Agreement Budget generally has four (4) different
categories called [Budget Cost Elements:]{.underline} Program, Training,
Procurement, and Indirect Costs. A sample Agreement Budget is included
below. On Standard Form 424A, Section B--Budget Categories, all eleven
[Object Class Categories]{.underline} have a footnote number next to
them. The footnote numbers next to the Object Class Categories
correspond to one of the four Cost Elements of the Cooperative Agreement
Budget. The 11 Object Class Categories fit within the four Cost Elements
of the Cooperative Agreement Budget. For this application, submit only
the Standard Form 424 and 424A, with the corresponding eleven (11)
Object Class Categories, supported by a detailed narrative. Do
**[NOT]{.underline}** use the four **Cost Elements of the**
**Cooperative Agreement Budget shown below**.

##### SAMPLE COOPERATIVE AGREEMENT BUDGET

-   SF 424, sec.B, Item 6

[Budget Cost Element]{.underline} [Object Class Category]{.underline}
[Budget Amount]{.underline}

-   Program Line a, b, c, and h \$\_\_\_\_\_

-   Training Line h \$\_\_\_\_\_

Procurement Line d, e and f \$\_\_\_\_\_

Indirect Costs Line j \$\_\_\_\_\_

Program's Total Budget \$\_\_\_\_\_

Funding arrangement:

Total USAID Amount \$\_\_\_\_\_

Recipient's Cost Share \$\_\_\_\_\_

Total Program Funding \$\_\_\_\_\_

[^1]: MCHIP will merge the functions of several current USAID/GH
    projects (ACCESS, BASICS III, Immunization BASICS, POPPHI, and
    CSTS+) to improve efficiency and effectiveness, and to support
    Mission needs for integrated MCH programs.

[^2]: Applicants are encouraged to review the list and descriptions of
    evidence-based, high impact MCH interventions on page 10 of the
    USAID report to Congress entitled "Working Toward the Goal of
    Reducing Maternal and Child Mortality: USAID Programming and
    Response to FY08 Appropriations" at
    <http://www.usaid.gov/our_work/global_health/mch/publications/mch_report.html>.

[^3]: In PMI countries (Angola, Benin, Ghana, Kenya, Liberia,
    Madagascar, Malawi, Mali, Mozambique, Rwanda, Senegal, Tanzania,
    Uganda, Zambia and Ethiopia), CSHGP projects should be implemented
    in collaboration with PMI efforts and priorities in country, which
    are based on close planning with National Malaria Control Programs
    (NMCPs). See the PMI website at [www.pmi.gov](http://www.pmi.gov/)
    for more information. In all countries, projects should be
    consistent with NMCP strategies and approaches. *Please note that
    malaria interventions are not restricted to PMI focus countries or
    regions.*

[^4]: Applies only to TB category applicants.

[^5]: All countries are weighted equally for the CSHGP FY09 RFA. The
    proposed project's strategic fit and relevance within a country
    context remain important. For reference, countries in bold are USAID
    MCH initiative priority countries, which are characterized by both
    high magnitude and severity of maternal and child deaths and meet
    other criteria, including country capacity and commitment and
    potential for interaction with other U.S. Government resources. See
    <http://pdf.usaid.gov/pdf_docs/PDACL707.pdf> (p.7).

[^6]: <http://www.usaid.gov/our_work/global_health/mch/publications/mch_report.html>

[^7]: <http://www.countdown2015mnch.org/>

[^8]: <http://www.usaid.gov/our_work/global_health/mch/publications/mch_report.html>

[^9]: <http://www.countdown2015mnch.org/>

[^10]: Providing TB diagnosis and/or treatment according to national
    norms.

[^11]: Reporting negative for positive or vice-versa.

[^12]: Infectious TB cases, which are found in adults, are the primary
    target population for TB category applications.