# Open Solicitation

# Program Announcement and Grant Application Instructions

# OMB Approval No. 0985-0018

Expiration 05/31/2010

# U.S. Administration on Aging

**2008**

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

**Administration on Aging (AoA)**

######## Funding Opportunity Title: Open Solicitation

**Announcement Type:** Initial

**Funding Opportunity Number:** HHS-2008-AoA-OP-0817

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

**Key Dates:** The deadline date for submission of applications is
**[9/12/2008]{.underline}**. All applications must be submitted via
[www.grants.gov](http://www.grants.gov/) by midnight Eastern Time.

**Additional Overview Content:** AoA is accepting applications for
proposed projects that further the purposes of Title IV of the Older
Americans Act, as amended, the AoA strategic plan, and the AoA mission.

Title IV projects must: test new and innovative approaches to the design
and delivery of programs and services for older persons; expand
knowledge and understanding of the older population and the aging
process; help meet the needs for trained personnel in the field of
aging; and/or increase awareness of the need for individuals to assume
responsibility for their own longevity.

When developing its application, an applicant should strongly consider
its data, measurement, collection, reporting, and evaluation
methodologies as AoA is particularly interested in funding innovative
performance models that can demonstrate successful outcomes and that may
be replicated by other organizations. Program demonstrations that are
based on evidence-based models that have been supported by research
(preferably randomized control trials that are published in peer
reviewed journals) are preferred.

An applicant applying for grant funds through this Open Solicitation
should be aware that *this is a highly competitive program*. Limited
funds are available to support applicants' proposed Open Solicitation
projects. AoA anticipates funding only 1-2 applications per fiscal year
submitted in response to this Open Solicitation.

The majority of AoA discretionary grant funds are directed to
applications submitted in response to funding opportunity announcements
for established AoA grant programs. Announcements for these programs are
also available at [www.grants.gov](http://www.grants.gov/). Applicants
seeking AoA grant funds for projects that would be eligible for funding
under an established grant program should submit applications in
response to an issued announcement for that program.

I.  **FUNDING OPPORTUNITY DESCRIPTION**

> Applications may be submitted in response to this Open Solicitation
> for funding of projects that further the purposes of Title IV of the
> Older Americans Act, as amended
> (http://www.aoa.gov/OAA2006/Main_Site/oaa/oaa_full.asp), the AoA
> strategic plan ([www.aoa.gov](http://www.aoa.gov/), click on "About
> AoA" and select "Strategic Plan"), and the AoA mission (provided in
> the AoA Strategic Plan, page 3). [Projects eligible for funding under
> a discretionary funding opportunity announcement published by AoA
> should apply for funding under that announcement and will not be
> considered under this Open Solicitation. .]{.underline}
>
> Title IV projects must: test new and innovative approaches to the
> design and delivery of programs and services for older persons; expand
> knowledge and understanding of the older population and the aging
> process; help meet the needs for trained personnel in the field of
> aging; and/or increase awareness of the need for individuals to assume
> responsibility for their own longevity.
>
> When developing its application, an applicant should strongly consider
> its data, measurement, collection, cost analysis, reporting, and
> evaluation methodologies as AoA is particularly interested in funding
> innovative performance models that can demonstrate successful outcomes
> and that may be replicated by other organizations. Program
> demonstrations that are based on evidence-based models that have been
> supported by research (preferably randomized control trials that are
> published in peer reviewed journals) are preferred.
>
> Proposals should reflect an understanding of the aging services
> network and detail the role that their proposal could play in the
> service systems of the network. A successful applicant will
> demonstrate in its application that the applicant organization
> possesses the necessary program knowledge, experience and resources to
> execute its proposed project if funded.
>
> Applicants applying for grant funds through this Open Solicitation
> should be aware that *this is a highly competitive program*. Limited
> funds are available to support applicant projects under this Open
> Solicitation. AoA anticipates funding only 1-2 applications per fiscal
> year submitted in response to this Open Solicitation.
>
> The majority of AoA discretionary grant funds are directed to
> applications submitted in response to funding opportunity
> announcements for established AoA grant programs. Announcements for
> these programs are available at
> [www.grants.gov](http://www.grants.gov/) when AoA is accepting
> applications. Applicants seeking AoA grant funds for projects that
> would be eligible for funding under an established grant program
> should submit applications in response to an announcement for that
> program.

**[Statutory Authority]{.underline}**

> The statutory authority for grants under this program announcement is
> contained in Title IV of the Older Americans Act (OAA) (42U.S.C.
> 3032), as amended by the Older Americans Act Amendments of 2006, P.L.
> 109-365. (Catalog of Federal Domestic Assistance 93.048, Title IV
> Discretionary Projects).

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

> Award Type: grant or cooperative agreement
>
> Estimated Federal Funds Available: \$750,000
>
> Estimated Annual Award Ceiling: \$750,000
>
> Estimated Annual Award Floor: \$25,000
>
> Estimated Number of Awards: 1
>
> Anticipated Project Start Date: on or before September 30, 2008
>
> Estimated Length of Project: one year

**III. ELIGIBILITY INFORMATION**

**1. Eligible Applicants**

> Domestic public or private and non-profit entities including state and
> local governments, community-based organizations, faith-based
> organizations, institutions of higher education, and Indian tribal
> governments (American Indian/Alaskan Native/Native American). Note
> that only organizations may apply.  Individual persons are not
> eligible organizations and cannot receive a grant under this
> announcement. 

**2. Cost Sharing or Matching**

> Under this Older Americans Act (OAA) solicitation, AoA will fund no
> more than 75% of the project's total cost, which means the applicant
> must cover at least 25% of the project's total cost with non-federal
> resources. In other words, for every three (3) dollars received in
> federal funding, the applicant must contribute at least one (1) dollar
> in non-federal resources toward the project's total cost. This
> "three-to-one" ratio is reflected in the formula included under Item
> 18 in Attachment A. You can use this formula to calculate your minimum
> required match. A common error applicants make is to match 25% of the
> federal share, rather than 25% of the project's total cost. Please
> note, applications with a match greater than the minimum required will
> **[not]{.underline}** receive additional consideration under the
> review. Match is not one of the responsiveness criteria as noted in
> Section III, 3 Application Screening Criteria.

3.  **Other**

>  
>
> **Application Screening Criteria**
>
> All applications will be screened to assure a level playing field for
> all applicants. Applications that fail to meet the three screening
> criteria described below will **[not]{.underline}** be reviewed and
> will receive **[no]{.underline}** further consideration.
>
> In order for an application to be reviewed, it must meet the following
> screening requirements:

1.  Applications must be submitted electronically via
    [www.grants.gov](http://www.grants.gov/) by 11:59 p.m. on 9/12/2008
    (Eastern time).

2.  The Project Narrative section of the Application must be
    **[double-spaced]{.underline}**, on 8 ½" x 11" plain white paper
    with 1" margins on both sides, **[and a font size of not less than
    11]{.underline}**.

3.  The Project Narrative must [**not exceed** **20
    pages**]{.underline}. NOTE: The Project Work Plan, Letters of
    Commitment, and Vitae of Key Project Personnel **[are not
    counted]{.underline}** as part of the Project Narrative for purposes
    of the 20-page limit.

4.  The application must be in the English language.

> **Responsiveness Criteria**
>
> Applications will go through an initial programmatic screening to
> verify that the proposed project:

1.  Meets Title IV Statutory Purposes (42 U.S.C.3001 et seq.):

    a.  tests new and innovative approaches to the design and delivery
        of programs and services for older persons;

    b.  expands knowledge and understanding of the older population and
        the aging process;

    c.  helps meet the needs for trained personnel in the field of
        aging; and/or

    d.  increases awareness of the need for individuals to assume
        responsibility for their own longevity.

2.  Does not include the following activities which are not fundable
    under Title IV of the Older Americans Act:

    a.  Construction or Major Rehabilitation

    b.  Basic research

    c.  Continuation and/or expansion of existing projects

    d.  Medical care, institutional care, or income maintenance

    e.  Projects whose outcomes do not have the potential for nationwide
        dissemination and replication

    f.  Equipment purchases unless the equipment is necessary to carry
        out a project that is otherwise fundable under Title IV.

3.  falls within the mission and priorities as detailed in the AoA
    strategic plan,

4.  meets the current fiscal year AoA funding priorities.

> The initial screening will also determine if the applicant is an
> eligible entity. Successful applications will demonstrate that the
> applicant organization possesses adequate knowledge, experience and
> resources to execute the proposed project if funded.

IV. **APPLICATION AND SUBMISSION INFORMATION**

## 1. Address to Request Application Package 

> Application materials can be obtained from
> [http://www.grants.gov](http://www.grants.gov/) or
> <http://www.aoa.gov/doingbus/fundopp/fundopp.asp>.

Application materials are also available by writing to:

U.S. Department of Health and Human Services

Administration on Aging

Stephen Daniels

Office of Grants Management

Washington, D.C. 20201

Or by calling: 202-357-3464

Or e-mailing: Stephen.Daniels@aoa.hhs.gov

Please note, AoA is requiring applications for all announcements to be
submitted electronically through
[www.grants.gov](http://www.grants.gov/). The Grants.gov registration
process can take several days. If your organization is not currently
registered with [www.grants.gov](http://www.grants.gov/), please begin
this process immediately. **For assistance with
[www.grants.gov](http://www.grants.gov/), please contact them at**
[support@grants.gov](mailto:support@grants.gov?subject=Support) **or
1-800-518-4726 between 7 a.m. and 9 p.m. Eastern Time.** At
[www.grants.gov](http://www.grants.gov/), you will be able to download a
copy of the application packet, complete it off-line, and then upload
and submit the application via the Grants.gov website.

Applications submitted via [www.grants.gov](http://www.grants.gov/) :

-   You may access the electronic application for this program on
    [www.Grants.gov](http://www.Grants.gov/). You must search the
    downloadable application page by the Funding Opportunity Number
    HHS-2008-AOA-OP-0817 or CFDA number(93.048).

-   At the www.grants.gov website, you will find information about
    submitting an application electronically through the site, including
    the hours of operation. AoA strongly recommends that you do not wait
    until the application due date to begin the application process
    through [www.grants.gov](http://www.grants.gov/) because of the time
    delay.

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

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

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

-   After you electronically submit your application, you will receive
    an automatic acknowledgement from www.grants.gov that contains a
    Grants.gov tracking number. The Administration on Aging will
    retrieve your application form from Grants.gov.

-   Each year organizations registered to apply for federal grants
    through [www.grants.gov](http://www.grants.gov/) will need to renew
    their registration with the Central Contractor Registry (CCR). You
    can register with the CCR online and it will take about 30 minutes
    ([http://www.ccr.gov](http://www.ccr.gov/)).

###### Content and Form of Application Submission 

> **a. Letter of Intent**
>
> Not applicable.
>
> **b. DUNS Number**
>
> The Office of Management and Budget requires applicants to provide a
> Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number
> when applying for Federal grants or cooperative agreements on or after
> October 1, 2003. It is entered on the SF 424. It is a unique,
> **nine-digit identification number**, which provides unique
> identifiers of single business entities. The DUNS number is *free and
> easy* to obtain.
>
> Organizations can receive a DUNS number at no cost by calling the
> dedicated toll-free DUNS Number request line at 1-866-705-5711 or by
> using this link to access a guide:
> <https://www.whitehouse.gov/omb/grants/duns_num_guide.pdf> **.**
>
> **c. Project Narrative**

##  

> The Project Narrative must be double-spaced, on 8 ½" x 11" paper with
> 1" margins on both sides, and a **font size of not less than 11**. You
> can use smaller font sizes to fill in the Standard Forms and Sample
> Formats. The suggested length for the Project Narrative is ten to
> twenty pages; twenty pages is the maximum length allowed. **AoA will
> not accept applications with a Project Narrative that exceeds 20
> pages**. The Project Work Plan, Letters of Commitment, and Vitae of
> Key Personnel are [not]{.underline} counted as part of the Project
> Narrative for purposes of the 20-page limit, but all of the other
> sections noted below are included in the limit.
>
> The components of the Project Narrative counted as part of the 20 page
> limit include:

-   Summary/Abstract

-   Problem Statement

-   Goal(s) and Objective(s)

-   Proposed Intervention

-   Special Target Populations and Organizations

-   Outcomes

-   Project Management

-   Evaluation

-   Dissemination

-   Organizational Capability

> The Project Narrative is the most important part of the application,
> since it will be used as the primary basis to determine whether or not
> your project meets the minimum requirements for grants under Title IV
> of the Older Americans Act. The Project Narrative should provide a
> **clear and concise** description of your project. AoA recommends that
> your project narrative include the following components:
>
> **Summary/Abstract.** This section should include a brief - no more
> than 265 words maximum - description of the proposed project,
> including: the goal, the list of objectives and the products to be
> developed. Detailed instructions for completing the summary/abstract
> are included in Attachment E of this document.
>
> **Problem Statement.** This section should describe, in both
> quantitative and qualitative terms, the nature and scope of the
> particular problem or issue the proposed intervention is designed to
> address, including how the project will potentially affect the elderly
> population and/or their caregivers (including specific subgroups
> within those populations), and possibly the health care and social
> services systems (e.g., the use of health care and/or nursing home
> services.)
>
> **Goals and Objectives.** This section should consist of a description
> of the project's goal(s) and major objectives. Unless the project
> involves multiple, complex interventions, we recommend you have only
> one overall goal.
>
> **Proposed Intervention.** This section should provide a clear and
> concise description of the intervention you are proposing to use to
> address the problem described in the "Problem Statement". You should
> also describe the rationale for using the particular intervention,
> including factors such as: "lessons learned" for similar projects
> previously tested in your community, or in other areas of the country;
> factors in the larger environment that have created the "right
> conditions" for the intervention (e.g., existing social, economic or
> political factors that you'll be able to take advantage of, etc.).
> Also note any major barriers you anticipate encountering, and how your
> project will be able to overcome those barriers. Be sure to describe
> the role and makeup of any strategic partnerships you plan to involve
> in implementing the intervention, including other organizations,
> funders, and/or consumer groups.
>
> **Special Target Populations and Organizations.** This section should
> describe how you plan to involve community-based organizations in a
> meaningful way in the planning and implementation of the proposal
> project. This section should also describe how the proposed
> intervention will target disadvantaged populations, including
> limited-English speaking populations.
>
> **Outcomes**. This section of the project narrative must clearly
> identify the [measurable]{.underline} outcome(s) that will result from
> the project. (NOTE: AoA will not fund any project that does not
> include measurable outcomes). This section should also describe how
> the project's findings might benefit the field at large, (e.g., how
> the findings could help other organizations throughout the nation to
> address the same or similar problems.) List measurable outcomes in the
> attached work plan grid (Attachment D) under "Measurable Outcomes" in
> addition to any discussion included in the narrative along with a
> description of how the project might benefit the field at large.
>
> A "measurable outcome" is an observable end-result that describes how
> a particular intervention benefits consumers. It demonstrates the
> functional status, mental well-being, knowledge, skill, attitude,
> awareness or behavior.) It can also describe a change in the degree to
> which consumers exercise choice over the types of services they
> receive, or whether they are satisfied with the way a service is
> delivered. Additional examples include: a change in the responsiveness
> or cost-effectiveness of a service delivery system; a new model of
> support or care that can be replicated in the aging network; or new
> knowledge that can contribute to the field of aging. A measurable
> outcome is not a measurable "output", such as: the number of clients
> served; the number of training sessions held; or the number of service
> units provided.
>
> You should keep the focus of this section on describing
> [what]{.underline} outcome(s) will be produced by the project. You
> should use the Evaluation section noted below to describe
> [how]{.underline} the outcome(s) will be measured and reported.
>
> Your application will be scored on the clarity and nature of your
> proposed outcomes, not on the number of outcomes cited. It is totally
> appropriate for a project to have only ONE outcome that it is trying
> to achieve through the intervention reflected in the project's design.
>
> **Project Management**. This section should include a clear
> delineation of the roles and responsibilities of project staff,
> consultants and partner organizations, and how they will contribute to
> achieving the project's objectives and outcomes. It should specify who
> would have day-to-day responsibility for key tasks such as: leadership
> of project; monitoring the project's on-going progress, preparation of
> reports; communications with other partners and AoA. It should also
> describe the approach that will be used to monitor and track progress
> on the project's tasks and objectives.
>
> **Evaluation**. This section should describe the method(s), techniques
> and tools that will be used to: 1) determine whether or not the
> proposed intervention achieved its anticipated outcome(s), and 2)
> document the "lessons learned" -- both positive and negative - from
> the project that will be useful to people interested in replicating
> the intervention, if it proves successful.
>
> **Dissemination.** This section should describe the method that will
> be used to disseminate the project's results and findings in a timely
> manner and in easily understandable formats, to parties who might be
> interested in using the results of the project to inform practice,
> service delivery, program development, and/or policy-making, including
> and especially those parties who would be interested in replicating
> the project.

## Organizational Capability Statement. Each application should include an organizational capability statement and vitae for key project personnel. The organizational capability statement should describe how the applicant agency (or the particular division of a larger agency which will have responsibility for this project) is organized, the nature and scope of its work and/or the capabilities it possesses. This description should cover capabilities of the applicant agency not included in the program narrative, such as any current or previous relevant experience and/or the record of the project team in preparing cogent and useful reports, publications, and other products. If appropriate, include an organization chart showing the relationship of the project to the current organization. Please attach short vitae for key project staff only. Neither vitas nor an organizational chart will count towards the narrative page limit. Also include information about any contractual organization(s) that will have a significant role(s) in implementing project and achieving project goals. 

> **d. Work Plan**.
>
> The Project Work Plan should reflect and be consistent with the
> Project Narrative and Budget. It should include a statement of the
> project's overall goal, anticipated outcome(s), key objectives, and
> the major tasks / action steps that will be pursued to achieve the
> goal and outcome(s). For each major task / action step, the work plan
> should identify timeframes involved (including start- and end-dates),
> and the lead person responsible for completing the task. Please use
> the Sample Work Plan format included in the Attachments.
>
> **e. Letters of Commitment from Key Participating Organizations and
> Agencies.**
>
> Include confirmation of the commitments to the project (should it be
> funded) made by [key]{.underline} collaborating organizations and
> agencies in this part of the application. Any organization that is
> specifically named to have a significant role in carrying out the
> project should be considered an essential collaborator. For
> applications submitted electronically via Grants.gov, signed letters
> of commitment should be scanned and included as attachments.
> Applicants unable to scan the signed letters of commitment may fax
> them to the AoA Office of Grants Management at 202-357-3466 by the
> application submission deadline.
>
> **f. Project Budget Narrative**
>
> The Budget Narrative should be provided using the format included as
> Attachment C of this Program Announcement. Applicants are encouraged
> to pay particular attention to Attachment B which provides an example
> of the level of detail sought. Please note that when more than 33% of
> project's budget falls under contractual, detailed budget narratives
> must be provided for each sub-contractor or sub-grant.

**3. Submission Dates and Times**

> The deadline for the submission of applications under this program
> announcement is 09/12/2008. Applications must be submitted
> electronically by 11:59 p.m. Eastern Time.
>
> Applications that fail to meet the application due date will
> **[not]{.underline}** be reviewed and will receive
> **[no]{.underline}** further consideration.
>
> Grants.gov will automatically send applicants a tracking number and
> date of receipt verification electronically once the application has
> been successfully received and validated in Grants.gov.

**4. Intergovernmental Review**

> This funding opportunity announcement is not subject to the
> requirements of Executive Order 12372, "Intergovernmental Review of
> Federal Programs"

**5. Funding Restrictions**

> The following activities are not fundable:

-   Construction and/or major rehabilitation of buildings

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

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

**6. Other Submission Requirements**

> Electronic submissions must be sent to:
> [http://www.grants.gov](http://www.grants.gov/).
>
> Applicants submitting their application through
> [www.grants.gov](http://www.grants.gov/) must register in the Central
> Contractor Registry (CCR) database in order to be able to submit the
> application. One element of the CCR is the DUNS number (see section
> IV.2), which must be obtained separately from CCR registration.
> Information about CCR is available at
> [http://www.ccr.gov](http://www.ccr.gov/). You must also register with
> the grants.gov credential service provider to receive a username and
> password to securely submit your grant application. Information is
> available at <http://apply07.grants.gov/apply/OrcRegister>.

V.  **APPLICATION REVIEW INFORMATION**

**1. *Criteria***

### Applications are scored by assigning a maximum of 100 points across four criteria:

### Purpose and Need for Assistance - (20 points); 

### Approach, Workplan and Activities - (30 points);

### Project Outcomes, Evaluation/Dissemination - (30 points); and 

### Level of Effort - (20 points).

> a\. [Purpose and Need for Assistance]{.underline} [Weight: 20
> points]{.underline}
>
> i\. Does the proposed project clearly and adequately respond to one or
> more areas of the AoA strategic plan, AoA mission, and Title IV of the
> Older Americans Act, as amended? (10 points).
>
> ii\. Does the application adequately and appropriately describe and
> document the key problem(s)/condition(s) relevant to its purposes? Is
> the proposed project justified in terms of the most recent, relevant,
> and available information and knowledge? (10 points)
>
> b\. [Approach, Work Plan and Activities]{.underline} [Weight: 30
> points]{.underline}
>
> i\. Is the intervention clearly defined? Does it reflect a coherent
> and feasible approach for successfully addressing the identified
> problem and achieving the identified outcome(s)? Does the project take
> into account barriers and opportunities that exist in the larger
> environment that may impact on the project's success? Does the
> intervention optimize the use of potential partnerships with other
> organizations and/or consumer groups, as appropriate? (10 points)
>
> ii\. Is the project work plan clear and comprehensive? Does it include
> sensible and feasible timeframes for the accomplishment of tasks
> presented? Does the work plan include specific objectives and tasks
> that are linked to measurable outcomes? Does the proposal include a
> clear and coherent management plan? Are the roles and responsibilities
> of project staff, consultants and partners clearly defined and linked
> to specific objectives and tasks? Are the qualifications of the
> project staff, consultants and/or partners, and the proposed level of
> effort, adequate to carryout the project? (10 points)
>
> iii\. Does the application describe how local community-based
> organizations will be involved in a meaningful way in the planning and
> implementation of the proposed project? Does the application include
> disadvantaged populations, including limited-English speaking
> populations in its target population? (10 points)

c\. [Project Outcomes, Evaluation and Dissemination]{.underline}
[Weight: 30 points]{.underline}

> i\. Are the expected project benefits/results clear, realistic, and
> consistent with the objectives and purpose of the project? Are the
> anticipated outcomes of the proposed project likely to be achieved and
> will they significantly benefit the populations affected by the
> intervention, and the field of aging as a whole? Are the proposed
> outcomes quantifiable and measurable, consistent with the definition
> of a project outcome contained in Attachment E of the Program
> Announcement? (10 points)
>
> ii\. Does the project evaluation reflect a thoughtful and
> well-designed approach that will be able to successfully measure
> whether or not the project has achieved its proposed outcome(s)? Does
> the plan include the qualitative and/or quantitative methods necessary
> to reliably measure outcomes? Is the evaluation also designed to
> capture "lessons learned" from the overall effort that might be of use
> to others in the field of aging, especially those who might be
> interested in replicating the project? (10 points)
>
> iii\. Will the dissemination plan get relevant and easy to use
> information in a timely manner to parties that might be interested in
> making use of its findings, particularly to those who might want to
> replicate the project? (10 points)

d\. [Level of Effort]{.underline}: [Weight: 20 points]{.underline}

i\. Do the proposed project director(s), key staff and consultants have
the background, experience, and other qualifications required to carry
out their designated roles? Are letters from participating organizations
included, as appropriate, and do they express the clear commitment and
areas of responsibility of those organizations, consistent with the work
plan description of their intended roles and contributions? (10 points)

> ii\. Is the budget justified with respect to the adequacy and
> reasonableness of resources requested? Is the time commitment of the
> proposed director and other key project personnel sufficient to assure
> proper direction, management and timely completion of the project? Are
> budget line items clearly delineated and consistent with work plan
> objectives? (10 points)

**2. *Review and Selection Process***

> An independent review panel of at least three individuals will
> evaluate applications that pass the screening and meet the
> responsiveness criteria, if applicable. These reviewers are experts in
> their field, and are drawn from academic institutions, non-profit
> organizations, state and local government, and federal government
> agencies. Based on the Application Review Criteria as outlined under
> section V.1, the reviewers will comment on and score the applications,
> focusing their comments and scoring decisions on the identified
> criteria.
>
> Final award decisions will be made by the Assistant Secretary for
> Aging (ASA). In making these decisions, the ASA will take into
> consideration: recommendations of the review panel; reviews for
> programmatic and grants management compliance; the reasonableness of
> the estimated cost to the government considering the available funding
> and anticipated results; and the likelihood that the proposed project
> will result in the benefits expected.

## Applicants have the option of omitting from the application specific salary rates for individuals specified in the application budget. Do not include Social Security Numbers for individuals specified in the application.

**3.** ***Anticipated Announcement and Award Dates** (Optional)*

## VI. AWARD ADMINISTRATION INFORMATION 

###### 1. Award Notices

> Successful applicants will receive an electronic Notice of Award. The
> Notice of Award is the authorizing document from the Administration on
> Aging authorizing official, Grants Management Office, and the AoA
> budget office. Unsuccessful applicants are notified within 30 days of
> the final funding decision and will receive a disapproval letter via
> e-mail or U.S. mail.

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

The award is subject to DHHS Administrative Requirements, which can be
found in 45CFR Part 74 and 92 and the Standard Terms and Conditions
implemented through the HHS Grants Policy Statement located at
<http://www.hhs.gov/grantsnet/adminis/gpd/index.htm>.

###### 3. *Reporting* 

> The SF-269 (Financial Status Report) is due annually and the AoA
> program progress report is due semi-annually. Final performance and
> SF-269 reports are due 90 days after the end of the project period.

## VII. AGENCY CONTACTS 

> [Project Officer:]{.underline}
>
> U.S. Department of Health and Human Services
>
> Administration on Aging
>
> Washington, DC 20201
>
> Attn: Greg Case
>
> e-mail: greg.case@aoa.hhs.gov
>
> [Grants Management Official:]{.underline}
>
> U.S. Department of Health and Human Services
>
> Administration on Aging
>
> Washington, DC 20201
>
> Attn: Rodd Clay
>
> e-mail: ­rodd.clay@aoa.hhs.gov

## VIII. OTHER INFORMATION*(Optional)*

###### A. Application Elements

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

2.  SF 424A -- Budget Information.

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

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

> 5\. Certifications
>
> 6\. Proof of non-profit status
>
> 7\. Copy of the applicant\'s most recent indirect cost agreement, if
> requesting indirect costs.
>
> 8\. Project Narrative with Work Plan (See Attachment for Sample Work
> Plan Format).
>
> 9\. Organizational Capability Statement and Vitae for Key Project
> Personnel.
>
> 10\. Letters of Commitment from Key Partners.
>
> 11\. "Survey on Ensuring Equal Opportunity for Applicants" (Optional
> non-profit applicants)
>
> **B. The Paperwork Reduction Act of 1995 (P.L. 104-13)**
>
> An agency may not conduct or sponsor, and a person is not required to
> respond to, a collection of information unless it displays a currently
> valid OMB control number.
>
> The project description and budget justification is approved under OMB
> control number 0985-0018 which expires on 5/31/10.
>
> Public reporting burden for this collection of information is
> estimated to average 10 hours per response, including the time for
> reviewing instructions, gathering and maintaining the data needed and
> reviewing the collection information.

**ATTACHMENTS**

**Attachment A:**

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

**Attachment B:**

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

**Attachment C:**

**Budget Justification -- Sample Format**

**Attachment D:**

**Project Work Plan - Sample Format**

**Attachment E:**

**Instructions for Completing the Summary/Abstract**

**Attachment F:**

**"Survey on Ensuring Equal Opportunity for Applicants"**

#  Attachment A

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

  -----------------------------------------------------------------------
  This section provides step-by-step instructions for completing the four
  (4) standard federal forms required as part of your grant application,
  including special instructions for completing Standard Budget Forms 424
  and 424A. Standard Forms 424 and 424A are used for a wide variety of
  federal grant programs, and federal agencies have the discretion to
  require some or all of the information on these forms. AoA does not
  require all the information on these Standard Forms. Accordingly,
  please use the instructions below in lieu of the standard instructions
  attached to SF 424 and 424A to complete these forms.

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

###### a. Standard Form 424

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

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

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

• New . • Continuation • Revision

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

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

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

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

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

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

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

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

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

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

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

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

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

matters related to this application.

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

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

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

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

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

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

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

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

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

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

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

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

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

There are two types of match: 1.) non-federal cash and 2.) non-federal
non-cash (i.e., in-kind). In general, costs borne by the applicant and
cash contributions of any and all third parties involved in the project,
including sub-grantees, contractors and consultants, are considered
[cash matching funds]{.underline}. Generally, most contributions from
third parties will be non-cash (i.e., in-kind) matching funds. Examples
of [non-cash (in-kind) match]{.underline} include: volunteered time and
use of facilities to hold meetings or conduct project activities.

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

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

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

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

**b. Standard Form 424A**

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

##### Section A ‑ Budget Summary

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

##### Section B ‑ Budget Categories

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

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

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

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

> [Line 12]{.underline}: Enter the amounts of non‑Federal resources that
> will be used in carrying out the proposed project, by source
> (Applicant; State; Other) and enter the total amount in Column (e).
> Keep in mind that if the match requirement is not met, federal dollars
> may be reduced.
>
> ***Section D ‑ Forecasted Cash Needs*** - Not applicable.
>
> ***Section E ‑ Budget Estimate of Federal Funds Needed for Balance of
> the Project***
>
> [Line 20]{.underline}: Section E is relevant for multi-year grant
> applications, where the project period is 24 months or longer. This
> section does not apply to grant awards where the project period is
> less than 17 months.

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

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

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

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

###### d. Certification Regarding Lobbying

> This form contains certifications that are required of the applicant
> organization regarding lobbying. Please note that a duly authorized
> representative of the applicant organization must attest to the
> applicant's compliance with these certifications.

###### e. Other Application Components

**Survey on Ensuring Equal Opportunity for Applicants**

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

**Proof of Non-Profit Status**

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

## Indirect Cost Agreement

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

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

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

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

+-----+-----+------+------+------+-----------------------------------+
| **  | **  | #    | *    | ##   | ### Justification                 |
| Obj | Fed | #### | *Non | ## * |                                   |
| ect | era |  Non | -Fed | [TOT |                                   |
| C   | l** | -Fed | eral | AL]{ |                                   |
| las |     | eral | I    | .und |                                   |
| s** | #   |      | n-Ki | erli |                                   |
|     |  Fu | ##   | nd** | ne}* |                                   |
| **C | nds | ###  |      |      |                                   |
| ate |     | Cash |      |      |                                   |
| gor |     |      |      |      |                                   |
| y** |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+
| *   | 0   | 0    | 0    | 0    | No equipment requested            |
| *Eq |     |      |      |      |                                   |
| uip |     |      |      |      |                                   |
| men |     |      |      |      |                                   |
| t** |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+
| **S | \   |      | \$2  | \$3  | Laptop computer for use in client |
| upp | $1, |      | ,000 | ,500 | intakes = \$1,340                 |
| lie | 500 |      |      |      |                                   |
| s** |     |      |      |      | Consumable supplies (paper, pens, |
|     |     |      |      |      | etc.)                             |
|     |     |      |      |      |                                   |
|     |     |      |      |      | \$100/mo x 12 months = \$1,200    |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Copying \$80/mo x 12 months = \$  |
|     |     |      |      |      | 960                               |
+-----+-----+------+------+------+-----------------------------------+
| **C | \$2 | \$50 | 0    | \    | Contracts to A,B,C direct service |
| ont | 00, | ,000 |      | $250 | providers (name providers)        |
| rac | 000 |      |      | ,000 |                                   |
| tua |     |      |      |      | adult day care contractor =       |
| l** |     |      |      |      | \$75,000                          |
|     |     |      |      |      |                                   |
|     |     |      |      |      | respite care contractor in home=  |
|     |     |      |      |      | \$75,000                          |
|     |     |      |      |      |                                   |
|     |     |      |      |      | respite care contractor-NF =      |
|     |     |      |      |      | \$50,000                          |
|     |     |      |      |      |                                   |
|     |     |      |      |      | personal care/companion provider  |
|     |     |      |      |      | = \$50,000                        |
|     |     |      |      |      |                                   |
|     |     |      |      |      | See detailed budget justification |
|     |     |      |      |      | for each provider (and then       |
|     |     |      |      |      | provide it!)                      |
+-----+-----+------+------+------+-----------------------------------+

+-----+-----+------+------+------+-----------------------------------+
| A   |     |      |      |      |                                   |
| tta |     |      |      |      |                                   |
| chm |     |      |      |      |                                   |
| ent |     |      |      |      |                                   |
| B:  |     |      |      |      |                                   |
| Bud |     |      |      |      |                                   |
| get |     |      |      |      |                                   |
| N   |     |      |      |      |                                   |
| arr |     |      |      |      |                                   |
| ati |     |      |      |      |                                   |
| ve, |     |      |      |      |                                   |
| P   |     |      |      |      |                                   |
| age |     |      |      |      |                                   |
| 3   |     |      |      |      |                                   |
| --  |     |      |      |      |                                   |
| Sam |     |      |      |      |                                   |
| ple |     |      |      |      |                                   |
| For |     |      |      |      |                                   |
| mat |     |      |      |      |                                   |
| w   |     |      |      |      |                                   |
| ith |     |      |      |      |                                   |
| EX  |     |      |      |      |                                   |
| AMP |     |      |      |      |                                   |
| LES |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+
| **O | \$  | \$8  | \$19 | \$37 | Local conference registration fee |
| the | 10, | ,000 | ,800 | ,800 | (name conference) = \$ 200        |
| r** | 000 |      |      |      |                                   |
|     |     |      |      |      | Printing brochures (50,000 @ \$   |
|     |     |      |      |      | .05 ea) = \$ 2,500                |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Video production = \$19,800       |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Video Reproduction = \$ 3,500     |
|     |     |      |      |      |                                   |
|     |     |      |      |      | NF Respite Training Manual        |
|     |     |      |      |      | reproduction                      |
|     |     |      |      |      |                                   |
|     |     |      |      |      | \$3/manual x \$2000 manuals = \$  |
|     |     |      |      |      | 6,000                             |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Postage \$150/mo x 12 months = \$ |
|     |     |      |      |      | 1,800                             |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Caregiver Forum meeting room      |
|     |     |      |      |      | rentals                           |
|     |     |      |      |      |                                   |
|     |     |      |      |      | \$200/day x 12 forums = \$ 2,400  |
|     |     |      |      |      |                                   |
|     |     |      |      |      | Respite Training Scholarships =   |
|     |     |      |      |      | \$1,600                           |
+-----+-----+------+------+------+-----------------------------------+
| *   | 0   | 0    | 0    | 0    | None                              |
| *In |     |      |      |      |                                   |
| dir |     |      |      |      |                                   |
| ect |     |      |      |      |                                   |
| Cha |     |      |      |      |                                   |
| rge |     |      |      |      |                                   |
| s** |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+
| ##  | \$2 | \$58 | \$27 | \    |                                   |
| ### | 67, | ,000 | ,767 | $352 |                                   |
|  TO | 100 |      |      | ,267 |                                   |
| TAL |     |      |      |      |                                   |
+-----+-----+------+------+------+-----------------------------------+

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

+-----+------+------+------+------+-----------------------------------+
| >   | *    | **N  | **N  | # T  | ### Justification                 |
|  ** | *Fed | on-F | on-F | OTAL |                                   |
| Obj | eral | eder | eder |      |                                   |
| ect | Fun  | al** | al** |      |                                   |
| >   | ds** |      |      |      |                                   |
|  Cl |      | **Ca | **I  |      |                                   |
| ass |      | sh** | n-Ki |      |                                   |
| > C |      |      | nd** |      |                                   |
| ate |      |      |      |      |                                   |
| gor |      |      |      |      |                                   |
| y** |      |      |      |      |                                   |
+-----+------+------+------+------+-----------------------------------+
| *   |      |      |      |      |                                   |
| *Pe |      |      |      |      |                                   |
| rso |      |      |      |      |                                   |
| nne |      |      |      |      |                                   |
| l** |      |      |      |      |                                   |
+-----+------+------+------+------+-----------------------------------+
| **  |      |      |      |      |                                   |
| Fri |      |      |      |      |                                   |
| nge |      |      |      |      |                                   |
| B   |      |      |      |      |                                   |
| ene |      |      |      |      |                                   |
| fit |      |      |      |      |                                   |
| s** |      |      |      |      |                                   |
+-----+------+------+------+------+-----------------------------------+
| *   |      |      |      |      |                                   |
| *Tr |      |      |      |      |                                   |
| ave |      |      |      |      |                                   |
| l** |      |      |      |      |                                   |
+-----+------+------+------+------+-----------------------------------+
| *   |      |      |      |      |                                   |
| *Eq |      |      |      |      |                                   |
| uip |      |      |      |      |                                   |
| men |      |      |      |      |                                   |
| t** |      |      |      |      |                                   |
+-----+------+------+------+------+-----------------------------------+

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

+------+------+------+----+------+-----------------------------------+
| >    | *    | **N  | *  | # T  | ### Justification                 |
| **Ob | *Fed | on-F | *N | OTAL |                                   |
| ject | eral | eder | on |      |                                   |
| > C  | Fun  | al** | -F |      |                                   |
| lass | ds** |      | ed |      |                                   |
| > Ca |      | **Ca | er |      |                                   |
| tego |      | sh** | al |      |                                   |
| ry** |      |      | ** |      |                                   |
|      |      |      |    |      |                                   |
|      |      |      | *  |      |                                   |
|      |      |      | *I |      |                                   |
|      |      |      | n- |      |                                   |
|      |      |      | Ki |      |                                   |
|      |      |      | nd |      |                                   |
|      |      |      | ** |      |                                   |
+------+------+------+----+------+-----------------------------------+
| **Su |      |      |    |      |                                   |
| ppli |      |      |    |      |                                   |
| es** |      |      |    |      |                                   |
+------+------+------+----+------+-----------------------------------+
| **C  |      |      |    |      |                                   |
| ontr |      |      |    |      |                                   |
| actu |      |      |    |      |                                   |
| al** |      |      |    |      |                                   |
+------+------+------+----+------+-----------------------------------+
| *    |      |      |    |      |                                   |
| *Oth |      |      |    |      |                                   |
| er** |      |      |    |      |                                   |
+------+------+------+----+------+-----------------------------------+
| **   |      |      |    |      |                                   |
| Indi |      |      |    |      |                                   |
| rect |      |      |    |      |                                   |
| C    |      |      |    |      |                                   |
| harg |      |      |    |      |                                   |
| es** |      |      |    |      |                                   |
+------+------+------+----+------+-----------------------------------+
| ###  |      |      |    |      |                                   |
| ## T |      |      |    |      |                                   |
| OTAL |      |      |    |      |                                   |
+------+------+------+----+------+-----------------------------------+

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

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

  **Measurable                                                                                                                                               
  Outcome(s):**                                                                                                                                              

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

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

  1\.                                                                                                                                                        

                                                                                                                                                             

                                                                                                                                                             

                                                                                                                                                             

  2\.                                                                                                                                                        

                                                                                                                                                             

                                                                                                                                                             

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

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

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

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

  3\.                                                                                                                                                       

                                                                                                                                                            

                                                                                                                                                            

                                                                                                                                                            

  4\.                                                                                                                                                       

                                                                                                                                                            

                                                                                                                                                            

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

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

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

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

  5\.                                                                                                                                                       

                                                                                                                                                            

                                                                                                                                                            

                                                                                                                                                            

  6\.                                                                                                                                                       

                                                                                                                                                            

                                                                                                                                                            

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

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

**Attachment E**

Instructions for Completing the Project Summary/Abstract

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

```{=html}
<!-- -->
```
-   To ensure uniformity, please limit the length to no more than 265
    words on a single page with a font size of not less than 11,
    doubled-spaced.

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

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

**Products --** materials, deliverables.

-   A model abstract/summary is provided below:

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

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

Attachment F

**Survey Instructions on Ensuring Equal Opportunity for Applicants**

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

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

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

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

Yes No

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

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

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

Less Than \$150,000

\$150,000 - \$299,999

\$300,000 - \$499,999

\$500,000 - \$999,999

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

\$5,000,000 or more

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

Yes No

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

Yes No

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

> Yes No

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

Yes No

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

Yes No

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

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

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

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

4\. Self-identify.

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

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

7.  Self-explanatory.

8.  Self-explanatory.

**Paperwork Burden Statement**

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

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

> OMB No. 1890-0014 Exp. 1/31/20